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HomeMy WebLinkAboutJANSMA BROS EXCAVATING & TRUCKING CORP. - INSURANCE CERTIFICATE (2)UP ID: RC ACOROe -- CERTIFICATE OF LIABILITY INSURANCE U T03/08 DIYYYY) f 03/OS/12 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 PFS Insurance Group -JT 970-635-9400 4848 Thompson Pkwy, Ste 200 970-635-9401 Johnstown, CO 80534 Tad Borrett CONTACT PHONE FAX _(A/C, No Est), (A/C, No): MAIL E-DRESS: -ADPRODUCER JANSM-3 _CUSTOMER ID N: INSURER(S) AFFORDING COVERAGE NAIC p INSURED Jansma Bros. Excavating & Trucking Corp. 1475 Backhoe Road INSURER A: Mountain States Insurance Grp INSURERS: Pinnacol Assurance 524210 Loveland, CO 80536 INSURER C: INSURER 0: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER- RFVI-¢InNNHMRFP- 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLTSUBR POLICY EFF PO JCYEXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CPP0117096 04/01/12 04I01113 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)_ $ 1,000,00 $ 100,00 MED EXP(Anyone person) $ 10,00 nket Acid'I Ins PERSONALS ADV INJURY $ 1,000,00 rCLAIMSWADEOCCUR nket Waiver GENERAL AGGREGATE $ 2,000,000 G;E1'L GREGATE LIMITAPPLIES PER' X PRO- n LOC PRODUCTS-COMP/OP AGG $ 2,000,00ICY $ A AUTOMOBILE LIABILITY ANY AUTO BAP0117096 04/01/12 04/01/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ A SCHEDULED AUTOS HIRED AUTOS X PROPERTY DAMAGE (Per accident) $ A X NON -OWNED AUTOS $ HUMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMSlr1ADE UMB0117096 04/01/12 04/01/13 DEDUCTIBLE $ Is RETENTION $ B WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNERIEXECUTIVE Y/N OFFICERVEMBER EXCLUDED? (Mandatory In NH) If yes, desrsibe and N/A —I�TORY 2342390 BLANKET WANER OF SUBRO 06/01/11 06/01/12 WC STATU- IOTH- LIMITS) 2 ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) L OPERATIONS — ALL LOCATIONS. FORT CO City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATME 4d1 �- © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD