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HomeMy WebLinkAboutJANSMA BROS EXCAVATING - INSURANCE CERTIFICATE (2)i� OP ID: AFRO CERTIFICATE OF LIABILITY INSURANCE o03124/1102014 03 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 PRODUCER IFS Insurance Group -JT 1848 Thompson Pkwy, Ste 200 Johnstown. CO 80534 INSURED Jansma Bros. Excavating INSURER A: EMC Insurance Companies 21415 & Trucking Corp. INSURER a: Pinnacol Assurance 41190 1475 Backhoe Road Loveland, CO 80538 INSURERC: INSURER D : 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. ILTR NSR TYPE OF INSURANCE POLICY NUMBER EFF MI DY MIWD EXP LIMITS A GENERAL LL40 TY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X BlanketAddrllns 4XO0700 04/01/2014 04/01/2015 EACH OCCURRENCE R 1,000,00 PREMISES Meoccurrena R 100,00 MED EXP (Any one parson) E 10,00 PERSONAL& ADV INJURY E 1,000,00 X Blanket Waiver GENERAL AGGREGATE E 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS -COMPlOP AGO B 2,000,00 & A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 4E90700 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT (Ee accident) $ 1,000,00 E R : = 6 X BODILY INJURY (Per person) BODILY INJURY (Per accid nd) PROPERTY DAMAGE (PERACCIDENT) X X A UMBRELLA LIAR X OCCUR EXCESS LIAR CLAIMS -MADE DEDUCTIBLE RETENTION $ 4X90700 04/("2014 04,11111112016 EACH OCCURRENCE E 1,000,00 AGGREGATE E 1,000,00 - E S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNERIEXECUTIVE r— OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Ifrs describe under DE SCRIPTION OF OPERATIONS below N/A 2342390 BLANKET WAIVER OF SUBRO 06/01/2013 06/01/2014 X WC STATU- OTH- E.L. EACH ACCIDENT E 100,00 E.L. DISEASE -EA EMPLOYE E 100,00 E.L. DISEASE -POLICY LIMIT _ B 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAeach ACORD 101, Additional Remarks Schedule, if more space is required) ALL OPERATIONS — ALL LOCATIONS. FORT CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE 4 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: RC ,a►��Ro CERTIFICATE OF LIABILITY INSURANCE D03/241201YY) 03/24/2014 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 endomementisl. PRODUCER PFS Insurance Group -JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 INSURED Jansma Bros. Excavating 1111INUSU& Trucking Corp. 1475 Backhoe Road Loveland, CO 80538 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 TYPE OF INSURANCE POLICY NUMBER M POLICYADDUSUBP POl1GY P]IP�Lm LMM A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [50 OCCUR X Blanket Add'I Ins 4X90700 04/01/2014 04101/2016 EACH OCCURRENCE S 1,000,000 PREMISES CE. occurrence S 100,000 MED EXP (Any one Pawn) $ 10,00 PERSONAL SADVINJURY $ 1,000,00 X Blanket Waiver GENERAL AGGREGATE $ 2,000,0 GENT AGGREGATE POLICY LIMIT APPLIES PER: X PRO- LOCJFCT PRODUCTS - COMPIOP AGG S 2,000,0 S A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 4E90700 04/01/2014 04/0112015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per peraan) $ BODILY INJURY (Par arddwt) $ PROPERTY DAMAGE (PER ACCIDENT) S X X S $ A UMBRELLA LIAR X OCCUR EXCESS LIAR CLAIMSAUDE - -- DeoucneLe RETENTION $ X90700 0410111014 0410112015 EACH OCCURRENCE S 1,000,00 AGGREGATE S 1,000, 000 6 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNER/EXEOUTNEYIN OFFICERNEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA 2342390 BLANKET WAIVER OF SUBRO 05/0112013 OW01IM4 X WC STATU- OTH- E.L. EACH ACCIDENT a 100,000 E.L. DISEASE - EA EMPLOYEE S 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AMEN ACORD 101, Aadtlanal Ree arks SNradWe, N nars space Is raqulned) ALL OPERATIONS - ALL LOCATIONS. CERTIFICATE HOLDER CANCELLATION FORT CO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD