HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (5)__e""aS JACOINV-01 LPREW
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llw z CERTIFICATE OF LIABILITY INSURANCE DA7rin/7n,QYY'
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
INSURED
Jacobs Investments LLC dba Colorado Boring Co; Northam
Lights Leasing LLC
3813 Canal Dr
Fort Collins, CO 80524
635-9400
COVERAGES CERTIFICATE NUMRER- REVISION NUMBER:
635-9401
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
SUER
POLICY NUMBER
POLICY EFF
POLICY EXPJJJL uM1T5
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE -OCCUR
Blkt Add'1 Insured
�6078887283
8/1/2019
EACH OCCURRENCE
8/1/2020 DAMAGE TORENTED
PREMISES (Ea occurencel
MED EXP (My one arson
PERSONALBADVINJURY
GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG
1,000,000
$
$ 300,000
X
$ 10,000
X
BlanketWalver
$ 1,000,000
GEN'L AGGREGATE LIMIT _ APPLIES PER:
POLICY ❑X JEL'T LOC
OTHER:III
2,000,000
It 2,000,000
A
AUTOMOBILE
LIABILITY
AUTO
SCHEDULEDAURTEO�S ONLY AUpT�OpSWEpccident AUTOS ONLY X AUTOS ONLY
Blanket Addl Insd X Blanket Waiver
6078887297
8/1/2019
18/1/2020
MaBIINyEenD SINGLE LIMIT
1_(Ea
1,000,000
BOA DILYINJURY Per ersonOWNED
iANY
X
PeoIRd Y� AMAGE
$
B
X
UMBRELLA LIAR
EXCESS LU1e
X
I OCCUR
CLAIMS -MADE
6078887302
8/1/2919
8/1/2020
EACH OCCURRENCE
$ 8,000,000
i AGGREGATE
8,000,000
DIED I X I RETENTIONS 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(MandatoryIn IJJFFII
If yes. describe under
OF OPERATIONS below
N/A
4211616
8/1/2019
8/1/2020
X PER OTH-
STATUTE
E.L. EACH ACCIDENT
1,000,000
E.L. DISEASE - EA EMPLOY
1,000,000
$
. DISEASE - POLICY LIMIT
1,000,000DESCRIPTION
$
A ILeased/Rented Equip
A 'Installation Fltr
16078887283
16078887283
8/1/2019
8/1/2019
8/1/2020
8/1/2020
'$5,000 Deductible
$2,500 Deductible
300,000
400,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
RE: Linden St. Duct Bank Work Order Number 5010082692. 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.
IN
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) In 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD