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HomeMy WebLinkAbout102747 JAX INC - INSURANCE CERTIFICATEClientk: 52345 JAXIN ACORD. CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDNYYY) 1/0712014 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). PRODUCER Flood and Peterson Corporate Mailing Address: P.O. Box 578 Greeley, CO 80632 CONTACT NAME: Br(anne Danielson PAHI u EXt:970 266.7118 A c No: 970 506.6846 ADDRESS: BDanielson@FloodPeterson.com INSURER(S) AFFORDING COVERAGE NAICS INSURER A: The Cincinnati Insurance Compan INSURED 10-1� t (i JAX, Inc. INSURERS: Pinnacol Assurance INSURER c: Zurich American Insurance Co. P.O. Box 469 Bellvue, CO 80512 NISURER 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 CONTRACTOR 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 LTRMR. TYPE OF INSURANCE ADDL UB IWO POLICY NUMBER MM�DY EFF MI'OwLICV EXP LIMITS A GENERALLIABUW X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EPP0175517 1/09/2014 01/0912011 EACH $1000000 NTURRENCE MERE reD. SSOO OOO MED EXP (Any one person) s5000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS-COMP/OP ADD $2000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTNOON-OWNED HIRED AUTOS H AUTOS IX EBA0175517 1/09/2014 01/09/201 EBMBINEDSINGLE LIMIT accident) 1,000,000 BODILY INJURY(Per person) S BODILY INJURY(Por accident) S ROPERTY DAAVIGES Per accident) S A UMBRELLA LIAB LESS LIAR X OCCUR CLAIMS -MADE EPP0175517 1/09/2014 01109/2015 EACH OCCURRENCE $S 000 000 AGGREGATE $5 000 000 DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE V/N OFFICER/MEMBER EXCLUDED? ❑ yandatory In NH) (M desbe under DESCRIPTION OF OPERATION$ below NIA 4161344 WC969190001 1/01/2014 01/0112015 X I WC STATU. OTH- E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE 11500000 E.L. DISEASE -POLICY LIMIT $500,000 C Workers' Comp. (Other States) 1/01/2014 01/01/2015 $500,000 Each Accident $500,000 Each Employee $500,000 Policy Limit DESCRIPTION OF OPERATIONS / LOCATIONS r VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Off Premise Archery Shoot Competition Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. i-.It of Fort Collins, Parks SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 413 South Bryan Avenue Fort Collins, CO 80521 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD -- — BXD