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HomeMy WebLinkAbout180828 COLORADO BORING - INSURANCE CERTIFICATE (3)OP ID: KH CERTIFICATE OF LIABILITY INSURANCE D08/041201ATE YY) o8/oa/zola 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 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen-ADDRESS' CONTACT NAME: PHONE FAX IMC, No Exit : AIC Halt EIdAIL PRODUCER COBOR-1 CUSTOMER ID, INSURERS) AFFORDING COVERAGE NAICR INSURED Jacobs Investments, LLC INSURER A: Acuity Insurance Co. 14184 Colorado Boring, LLC Northern Lights Leasing, LLC 3813 Canal Drive INSURER 9: Travelers Insurance Group 25615 INSURER C: Fort Collins, CO 80524 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 TR OF INSURANCE _ADCTYPE INS UB POLICY NUMBER POLICY EFF MM/DDYYYY POLICY EXP MM IDD YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR X Limited Pollution L.01542 Z01542 08/01/2014 018/01/2014 08/01/2015 08/01/2015 EACH OCCURRENCE $ 1,000,00 DAMAT R N PREMISES PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL BADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY X PROJECT LOC PRODUCTS-COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS Z01542 08I01I2014 08I01I2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Z01542 08/01/2014 08/01/2015 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERrtAEMBER E%CLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA Z01642 BLKT WOS 08/01/2014 08/01/2014 08/01/2016 08/01/2015 X I WCSTATU- X OTH- LIMLT$ E.L. EACH ACCIDENT $ 1,000,00 CC E.L. DISEASE -EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 B Inland Marine 6663P6141 I08/01/2014 08/01/2015 Deductibl 5,00 Scheduled 2,044,93 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space Is required) If required by written contract or written agreement, The City of Fort Collins and COOT are included as additional insured for ongoing operations under General Liability. FORT-01 City of Fort Collins Purchasing 281 North College Ave Fort Collins, CO 805220580 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 414 © 1988-2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD