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CERTIFICATE OF LIABILITY INSURANCE
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(us) must have ADDITIONAL INSURED provisions or be
endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A
Hiscox Inc.
520 Madison Avenue
32nd Roor
New York, New York 10022
INSURED
Robert Maze DBA Centennial State Plumbing, LLC
2110 Peach Blossom dr
Windsor, CO 80550
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.
IXS0.
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TYPE OF INSURANCE
AOOL
WOR
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MWDDYEFF
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PM/
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DESLRIWION OF OPERATONS I LOCATIONS I VEHICLES (MORD 101, Addhirml Ramnka Scmduh, may M mumbW Nmam spua b mpuiM)
CERTIFICATE HOLDER CANCELLATION
City of Meg Ridge
7500 W. nth Ave.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Wheat Ridge, CO 80033
THE EXI'Mo TON DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORUMDREPRESENTATVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2018/03) The ACORD name and logo are registered marks o1 ACORD
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