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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (2)IACOINV-01 LPREWITT ACORO �i CERTIFICATE OF LIABILITY INSURANCE DATE INVVVV) 7/30/230/2019 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 PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 CONTACT NAME; ja"c°,No,Ext: (970) 635-9400 PC,) 635-9401 lirp&ss, info@mypfsinsurence.com INSURERS AFFORDING COVERAGE NAIC # INSURERANalley Forge Insurance 20508 INSURED INSURER B:Continental Insurance Company 35289 INSURER C : Pinnacol Assurance Co 41190 Jacobs Investments, LLC Colorado Boring CO; Northern Lights Leasing, LLC 3813 Canal Drive INSURER D: INSURERE: Fort Collins, CO 80524 INSURER F : fY1\ICO NrY CC r•connrnrc L!"RAMr-1 O1=VICIr1iU NI IMRFR- 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 TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Blkt Add'I Insured Blanket Waiver 6078887283 8/1/2019 8/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED^ PREMISES (Ea occurreX $ 300,000 MED EXP (Any oneperson) $ 10,000 X PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [XIjP(T LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITYCOMBINED X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS �yy� X AUTOS ONLY X AUTOS ONE X Blanket Atltl'I Instl X Blanket Waiver 6078887297 8/1/2019 8/1/2020 SINGLE LIMB (Ea accident) $ 1,000,000 BODILY INJURY Per rson $ BODILY INJURY Per aaitlent S Pd2ef0°PEER. Y AMAGE B X UMBRELLA LIAB EXCESS LIAS X OCCUR CLAIMS -MADE 6078887302 8/1/2019 8/1/2020 EACH OCCURRENCE 11 8'000,000 AGGREGATE $ 8,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION ANDEMPLOYER5LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICER 9MBW EXCLUDED? �1�°°I°ntlat° It fIJJMH H yes, describe under DESCRIPTION OF OPERATIONS below NIA 211616 8/11M9 8/112M X I PER STATUTE— OTH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEES 1'000,006 1,000,000 $ E.L. DISEASE -POLICY LIMIT A Leased/Rented Equip 6078887283 8/1/2019 8/1/2020 $5,000 Deductible 300,000 I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Prospect & Timberline Duct Bank, Spacer Bore & Steel Casing Bore. Work order #1630-2672. If required by written contract or written agreement the City of Fort Collins is included as additional insured for ongoing operations under General Liability and additonal insured with regard to automobile liability. City of Fort Collins 300 LaPorte Ave. 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. REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD