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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC COLORADO BORING CO NORTHERN - INSURANCE CERTIFICATE (7)JACOINV-01 LPREW A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE A E(MMI 019YY) 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 (ac, No, EXry: (970) 635-9400 (Ax , No):(970) 635-9401 Johnstown. CO 80534 1 er ni 6,,. infoRmy0sinsurance.com INSURED Jacobs Investments LLC dba Colorado Boring Cc; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: REVISION Nt1MRFR- 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OOCCUR Blkt Add'I Insured 6078887283 8H/2019 8/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED 1 $ 300,000 X MED EXP (Any one arson) $ 10,000 X Blanket Waiver PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X JECT El LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AU UpTNOpSWry p AUTOS ONLY X AU70S ONLY Blanket Adel Insd X Blanket Waiver 6078887297 8/1/2019 8/1/2020 COMBINED SINGLE LIMIT (Ea amid nil $ 1,000,000 1X BODILY INJURY Per rson BODILY INJURY Per accident X pR0PPEER.�nt AMAGE X B X UMBRELLA LIAB EXCESSLwB X I OCCUR CLAIMS -MADE 16078887302 8/1/2019 8/112020 EACH OCCURRENCE 8,000,000 AGGREGATE 8,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEM REXCLUDED9 (Mandatory n �iFil) If yes describe ender DESCRIPTION OF OPERATIONS below N/A I4211616 8/1/2019 8/1/2020 X PERTUTE OTH- E.L. EACH ACCIDENT 1,000 000 E.L. DISEASE - EA EMPLOYE 1,000,000 E.L. DISEASE - POLICY LIMIT i,000,000 A Leased/Rented Equip A 'iInstallation FBr 6078887283 6078887283 8/1/2019 8/1/2019 8/1/2020 8/1/2020 $5,000 Deductible $2,500 Deductible 300,006 400,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) RE: Harmony Duct Bank Phase 2, Work Order #5010082663. 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