The URL can be used to link to this page

Home My WebLink About180828 COLORADO BORING LLC - INSURANCE CERTIFICATEOP ID: KH CERTIFICATE OF LIABILITY INSURANCE" " ' DAT08/01D/YYYY) 08/01 /11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements : PRODUCER 970-635-9400 CONTACT NAME PFS Insurance Group -JT 970-635-9401 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Tad Borrett PHONE FA% JAID No Eat), - - AIC-No - E-MAIL ' ADDRESS: _ - --- - - -- PRODUCER COBOR-1 CUSTOMER ID N: INSURERS AFFORDING COVERAGE NAIc 4 INSURED Jacobs Investments, LLC INSURER A: Travelers Insurance- ' Colorado Boring, LLC Northern Lights Leasing, LLC 812 Queens Court INSURER B: Pinnacol Assurance 41190 INSURER C: Fort Collins, CO 80525 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN$R TR I OF INSURANCE ADDLTYPE INSR M POLICY NUMBER MOLOYEFF MMIDOIY POLICY EXP YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERALLLABILITY 0075R25A 08/01/11 08/01/12 pRAEMISEs ER%NTE mda s 300,00 CLAIMS -MADE I I OCCUR MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGRE ATATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY X PROJECT- LOC IS -- A AUTOMOBILE LIABILITY ANY aulo 0075R25A 08/01111 08/01112 COMBINED SINGLE LIMIT- (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ . ALL OWNED AUTOS- _ -BODILY INJURY (Per accident), S SCHEDULED AUTOS _ HIRED AUTOS - PROPERTY DAMAGE (Peraccidenl) _ $ X X $ NON -OWNED AUTOS $ - X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 5,000,0O A EXCESS LAB CLAIMS -MADE 0075R25A 08I01111 08/01112 - DlebucrlBLE a rxi $ RETENTION $ 10,000 _ B WORKERS COMPENSATION - -ANO EIr1PWYERS EIABILIry ANY PROPRIETORIPARTNERIEXECUTIVE F— OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA _ __ 4021687 BLANKET WAIVER OF SUBROGA 08/01111 08/01/11 ' " 08/01/12' 08/01/12 X. wC STATU- X OTH- T"R'(' IMT^ ._ _ _. -... E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Inland Marine 8137POOB 08/01/11 08/01/12 Deductibl 1,00 Scheduled 936,60 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) If required by written contract or written agreement, The City of Fort Collins and COOT are included as additional .. insured for ongoing operations under General Liability. FORT-01 City of Fort Collins Purchasing 281 North College Ave Fort Collins, CO 805220580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD