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HomeMy WebLinkAboutBOULDER ROOFING INC - INSURANCE CERTIFICATE (9)DATE (MMIDD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 2/27/2017 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 endorsement(s). PRODUCER CONTACT Christine Walker CISR CRIS NAME: Moody Insurance Agency, Inc. PHONE (303)824-6600 No:(303)370-0118 NQ. Ext): 8055 East Tufts Avenue E-MAIess:christine.walker@moodyins.com ADDR Suite 1000 INSURERS AFFORDING COVERAGE NAIC S Denver CO 80237 _ INSURERA:Pinnacol Assurance 41190 INSURED INSURER B : Boulder Roofing, Inc. INSURERC: 3551 Pearl St INSURER D : INSURER E : Boulder CO 80301 INSURER F: r_r1VFRAr.FS CFRTIFICATF Nt)MRFR.17-18 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMupY EFF POLICYEXP LTR MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DA'GE ToRENTED PREM SES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ PRO- PR ❑ LOC JO- $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ NON OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ RDEXCESS AGGREGATE $ LIAB CLAIMS -MADE ED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE X STATUTE ER E.L. EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 2058510 4/1/2017 4/1/2018 E.L. DISEASE - EA EMPLOYEd $ 100,000 E.L. DISEASE - POLICY LIMIT I $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below 7 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER GANGtLLA I IUN 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/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)