HomeMy WebLinkAbout453145 INDEPENDENT ROOFING INC - INSURANCE CERTIFICATE (11)P/NNACOL
ASSURANCE
INSURED:
Independent Roofing Inc
405 22nd Street
Greeley, CO 80631
ENDORSEMENT: Waiver Of Subrogation
7501 E Lowry Blvd
Denver, CO 80230-7006
Phone: (303) 361-4000 / (800) 873-7242
Fax: (303) 361-5000 / (888) 329-2251
www.pinnacol.com
NCCI #: WC000313
Policy #: 866470
We have the riaht to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522
Effective Date: January 10, 2017 Expires on January 1, 2018
Pinnacol Assurance has issued this endorsement January 10, 2017.
Joseph Rutigliano
Underwriter
Pinnacol Assurance' 7501 E Lowry Blvd' Denver, CO 80230
Page 1of3 PINNAWEB- 01/10/201718:25:29 866470 Updated:02101/2007 UW137