Loading...
HomeMy WebLinkAboutJANSMA BROS EXCAVATING & TRUCKING CORP - INSURANCE CERTIFICATE (3)JANSBRO-01 RCAMPBELL 14� Rom@ CERTIFICATE OF LIABILITY INSURANCE DATE4/1/2 D/YYYY) /1/2016 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 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 CONTACT NAME: PHONE 970 635-9400 FAX /c No Ext: ( ) A/C No: (970) 635-9401 LA/C. E-MAIL ADDRESS: info@mypfsinsurance.com m fsinsurance.com INSURER(S) AFFORDING COVERAGE NAIC M INSURER A: American Builders Insurance Company 11240 INSURED INSURER B : Employers Mutual Casualty CO Jansma Bros. Excavating INSURER C: Pinnacol Assurance Co 41190 & Trucking Corp. 1475 Backhoe Road INSURERD: INSURERE: Loveland, CO 80537 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. I LTR TYPE OF INSURANCE ADDLSUBR IN D POLICY NUMBER MMDD�Y POLICYEXP LIMITS A X COMMERCIAL GENERAL LABILITY CLAIMS -MADE X OCCUR Blkt Add'I Insured 7PKGO19028301 04/01/2016 04/0112017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence S 100,00 X MED EXP (Any one person) $ 5,00 X Blkt Waiver of Subro PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY W JE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED gAkkUttTOS Blkt Add'I Insured X Rlu rWaiver of 4E90700 04MI12016 04/01/2017 COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB019028401 04/01/2016 04/01/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A 2342390 06/01/2015 00101/2016 PER OTH- X STATUTE ER E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLO $ 100,000 E.L. DISEASE- POLICY LIMIT I $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ALL OPERATIONS - ALL LOCATIONS. I t MULUtK City of Fort Collins P.O. Box 580 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD