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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC / COLORADO BORING CO - INSURANCE CERTIFICATEJACOINV-01 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)07/28/2017 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 Colorado Boring CO; Northern Lights Leasing, LLC 3813 Canal Drive Fort Collins, CO 80524 INSURER D : INSURER E : 635-9400 iaC, No):(970) 635-9401 Travelers Property Casualty Company of America 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. INSR TYPE OF INSURANCE ADDLINSD ISUBR WVD LTR POLICY NUMBER POLICY EFF POLICY EXP M/DDNYYYILIMITS A )( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS -MADE X OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 300,000 DAMAGSESIE,E TO RENTED wimirr Blanket Add'I Insd X MED EXP (Any one erson 10,000 Blanket Waiver X PERSONAL & ADV INJURY $ 1,000,000 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG 2,000,000 PEA LOC POLICY X I OTHER: Limited Pollubon B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident)_ X7 ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY BODILY INJURY Per accident _AUTOS X HIRED X NON WNEED ANMAGE (Pe0acEcideM $ AUTOS ONLY � AUTO-s ONLY X Blanket Add'I Insd X Blanket Waiver B UMBRELLA LABX OCCUR EACH OCCURRENCE 2,000,000 $ EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE a 2,000,000 X DED I X RETENTION $ 10,000 A WORKERS COMPENSATION PEiR OTH- X I AND EMPLOYERS' LIABILITY Y / N UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NfA 19000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 C Leased/Rented Equip QT-660-8137P008-TIL-17 08/01/2017 08/01/2018 �$5,000 Deductible 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Prospect & Timberline Duct Bank, Spacer Bore & Steel Casing Bore. Work order #1630-2672. If required by written contract or written agreement the City of Fort Collins is included as additional insured for ongoing operations under General Liability and additonal insured with regard to automobile liability. City of Fort Collins 300 LaPorte Ave. Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ACORD 25 (2016/03) U 19tit$-ZU15 AL:UKLJL UKVUKA I IUN. All ngm:s re5erveu. The ACORD name and logo are registered marks of ACORD �•� JACOINV-01 LPREW ACORO FDA.TE,,(2 CERTIFICATE OF LIABILITY INSURANCE MMlDDlYYYY) 8/2017 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: _ PFS Insurance Group PHO N 4848 Thompson Parkway Suite 200 o); (970) 635-9400 WC, No :(970) 635-9401 Johnstown, CO 80534 L . info@mypfsinsurance.com INSURERS) AFFORDING COVERAGE NAIC I INSURER A: Phoenix Insurance Company 25623 INSURED INSURER B: Travelers Property Casualty Company of America 25674 Jacobs Investments LLC dba Colorado Boring Co; Northern INSURERC:Travelers Insurance Group 25615 Lights Leasing LLC 3813 Canal Dr INSURERD: Fort Collins, CO 80524 INSURER E: 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 INSD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRM/DD 1YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑X OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 PR AGETO e NTED $ 3001000 X Blanket Add'I Insd MED EXP (Any one arson $ 10,000 X Blanket Waiver i PERSONAL 8 ADV INJURY $ 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $ 2,000,000 POLICY ❑X JJECT LOC PRODUCTS - COMP/OP AGG $ X OTHER: Limited Pollution B Ea MBISINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY nt ac_cideD $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Pe rperson) _ $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident), $ X HIRED X r.N-OWNED ONLY PdrOacudeTMM AMAGE AUTOS ONLY AUTOS X Blanket Add; Insd X Blanket Waiver $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADEI DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2'000'000 DED X RETENTION $ 10,000 A WORKERS COMPENSATION X PER EAT OTH ER AND EMPLOYERS' LIABILITY YIN UB-4H86628A-17-26-G 08/01/2017 08/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE FICER/MEMBER EXCLUDED? NIA E L EACH ACCIDENT $ W1,000,000 andatory in NH) E L, DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT 1,000,000 $ C Leased/Rented Equip QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $5,000 Deductible 300,000 C Installation QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $2,500 Deductible 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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. CERTIFICATE HO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty 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 JACOINV-01 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DD/YYYY)07/28/2017 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 E,dl: (970) 635-9400 iAIC, Nol:(970) 635-9401 i nfogbmvafsi nsu rance.com INSURED INSURER B : Travelers Property Casuiiift Company of America 25674 Jacobs Investments LLC dba Colorado Boring Co; Northern INSURER C: Travelers Insurance Group 25615 Lights Leasing LLC 3813 Canal Dr INSURERD: Fort Collins, CO 80524 INSURERE: INSURER F : rern. DCVICIrIKI IJI IMQCD- v THIS IS TOCERTIFYTHAT 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 LTRMM/DD/YYYY A, X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS -MADE X OCCUR Blanket Add'I Insd DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018' DAMAGE TO RENTED PREMISES (Ea _occurren MED EXP (An one erson X 800,000 $ $ 10,000 Blanket Waiver PERSONAL & ADV INJURY X 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG GENT AGGREGATE LIMIT APPLIES PER: ❑1% J LOC $ 2,000,000 $ 2,000,000 RPOLICY X OTHER: Limited Pollution B AUTOMOBILE LIABILITY (Ea accdentl SINGLE LIMIT $ 1,000,000 $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident NN pp (Per a eRld Y AMAGE AUTOS ONLY X AUOTOS ONLDYBlanket Add'I Insd X Blanket Waiver �X_ $ $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE r $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE _ $ 2'000'000 DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y/N UB-4H86628A-17-26-G 08/01/2017 08/01/2018 ANY PROPRIETOR/PARTNER/EXECUTIVE F E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 $ 1,000,000 $ If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 C 'Leased/Rented Equip QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $5,000 Deductible 300,000 C Installation QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $2,500 Deductible 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if 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. CERTIFICATE HOLDER cANctL.L.A I IUN 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All ngnts reservea. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREWITT ACORD ( CERTIFICATE OF LIABILITY INSURANCE DATEMM/DDlYYYY) 07/28/2017 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). CONTACT PRODUCERNAME: PFS Insurance Group No, Ext : 970) 635-9400 1 (FAc, No):(970) 635-9401 4848 Thompson Parkway Suite 200aL Johnstown, CO 80534 . info@mypfsinsurance.com INSURED Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 Travelers Properly Casualty Company of America INSURER C: Travelers Insurance Group INSURER D : INSURER E : INSURER F : r�r��wTc w u�oco. DC:%1ICIr11J WI IRfili v THIS, IS TOCERTIFYTHAT 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 ADDL SUBR 7R TYPE OF INSURANCE INSD WVD POLICY EFF POLICY EXP POLICY NUMBER M / LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PR€WISES (Ea 2ccuu(tenc 300,000 $ CLAIMS -MADE OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 X Blanket Add'I Insd MED EXP An one arson $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Blank@t Waiver 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: J GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG 1 $ 2,000,000 POLICY X JECT LOC $ X I OTHER Limited Pollution B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accidentl____. _- $ X ANY AUTO I DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Perperson) . $ _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED PerOaEa:iRd Y DAMAGE $ AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver $ B UMBRELLA LIAB X ' OCCUR EACH OCCURREN_ CE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2,000,000 DED I X RETENTION $ 10,000 $ A WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y / N _ UB-4H86628A-17-26-G 08/01/2017 08/01/2018 1,000,000 $ ANYPROPRIETOR/PARTNER/EXECUTIVE N / A W,_E.L.EACHACCIDENT FICER/MEMBER EXCLUDED? 1,000,000 andatoryin NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT C Leased/Rented Equip QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 'S5,000 Deductible 300,000 C Installation QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $2,500 Deductible 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 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 (:AN 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 ACORD 25 (2016/03) U 1988-ZU15 AGUKLJ GUKVUKA I IUN. Au rlgnts reserves. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREW ACORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F07/28/2017 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; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 C NTACT PHOacc,Nnw, Et): (970) 635-9400 WC, No :(970) 635-9401 e info@mypfsinsurence.com INSURE S AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company 25623 INSURER B: Travelers Property Casulaitf Company of America 25674 INSURERC:Travelem Insurance Group 25615_ INSURER D : INSURER E . INSURER F : nQVERAQES CERTIFICATE NI IMRFR• 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. INSR TYPE OF INSURANCE ADDL,SUBR LTRA POLICY NUMBER M M POLICY EFF POL/DDICY/YEXPYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE '- OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED PREMISES (Ea o $ 300,000 Blanket Addrl Insd MED EXP (Any one on X $ 10,000 Blanket Waiver PERSONAL & ADV INJURY X $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY X �ECOT- —1 LOC GENERAL AGGREGATE PRODUCTS - COMPlOP AGG �GENT $ 2,000,000 $ 2,000,000 OTHER. Limited Pollution B AUTOMOBILE LIABILITY COMBINED e BINEDt I GLE LIMIT $ 1,000,000 X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Per person $ _ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'Ilnsd X Blanket Waiver BODILY INJURY Per accident PROPERTY OPEciRd Y DAMAGE I (Per $ B UMBRELLA LIAB �Xj OCCUR EACH OCCURRENCE 2,000,000 2,000,000 EXCESS LU1B CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE 1 $ 10 000 DED X I RETENTION $ r A WORKERS COMPENSATION LITY RIETOREXC NEFIUE YfN ANY PROPRIEEOR/P RBINER/EXECUTIVE $=MUTE UB-4H86628A-17-26-G 08/01/2017 08/01/2018 X - ORH- E. EACH ACCIDENT $ 1,000,000 ANYPRO Q NIA (Mandatory in NH) E L DISEASE_-_E_A_EMPLOYEE' _$ 1'000r000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMB 1,000,000 C Leased/Rented Equip OT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $5,000 Deductible 300,000 C Installation ,OT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $2,500 Deductible 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 #5010052705. 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. CATE 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) 07/28/2017 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; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: 635-9400 1togmyptslnsurance.com 635-9401 INSURER(S) AFFORDING COVERAGE NAI Phoenix Insurance Company 25623 Travelers Property Casualty Company of America 25674 Travelers Insurance Group 25615 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. INSR TYPE OF INSURANCE ADDLISUBR POLICY NUMBER TPOLICY EFF POLICY EXP LIMITS I / D/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS -MADE X I OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED PREMISES_(E_a occurrenc 300,000 $ _ Blanket Add'I Insd MED EXP (Any oneperson) X $ 10,000 Blanket Waiver PERSONAL & ADV INJURY X $ 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC El $ 2,000,000 $ 2,000,000 X OTHER Limited Pollution B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT :AEaaccident _ 1,000,000 $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED Xl NON -OWNED ,AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver BODILY INJURY Per accident PROPER .,UrftDAMAGE Pe -� $ _ -_ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2,000,000 X DED X I RETENTION $ 10,000 I $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A`' (Mandatory in NH) UB-4H86628A-17-26-G 08/01/2017 08/01/2018 X PTR ERRH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE i $ 1,000,000 E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below 1,000,000 $ C Leased/Rented Equip QT-660 8137PO08-TIL-17 08/01/2017'1 08/01/2018 $5,000 Deductible 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: East Prospect duct Bank at boxelder Creek. 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. CERTIFICATE 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/28/2017 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). CONTACT PRODUCER NAME: PFS Insurance Group PHONE FAx (970) 635-9401 4848 Thompson Parkway Suite 200 (A/C, No, Ext): (970) 635-9400 A/C, No Johnstown, CO 80534 E-MRE . info@mypfsinsurance.com INSURED INSURERS : Travelers Property Casualty Company of America 25674 Jacobs Investments LLC dba Colorado Boring Co; Northern INSURERC:Travelers Insurance Group 25615 Lights Leasing LLC 3813 Canal Dr INSURERD: Fort Collins, CO 80524 INSURERE: 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. INSR TYPE OF INSURANCE ADDLISUBR LTR POLICY NUMBER POLICY EFF POLICY EXP LIMITS MM/D Y (MMIDDrCfM A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE j $ 1,000,000 CLAIMS -MADE �X OCCUR Blanket Add'I III DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED PREMISES (Ea occurrence) MEDEXP,JMone person) Y $ 300,000 X $ 1�'��� PERSONAL & ADV INJURY X Blanket Waiver $ 1,000,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: POLICY CX ' PE El LOC CT $ 2,000,000 2,000,000 X OTHER: Limited Pollution B AUTOMOBILE LIABILITY COMBINED L accident)INGLE LIMIT $ 1,000,000 $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver BODILY INJURY Per accident (PercRde t DAMAGE - - $ $ -- B UMBRELLA LIAB X OCCUR *CH OCCURRENCE $ 2,000,000 $ 2,000,000 X EXCESS ICLAIMS-MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE DED X RETENTION $ 10,000 A I WORKERS COMPENSATION i AND EMPLOYERS' LIABILITY y/ry 'ANY PROPRIETOR/PARTNER/EXECUTIVE ;OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) X PEER AT IE_ R UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E.L._EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ 1,000,000 $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 C Leased/Rented Equip QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 $5,000 Deductible 300,000 C Installation QT-660-8137P008-TIL-17 08/01/2017 08/01/2018 �$2,500 Deductible 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Fort Collins Parking. 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. L;AIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Transfort/Parking Serivices 215 N. Mason Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) U 1988-2015 ACURD GURPURA I IUIV. Ali ngnts reservea. The ACORD name and logo are registered marks of ACORD JACOINV-01 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (28/2 Y7 07/1017 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 ME: PFS Insurance Group PHONE N ; (970) 635-9400 (Air, No1:(970) 635-9401 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 E . info@mypfsinsurance.com INSURED INSURER B : Travelers Property Casualty Company of America i25674 Jacobs Investments, LLC Colorado Boring CO; Northern INSURERC:Travelem Insurance Group 25615 Lights Leasing, LLC 3813 Canal Drive wsuRERD: Fort Collins, CO 80524 INSURERE: INSURER F : DC\/ICIr%Kl Al11MRFR• vv vTHIS 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 ADDL SUBR TYPE OF INSURANCE I POLICY EFF POLICY EXP POLICY NUMBER LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �"MMERCIAL CLAIMS -MADE OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED PREMISES a occurre $ 300,Qp0 X Blanket Add'1 Insd MED EXP An one arson 10,000 PERSONAL & ADV INJURY X Blanket Waiver $ 1,000,000 AGGREGATE $ 2'000r000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL PRO $ 2,000,000 POLICY ❑X JECT LOC PRODUCTS - COMP/OPAGG $ _ X OTHER Limited Pollution B COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY X ANY AUTO (Ea accident] _ _ - . DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Per erson OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON -AWNED PROPERTY AMAGE $ AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd r X Blanket Waiver $ BHUMBRELLA LIAB X, OCCUR EACH OCCURRENCE $ - 2,000,000 EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE _ $ 2,000,000 DED X I RETENTION $ 10,000 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E.L. EACH ACCIDENT 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) _$ E L. DISEASE - EA EMPLOYEE. $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Leased/Rented Equip QT-660-8137P008-TIL-17 08/01/2017 08/01/2018 $5,000 Deductible 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project Harmony Duct Bank Timberline Sub to Ziegler. If required by written contract or written agreement the City of Fort Collins is included as additional insured for ongoing operations under General Liability. Special Form - Replacement Cost - $2,500 deductible - Intallation Floater regarding 05" Bore Gard Pime Conduit Material. Limit $336,000 on job site/in transit/temporary location. CERTIFICATE HOLDER I,+AN%,r—LLA I IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Financial Services P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) lJ TyStf ZUTS AI+V KU I.VKF VKH I IVrv. All rKJIILS ICz Vl V VU. The ACORD name and logo are registered marks of ACORD