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Home My WebLink AboutJANSMA BROS EXCAVATING & TRUCKING CORP - INSURANCE CERTIFICATE (2)OP ID: RC ACORO" CERTIFICATE OF LIABILITY INSURANCE O05MM S/194 /19//2 r014 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 PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80634 Tad Borrett CONTACT NAME: PHONE FAX LAID. No Eat: A/c No: EMAIL ADDRESS: PRODUCER JANSM-3 CUSTOMERIDp: INSURER(S) AFFORDING COVERAGE HAD N INSURED Jansma Bros. Excavating INSURER A: EMC Insurance Companies 21415 & Trucking Corp. INSURER B:Pinnacol Assurance 41190 1475 Backhoe Road Loveland, CO 80538 INSURER C : INSURER 0: 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 ADDL UB POLICY NUMBER Y EFF MMIDDOO POLICY EXP DOIYYYY LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LAJ OCCUR X Blanket Add'llns 4X9O7OO 04/01/2014 04/01/2015 EACH OCCURRENCE $ 1,000,00 _ITAPACA T RENTED PREMISES RENTS occurrence) $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 X Blanket Waiver GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY Eh PRODUCTS - COMP/OP AGG $ 2,000,00 $ A A A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 4ES0700 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ X X $ A UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 4X90700 04I0112014 04/01I2075 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in Ni I(yes describe under DESCRIPTION OF OPERATIONS below N/A 2342390 BLANKET WAIVER OF SUBRO 06/01/2014 06/01/2015 X WC STATU- OTH- T ITS ER E.L. EACHACCIDENT $ 100,00 E. L. DISEASE - EA EMPLOYEE $ 100,00 EL DISEASE -POLICY LIMIT I $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 (E) 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD