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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (3)i7.riT1111,1IXIYRd' I PRFWITT ,a►co�zo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/VYYY) 7/30/2019 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 CONTACT FAX PFS Insurance Group n"c°, No, Ext : (970) 635-9400 (AIC, No :(970) 635-9401 4848 Thompson Parkway Suite 200 E-MAIL Johnstown, CO $0634 info ypfsinsurance.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERANalley Forge Insurance 20508 INSURED INSURER B:Continental Insurance Company 35289 INSURER C : Pinnacol Assurance Co 41190 Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr INSURER D: INSURER E : Fort Collins, CO 80524 INSURER F : rnvCe wnCcl COTICIPATC WtltillQCo. RFVLCIrTW NI IMRFR- v 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. WSR LTRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERALLIABILITY CLAIMS -MADE I occuR Bikt Add'I Insured 6078887283 8l1/2019 ! EACH OCCURRENCE 8/1/2020 DAMAGE TO RENTED r MED EXP (Any one arson PERSONAL BADVINJURY GENERAL AGGREGATE PRODUCTS - COMPIOP AGG $ 1,000,000 $ 300,000 X $ 10,000 )( Blanket Waiver $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JET LOC OTHER' $ 2,000,000 $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AU�TNOOSWNEp X AUTOS ONLY X AUTOS ONLY X Blanker Atltll Instl X Blanket Waiver 6078887297 6/112019 8/1/2020 COMBINED SINGLE LIMIT (Ea aocidenti$ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PR r acc NmDAMAGE Fe $ B X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 6078887302 8/1/2019 8/1/2020 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYICER/M IIMBOERR EXCLUDED? D'! ECUTIVE Y❑ (Mandatory in NH)DISEASE M yas. a scribe under DESCRIPTION OF OPERATIONS below NIA 211616 8H/2019 811/2020 X I PER OTH- STATI FIR E.L. EACH ACCIDENT 1,000,000 - EA EMPLOYE $ 1'000'000 E.L. DISEASE -POLICY LIMIT 1,000,000 A Leased/Rented Equip 6078887283 811R019 8111M0 $5,000 Deductible 300,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: East Prospect duct Bank at boxelder Creek. If required by written contract or written agreement the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder, is included as Additional Insured for ongoing operations under General 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD