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HomeMy WebLinkAboutJANSMA BROS EXCAVATING & TRUCKING - INSURANCE CERTIFICATE (2)OP ID: SL ,acoRO` CERTIFICATE OF LIABILITY INSURANCE 03I28/3 D0312810IY2013 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 endorsement(s). PRODUCER- Phone: 970-635-9400 CONTACT NAME: PFS Insurance Group -JT 4848 Thompson Pkwy,.Ste 200 : Fax: 970-635-9401 Johnstown, CO 80534 Tad Borrett PHONE FAX - (AIC No Eat(AIC No): , E"MAIL - - AOORESS: PRODUCER JANSM-3 " CUSTOMER to b INSURERS) AFFORDING COVERAGE NAIC N INSURED Jansma Bros. Excavating INSURER A: EMC Insurance Companies 21415 & Trucking Corp. 1475 Backhoe Road INSURER B: Pinnacol Assurance 41190 Loveland, CO 80538 INSURER C 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADD �bUBR I POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIODIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 4X90700 04/0111011 04/01/2014 AMA T RENTED PREMISES Ea occurrence $ 100,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Blanket Add'I Ins X Blanket Waiver GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY' X PROF* r LOC $ A AUTOMOBILE X LIABILITY- -_. ANY AUTO ' 4E90700 04/01/2013 0410112014 COMBINED SINGLE LIMIT (Ea decided) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS ' BODILY INJURY (Per accident) b X A SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X $ A NON -OWNED AUTOS g UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,00 A EXCESS LIAB CLAIMS MADE aX9o7oo oa/ovzol3 oarovzola -. DEDUCTIBLE 8 8 RETENTION $ B - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED' (Mandatory In NH) NIA 2342390 BLANKET WAIVER OF SUBRO 06/01/2012 0610112013 X WC STATU- I OTHI TORY LIMITS ER EEACH ACCIDENT I b 100,000 E.L.L DISEASE- EA EMPLOYEE $ 100,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) ALL 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. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD