0001700167-17-000002.txt : 20171113
0001700167-17-000002.hdr.sgml : 20171113
20171113154940
ACCESSION NUMBER: 0001700167-17-000002
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20171113
DATE AS OF CHANGE: 20171113
EFFECTIVENESS DATE: 20171113
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: Covered Insurance Solutions, Inc.
CENTRAL INDEX KEY: 0001700167
IRS NUMBER: 814512828
STATE OF INCORPORATION: SD
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-298575
FILM NUMBER: 171195689
BUSINESS ADDRESS:
STREET 1: 4884 CLIFF DRIVE
CITY: RAPID CITY
STATE: SD
ZIP: 57702
BUSINESS PHONE: 605-209-1062
MAIL ADDRESS:
STREET 1: 4884 CLIFF DRIVE
CITY: RAPID CITY
STATE: SD
ZIP: 57702
D
1
primary_doc.xml
X0708
D
LIVE
0001700167
Covered Insurance Solutions, Inc.
4884 CLIFF DRIVE
RAPID CITY
SD
SOUTH DAKOTA
57702
605-209-1062
SOUTH DAKOTA
None
None
Corporation
true
2016
Ross
Diedrich
4884 Cliff Drive
Rapid City
SD
SOUTH DAKOTA
57702
Executive Officer
Director
Promoter
Michael
Diedrich
4884 Cliff Drive
Rapid City
SD
SOUTH DAKOTA
57702
Executive Officer
Director
Promoter
Christopher
Diedrich
2946 S. Bannock Street
Englewood
CO
COLORADO
80110
Executive Officer
Director
Promoter
Other Technology
Decline to Disclose
- 06b
false
2017-11-01
false
true
true
false
0
90
90
0
Total Offering Amount represents the purchase price of the warrants and amount receivable by the Issuer upon the exercise of the warrants to purchase capital stock of the Issuer. The warrants have not yet been exercised.
false
2
0
0
0
false
Covered Insurance Solutions, Inc.
/s/ Ross P. Diedrich
Ross P. Diedrich
President
2017-11-13