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HomeMy WebLinkAboutJACOBS INVESTMENTS - INSURANCE CERTIFICATEOP ID JL DATE (MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE COBOR-1 07 24 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LBN Insurance Agcy-Johnstown HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4848 Th Pk Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ompson wy, Johnstown CO 80534 Phone:970-635-9400 Fax:970-635-9401 INSURED Jacobs Investments LLC Colorado Boring, LLC NorthernLights Leasing, LLC Queens CC Fort Collins CO 80525 rnVFRer;FS INSURERS AFFORDING COVERAGE NAIC # INSURER A: Auto —Owners Insurance Co. 18988 INSURER B: Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E: 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. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE (MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 PREMISES(E.Tcurence) $ 300,000 A X COMMERCIAL GENERAL LIABILITY 74731383 08/01/09 08/01/10 CLAIMS MADE ® OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICYFX7 PROECT LOC J A AUTOMOBILE LIABILITY ANY AUTO 47731383 08/01/09 08/01/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS $ X BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED AUTOS $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO N/A $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE s5,000,000 A X I OCCUR �CLAIMSMADE 47731383 08/01/09 08/01/10 AGGREGATE $5,000,00.0 $ DEDUCTIBLE $ X RETENTION $ 10 , 0 0 0 WORKERS COMPENSATION AND TATI X TORY LIMITS 577 B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4021687 BLANKET WAIVER OF SUBROGA 08/01/09 08/01/09 08/01/10 08/01/10 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER A Inland Marine 74731383 08/01/09 08/01/10 Deductibl 500 Scheduled 1266500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of Fort Collins and CDOT are named as additional insured in regards to the general liability policy. CERTIFICATE HOLDER CANCELLATION FORT-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Purchasing 281 North College Ave REPRESENTATIVES. Fort Collins CO 805220580 AUT Z�D f�E�RESE ATIV ACORD 25 (2001108) ©ACORD CORPORATION 1988