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HomeMy WebLinkAbout380591 J 2 CONTRACTORS - INSURANCE CERTIFICATE (4)ACCRD CERTIFICATE OF LIABILITY INSURANCE i2i28/2'007 PRODUCER (303) 824-6600 FAX (303) 370-0118 Moody Insurance Agency, Inc. 3773 Cherry Creek North Drive Suite 800 Denver CO 80209-3804 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED J-2 Contracting Company 450 East 16th Street Greeley CO 80632 INSURERA Pinnacol Assurance 41190 NsuRERB INSURER INSURER D INSURER THE POLICIES OF INSURANCE LISTED 13ELOW 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDA:' POLICY EXPIRATION DATE MM/DD/VV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ AMAGECOM PREMSES OE a oecurrreme $ MERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED EXP (Any oneperson) $ PERSONAL B ADV INJURY $ _ GENERAL AGGREGATE $ _ GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY F JI tOC AUTOMOE31LE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY OCCURRENCE $ -EACH OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETI---NTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE X. WC STATU- R E TORV LIMIT ER EACH ACCIDENT $ 1,000,000 _EL EL DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED' 3114522 10/l/2007 10/1/2008 If yes describe under SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re LPATH Beim Erosion Protection Measures, Fort Collins, CO This certificate is subject to the terms, conditions, and exclusions of the policies In the event of cancellation for non-payment of premium, a 10-day notice of cancellation will apply City of Fort Collins 215 North Mason Street 2nd Floor Fort Collins, CO B0522 SHOULD AIJY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENI ATIVES AUTHORIZED REPRESENTATIVE 2osemary ACORD 25 (2001/08) ©ACORD CORPORATION 1988 [hic ,n.nog n._ �­ I M I IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25 (2001108) INS025 (0ID8) oaa Page 2 of 2 ACORD,. CERTIFICATE OF LIABILITY INSURANCE 12/28/2007' PRODUCER (303) 824-6600 FAX (303) 370-0118 Moody Insurance Agency, Inc 3773 Cherry Creek North Drive Suite B00 Denver CC 80209-3804 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED J-2 Contracting Company 450 East 16th Street Greeley CO 80632 INSURERA Pinnacol Assurance 41190 INSURER INSURER INSURER D INSURER 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES TOoccRENTurrence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED EXP (Any one erson $ I PERSONAL 8 ADV INJURY $ _ GENERAL AGGREGATE $ _ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ O- POLICY JPERCT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Perperson) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accdent) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA A $ ANYAUTO $ AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY OCCURRENCE $ -EACH OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE X WC STATU- OTH- CRY TS ER E L EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? 3114522 10/1/2007 10/1/2008 yes, describe under S SPECIAL PROVISIONS below E L DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPEFZATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re Oak Street Plaza, Fort Collins, CO This certificate is subject to the terms, conditions, and exclusions of the policies In the event of cancellation for non-payment of premium, a 10-day notice of cancellation will apply City of Fort Collins 300 Laporte Avenue Fort Collins, CO 60522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE _ Rosemary ACORD 25 (2001/08) INICn79,n ,— © ACORD CORPORATION 1988 o—t n!I IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25 (2001/08) Page 2 of 2 INS025 (OtoB) oBa