0001700167-18-000002.txt : 20180309 0001700167-18-000002.hdr.sgml : 20180309 20180309115924 ACCESSION NUMBER: 0001700167-18-000002 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180309 DATE AS OF CHANGE: 20180309 EFFECTIVENESS DATE: 20180309 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/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-298575 FILM NUMBER: 18679174 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/A 1 primary_doc.xml X0708 D/A 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 David Fitzgerald 4884 Cliff Drive Rapid City SD SOUTH DAKOTA 57702 Director Other Technology Decline to Disclose 06b true 0001700167-17-000002 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 2018-03-09