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HomeMy WebLinkAboutJANSMA BROS EXCAVATING & TRUCKING CORP - INSURANCE CERTIFICATE (6)JANSBRO-01 LPREWITT CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 03/30/2018 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 CONTACT NAME: PFS Insurance Group PHONE FAX 4848 Thompson Parkway Suite 200 AUC, No, Exty (970) 635-9400 � (A/C, No►:(970) 635-9401 Johnstown, CO 80534gs: info@mypfsinsurance.COm INSURERL3J AFFORDING COVERAGE NAIC # INSURERA:American Builders Insurance Company 11240 INSURED INSURER B : Employers Mutual Casualty Company 21415 Jansma Bros. Excavating INSURER C:Pinnacol Assurance Co 41190 o, Trucking Corp. — 1475 Backhoe Road Loveland, CO 80537 INSURER D : INSURER E : 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 ADDL'bUBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD MOMMONYM LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE + $ 1,000,000 CLAIMS -MADE X OCCUR PKGO9028303 04/01/2018 04/01/2019 DAMAGE TO RENTED PREMISES (Ea occurrenceL—$ 100,000 Blanket Addl Insured 5,000 ___ _ . ___ MED EXP (Any one person $ X Blanket Waiver PERSONAL 8 ADV INJURY 1 000 000 _ _ _ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY LX LOC 2,000,000 JE� PRODUCTS - COMP/OP AGG $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidents $ 1,000,000 X ANY AUTO 4E90700 04/01/2018 04/01/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY Per accident) $ X HIRED X NON -AWNED AUTOS ONLY AUTOS ONLY PROPERTY AMAGE fPer_eCCiden>t $ _ X e t Addl X Blanket Waiver IBllan UMBRELLA LAB X OCCUR A X41EDED EACH OCCURRENCE $ 1,000,000 XCESS LAB CLAIMS -MADE UMB019028404 04/01/2018 04/01/2019 ..AGGREGATE_ _.$ 1,000,000 X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- X SJAT_U7`E_.i LE& 100,000 y I N 2342390 06/01/2017 06/01/2018 ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? in NH) 100,000 (Mandatory E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ALL OPERATIONS - ALL LOCATIONS. 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD