HomeMy WebLinkAbout380591 J2 CONTRACTING COMPANY INC - INSURANCE CERTIFICATE (4)A`CORO® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
12/19/2018
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 have ADDITIONAL INSURED provisions or 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
CONTACT Jennifer Winter, CISR
NAME:
Flood and Peterson
PHONE
/CO N Ex : (970) 506-3206 (IC No : (970) 506-6846
E-MAIL JWinter@fioodpeterson.com
ADDRESS:
PO Box 578
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Phoenix Insurance Company
25623
Greeley CO 80632
INSURED
INSURER B : Travelers Indemnity Company
25658
INSURER C : Travelers Property Casualty Company of America
25674
J2 Contracting Company, Inc.
INSURER D : Pinnacol Assurance
41190
105 Coronado Court, Suite At 01
INSURER E :
INSURER F :
Fort Collins CO 80525
COVERAGES CERTIFICATE NUMBER: CL18121926701 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
NDICATED. 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
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
�/
CLAIMS -MADE OCCUR
DAMAGET N
PREMISES Ea occurrence
300,000
$
X
MED EXP (Any one person)
$ 5,000
PD Ded:2,500
PERSONAL SADVINJURY
$ 1,000,000
A
Y
DTC0325D6576PHX18
01/01/2019
10/01/2019
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY PRO ❑
JECT LOC
PRODUCTS-COMP/OPAGG
2,000,000
$
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
Y
8102L9156611826G
01/01/2019
10/01/2019
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
X
$
DOC
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
C
EXCESS LIAB
CLAIMS -MADE
CUP9H7218771826
01/01/2019
10/01/2019
DED I X1 RETENTION $ 10,000
$
ID
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
ANY
EXCLUDED?
(Mandatory in NH)
NIA
3114522
10/01/2018
10/01 /2019
STER ATUTE EORH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Fossil Creek Trail - Shields to College
City of Fort Collins, its officers, agents, and employees, are listed as Additional Insureds as respects General Liability, including ongoing and completed
operations, and Auto Liability. A 30-day written notice of cancellation applies.
CERTIFICATE HOLDER CANCELLATION
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.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
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