HomeMy WebLinkAboutJ B EXCAVATING - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID R DATE(MMIDD/YYYY)
JBEXC-2 03 18 05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LEIN Insurance Agency, LLC FC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1614 Oakridge Drive, Unit A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Collins CO 80525
Phone:970-229-9304 Fax:970-229-1398
J B Excavating, Inc.
1012 NE Frontage Road
Fort Collins CO 80524-9218
1 VvcR uco
INSURERS AFFORDING COVERAGE I NAIC #
INSURER A: Mountain States Insurance Grp
INSURER B: Pinnacol Assurance
INSURER C:
INSURER D:
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.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDD/YY
DATE MM/DDIVY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 , 000 , 000
PREMISES (Ea occurence)
$100,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X� OCCUR
CPPOO81222
03/22/05
03/22/06
MED EXP (Any one Person)
$ 5 000
X Blanket Add' 1 Ins
PERSONAL & ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$2,000,000
POLICY FX7 PRO-
JECT LOC
A
AUTOMOBILE
LIABILITY
ANYAUTO
BAP0081222
03/22/05
03/22/06
(EaCOMBINED SINGLE LIMIT
CO accident)
$ 1 r000, 000
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per Person)
$
HIRED AUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHERTHAN EA ACC
$
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
X I OCCUR 71CLAIMSMADE
UMB0081222
03/22/05
03/22/06
EACH OCCURRENCE
$ 2 000 000
AGGREGATE
$2,000,000
DEDUCTIBLE
RETENTION $
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
N yes, describe under
SPECIAL PROVISIONS below
876410
04/01/05
04/01/06
X TORY LIMITS ER
E.L. EACH ACCIDENT
s500,000
E.L. DISEASE - FA EMPLOYEE
$SOO, OOO
E.L. DISEASE - POLICY LIMIT
$500 000
OTHER
A
Installation Float
CPPOO81222
03/22/05
03/22/06
Limit $50,000
Dad $500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
All Operations - All Locations. The City of Fort Collins is named as an
additional insured.
CERTIFICATE HOLDER CANCELLATION
FORTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
CITY OF FORT COLLINS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PURCHASING AND RISK MANAGEMENT IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES.
FT. COLLINS CO 80522-0580 Au Rlz REPRES I'�
ACORD 26 (2001/08)