HomeMy WebLinkAbout380591 J2 CONTRACTING COMPANY INC - INSURANCE CERTIFICATE (3)''� �'r CERTIFICATE OF LIABILITY INSURANCE
9/22/20IY4
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
Moody,Insurance Agency, Inc.
8055 East Tufts Avenue
Suite 1000
Denver CO 80237
CONTACT NAME: A11t11aB1 Lee, CISR
PHONE (303)824-6600 FAx
A/C No:(303)310-0118
EMAILESS . alee®moodyins.com
DR
INSURERS AFFORDING COVERAGE
NAICE
INSURER A:Pinnacol Assurance
INSURED
J-2 Contracting Co., Inc.
PO BOX 129
JGreeley CO 80632
INSURER B:
I INSURER C:
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER::.,:._ REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE UsTED13ELOW 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 INSL]f_xN_ee 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
SUBRPOLICY
POLICY NUMBER
EFF
MMA)DMYYI
POLICY EXP
(MMMONYYYI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
E
COMMERCIAL GENERAL LIABILITY
DAMAGE 0 RENTEDPREMISES Ea occurrence
S
MED EXP (My one person)
$
CLAIMS -MADE OCCUR
PERSONAL B ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY
PRO LOG
S
MOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accidemNVAUTOBODILY
INJURY (Per person)
$
OWNED SCHEDULED
UTOSAUTOS(
RALL
BODILY INJURY Per accident
)IRED
$
PROPERTY DAMAGE
Per accident
$
AUTOS NON -OWNED
AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION$
$
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOWPARTNERIEXECUTIVE
OFFICEWMEMBER EXCLUDED'
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
114522
0/1/2019
0/1/2015
WC ISTATU- OTH-
XITS ER
E.L. EACH ACCIDENT
$ 11000,000
E. L. DISEASE - EA EMPLOYE
$ 11000,000
E. L. DISEASE -POLICY LIMIT 1
E 11000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required)
City of Fort Collins
215 North Mason Street
2nd Floor
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
ACORD 25 (2010/05)
Lee, CISR/AUTLEE
01988-2010 ACORD CORPORATION. All rights reserved.
INsu20 (201005) oI The ACORD name and logo are registered marks of ACORD