0001700167-19-000004.txt : 20191206
0001700167-19-000004.hdr.sgml : 20191206
20191206103840
ACCESSION NUMBER: 0001700167-19-000004
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20191206
DATE AS OF CHANGE: 20191206
EFFECTIVENESS DATE: 20191206
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: Covered Insurance Solutions, Inc.
CENTRAL INDEX KEY: 0001700167
IRS NUMBER: 814512828
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-354945
FILM NUMBER: 191272040
BUSINESS ADDRESS:
STREET 1: 1391 SPEER BLVD, STE 850
CITY: DENVER
STATE: CO
ZIP: 80204
BUSINESS PHONE: 605-209-1062
MAIL ADDRESS:
STREET 1: 1391 SPEER BLVD, STE 850
CITY: DENVER
STATE: CO
ZIP: 80204
D
1
primary_doc.xml
X0708
D
LIVE
0001700167
Covered Insurance Solutions, Inc.
1391 SPEER BLVD, STE 850
DENVER
CO
COLORADO
80204
605-209-1062
DELAWARE
None
None
Corporation
true
2016
Ross
Diedrich
1391 Speer Blvd, Ste 850
Denver
CO
COLORADO
80204
Executive Officer
Director
Promoter
Michael
Diedrich
1391 Speer Blvd, Ste 850
Denver
CO
COLORADO
80204
Executive Officer
Director
Promoter
Christopher
Diedrich
1391 Speer Blvd, Ste 850
Denver
CO
COLORADO
80204
Executive Officer
Director
Promoter
David
Fitzgerald
1391 Speer Blvd, Ste 850
Denver
CO
COLORADO
80204
Director
Michael
Sandler
1391 Speer Blvd, Ste 850
Denver
CO
COLORADO
80204
Director
Other Technology
Decline to Disclose
- 06b
false
2019-11-21
false
true
true
true
true
Promissory notes convertible into equity securities of the Issuer.
false
0
2500000
1500000
1000000
false
1
0
0
0
false
Covered Insurance Solutions, Inc.
/s/ Ross P. Diedrich
Ross P. Diedrich
President
2019-12-06