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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (4)IArnlluv-ni I PRFWITT ,4COR0 CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 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 M COACT A IAINc°,Nrc, Ext : (970) 635-9400 AJC, No :(970) 635-9401 PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 EADD -MAIL ESS:info@mypfsinsurance.com INSURIER(Sl AFFORDING COVERAGE NAIC # INSURIERANalley Forge Insurance 20508 INSURED INSURER B: Continental Insurance Company 35289 INSURER C : Pinnacol Assurance Co 41190 Jacobs Investments LLC dba Colorado Boring Cc; Northern Lights Leasing LLC 3813 Canal Dr INSURER D: INSURERE: Fort Collins, CO 80524 INSURER F : CnVFDArFe L'FDTICIr`ATF NI IMRFR- RFVISION NIIMRFR- 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 ADDL BURR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR BlktAdd+I Insured 6078887283 8/1/2019 8/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGEETO RENTED 300,000 )( MEDEXP (Any one arson 10,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY �X ipEST LOC OTHER: I GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AURTEO�S ONLY AUTOS X AUTOS ONLY X AUTOS ONLDY X Blanket Atld'I Insd X Blanket Waiver 6078887297 8/1J2019 8/1/2020 COMBINED SINGLE LIMIT accident) 1,000,000 $ BODILY INJURY Perperson) $ BODILY BODILY INJURY Per accident $ PRer azci I AMAGE FF $ B X UMBRELLA LIAR EXCESSLIAB X OCCUR CLAIMS -MADE 6078887302 6/1/2019 8/1/2020 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,000 DIED I X I RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ ppFFICER/MSMBER EXCLUDED? (Mandatorym NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 211616 8/1/2019 8/1/2020 - X PERT OTHSTA ER E.L EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ A A Leased/Rented Equip Installation Fltr 6078887283 6078887283 8/1/2019 8/1/2019 8YI/2020 8/1/2020 $5,000 Deductible i$2,500 Deductible 300,000 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES )ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Portner Sub Circuit Job #6010052705. 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. REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD