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Home My WebLink About180828 COLORADO BORING - INSURANCE CERTIFICATE (2)OP ID: KH ,4�JI2o' CERTIFICATE OF LIABILITY INSURANCE 0M 12.0 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the policy(fes) must be endorsed. if SUBROGATION 15 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 Phone: 970-635-9400 NAMEACY - - - PFS Insurance Group -JT 4848 Thompson Pkxy, Ste 200 Fax: 970fi35-9401 Johnstown, CO 80534 Tad BorreU PIIOIE EMAIL ADDRESS: CUSNTOME%55 0.ID /: CO130R-1 tNSU- - AFFORDWG COVERAGE MCA INSURED Jacobs Investments, LLC e1SUMEFt A: Travelers Insurance 25615 Colorado Boring, LLC wsuRER B. Northern Lights Leasing, LLC 3813 Canal Drive easuREn°i INSURER 0 Fort Collins, CO 80524 NSURER E : NSURER 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS Lgp TYPE OF INSURANCE AM lon POUCY NURSER MMO E MY Leon GENERAL LIABILITY EAOI OCCURRENCE S T,000,O A X COMMEROALGENEFtAI-UUAurr 0.NMSMADE ❑X OCCUR OD75R25A 0810112D13 08JDI2014 PREMISES Es oaunen<e t 300,ODC MEDF tAnYmemrson) S 10,0 X Limited Pollution 0075R25A 08/0112013 08/012014 PERSONAL S ADVIH.uRY 1 1,000,000 GENERALAGGREGATE $ 2,000,00 GENT AGGREGATE UMIT APPLIES PER PRODUCTS- AGO $ 2,000.000 POLICY X PRO- WC S A AUTOMOBILELAMITY X - ANY AUTO 075R25A 09/0112013 08f012D14 COMUINED SINGLE LIMIT (Ea occident S 1,000,00 EODLY IN.)URY(Per DMsan) $ ALL OWNED AUTOS GODLY INXRY(Nr madam) S X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Pw vc'idam) S X NON -OWNED AUTOS S S X UYBPELLA LIAe X OCCUR EACH OCCURRENCE 1 5,000,0 AGGREGATE 1 5,000,0 A EXCESS LUS CLAIMSWADE 075R25A 08/a112013 08i0112OI4 DEDUCTIBLE S H X RETENTION S 10,000 1 A WORKERS COMPENSAnON AMFIAMOYER4LIABILITY ANf PROPRIETORPARTNERIEAECUMVE YIN OFDCERNENCERE UDEDI (MAndeory M W) NIA DTN-UB41340394-7-13 BLKT WOS 0810112013 081012013 081Di120141=I, DB/OV2014 WCSTATU- OTH- X TORY LIMITS X ER -- EACLI ACCIDENT ` 1 1,000,0 EL. DISEASE - EA EMPLOYEE S 1,000, IIYo dgscdeeunder UESCRIPPONOFOPERATIONSbelw E L DISEASE, POLICY LIMIT S 1,000,000 A nland Marine - - 137P008 08/012013 081012014 Deductibl 1, Scheduled 1,112,01 DESCRtnIONOFOPE MOMILOGTIONSIVEHCLES(AS/c11ACOBD10VAddldorml RomukaechMle,Bm"We lerigdmd) If required by written Contract or written _gzeement, The City of Fort Collins and CDOT are included as additional sured for ongoing operations under General Liability. FORT-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATS THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing AurN°n"IZED REPRESENTATIVE 281 North College Ave Fort Collins, CO 805220580 W I V00-LDVa A6VKU UVKPUKAI IUN. NI nghte reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD. OP ID: KH CERTIFICATE OF LIABILITY INSURANCE 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(les) 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). PROWLER Phone: 970-635-940000MA PFS Insurance Group-JT 4848 Thompson Pkwy, Ste 200 Fax: 970-635-9401 Johnstown, CO 80534 Tad Barrett E P a As E41AIL A000.ES3: CUSTOMER IDa: COBOR-1 WSU AFFORDING COVERAGE NAICB INSURED Jacobs Investments, LLC NSURERA: Travelers Insurance 25615 Colorado Boring, LLC Northam Lights Leasing, LLC 3813 Canal Drive NsuREae` INSURER C: INSURER D: Fort Collins, CO 80524 NSURER E : NWRER F : COVERAGFS CFRTTFlGaTEMIIAIRFR- cnnclnu uuuocv. 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR OF NSUIRANCE ADUCTYPE POUCYNWBE0. MINA Ei OUCTE3N LOIIiS GENERAL LIABUTY EACH OCNRRTCE S 1,000,00 A X COMMERaALGEMRk-UAUUIY LLAIMSMAUE OCCUR 0075R25A 0810112013 08/01/2014 PR Is=s Ea 141 R ce f 300,000 MEDEX Wv"emllr) S 10,000 X Limited Pollution 0075R25A 08ro12013 08/012014 MRSONALBAOVINJJRY $ 1,000.000 GENERAL AGGREGATE S 2,000,0001 GEM. AGGREGATE POLICY LIMIT APPLIES PER X PRI LOC PRCDUCT5-00MPIOPAGG S 2,000,0 S A AUTOMOBILE X X LIABBJTY Ar.+AUTO ALL OWNED AUTOS SCHEDULIDAUTOs HIRED AUTOS 075R25A O8ro12013 08/01201d COM5NED SINGLE UNI T E.acad.0 S 1,000,000 BOgLY Il:JURY {Por Oermn) S BOULY Ir:JORY IPx aOtlaml S PROPERTY DAMAGE (Per accidanU S X NONOWNED AUTOS $ S X UMBRELLA LU9 X OCCUR EACH OCCURRENCE S 5,000,0DC A EXCESS LIAR RAIMSMADE 075R25A 08/01/2013 08JO112014 AGGREGATE S S,000,O DEDUCTIBLE s X RETENT10N 5 10,000 A WORKERS COMPENSARON AND EMPLOYERY LIABILITYTORY ANY PROPRIETORPARTNERIET_CURVE YIN OFHCERNENUER EXCLUDED'! (wndraryNEN) 11 ryyo^ dm mee unaet 'ESRIPTIONOFOPERATIONSDeIaIr NIA DTN-UB-0D40394-7-13 BLKT WOS - 0810112017 08/012013 08/0120141�.L 08/012014 X TWCSTATu oTH LIMA i X R -EAcn AccicEr:i $ 1,000,000 E.L. USEASE - EA FMPLOYEES 1,00%000 EL. DISEASE.POLICYUMU S 1,000,0 A nland Marine 137P008 08I012013 08101/20I4 Deductibl 1,0 Scheduled 1,112,014 DESCR NOFOPERARONSILOCATONSIVEHCLEB (ABaCI ACOPD 101, AddlServl RamaAa 6cha3da,Kman vpan la ramindT If required by xritten contract or written agreement, certificate holder is included as additional insured for going operations under General Liability. FORT-01 • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City aF Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Building and Zoning pUnORIZED REPRESEMATWE North College Ave Fort Fort Collins, CO 605220580 (0 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD