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