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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (6)JACOINV-01 LPR E W I I I ,a►c�oizo CERTIFICATE OF LIABILITY INSURANCE DATE/3012DrY YYY 730/2019 9 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 CO NAWCT PFS Insurance Group PHONE Exo ; (970) 635-9400 or'4 . No :(970) 635-9401 4848 Thompson Parkway Suite 200 Johnstown, CO 80634 ' inf mypfsinsufance.com INSURED Jacobs Investments LLC dba Colorado Boring Cc; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 F: rnvcDAcoc ! PDTI=If-ATC ulnJnPD• RFVISInfJ 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR Blkt Addrl Insured 6078887283 8N/2019 8/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES IEa occurrence)X MED EXP (Any one n $ 300,006 $ 10,000 X Blanket Waiver PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [X] jECOT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AURTEO,1 ONLY AUUTNOSyyryEp X AUTOS ONLY X AU70� ONLY X Blanket Add'I Intl X Blanket Waiver 6078887297 8/1/2019 8/1/2020 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Per rson) $ BODILY INJURY Per accident $ GE PReOr aPc a'CeM $ B X UMBRELLA UAB X EXCESS LIAB OCCUR CLAIMS -MADE 6078887302 8/1/2019 811/2020 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 8,000,006 DED I X I RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMftR EYIN XCLUDED? ECUTIVE ( andetory in ) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 211616 8/1/2019 8l1/2020 X PER OTH- ITE E.L. EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY LIMB 1,000,6wo A A Leased/Rented Equip Installation Fitr 6078887283 6078887283 8/1/2019 8/1/2019 8/1/2020 8/1/2020 ;$6,000 Deductible $2,600 Deductible 300,000 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required RE: Cherry Street Duct Bank Tie. If required by written contract or written agreement the following provisions app y subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder, is included as Additional Insured for ongoing operations under General Liability. I:FRTIFIr ATF Wr l r1FR r:AN('FI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD