HomeMy WebLinkAboutBOULDER ROOFING INC - INSURANCE CERTIFICATE (8)DATE (MMIDDNYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
3/6/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
PRODUCER CONTACT Christine Walker CISR CRIS
NAME: r r
Moody Insurance Agency, Inc. ae . (303)824-6600 1 XNo;(303)370-0118
8055 East Tufts Avenue ADDRESS: christine.walker@moodyins.com
Suite 1000 INSURERS AFFORDING COVERAGE NAIC N
Denver CO 80237 INSURERA:Pinnacol Assurance 41190
INSURED INSURER 8 :
Boulder Roofing, Inc. INSURERC:
3551 Pearl St INSURER D :
INSURER E :
Boulder CO 80301 1 INSURERF: I I
cnVFRAr_Fc CFRTIFIr _ATF NI IMRFR•18-19 WC REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
-- - - --
TYPE OF INSURANCE
ADDL
SUBR
MoaPOLICY
NUMBER
POLICY EFF
MMIDD
POLICY EXP
M D
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE n OCCUR
EACH OCCURRENCE
$
DAMAGE TO REED
PREMISES Ea occurrrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
JPRO-
POLICY PRO CT EILOC
OTHER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED'
AUTOS _ AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COEa aMBINEDccident SINGLE LIMIT
1
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
ESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
?DX�E`D
AGGREGATE
$
RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN ANY PROPRIETOR/PARTNER/EXECUTIVE
(MandatoryEMBER m NH EXCLUDED?
( ry ' )
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
2058510
4/1/2018
4/1/2019
X I PER STATUTE OH -
ER
'$ 100OFFICER/000
_
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80500
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C Walker, CISR, CRIS/ a>^ -A, QtiA
U 1988-2014 AGUKU GUKF L)KA I IVN. All rlgnts reservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)