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HomeMy WebLinkAbout180828 COLORADO BORING - INSURANCE CERTIFICATE (4)JACOINV-01 RCAMPBELI ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `� 05/24/2017 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 CONTACT NAME: __, __ PFS Insurance Group 4848 Thompson Parkway Suite 200 (a/co, No, Exq: (970) 635-9400 FAX , No►:(970) 635-9401 E-MAIL info@mypfsinsurance.com Johnstown, CO 80534 ADDRESS:_ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Phoenix Insurance COmDanV 125623 INSURED INSURER B :Travelers Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr INSURERC: INSURER D : Fort Collins, CO 80524 INSURER E : INSURER F : of America r`rNlCCAn=Q r`CDTICIr`ATC KIII IMRCD• RF\/ISIr1M NI IMRFR• 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 LTR A X - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DT-CO-4H829467-PHX-16 08/01/2016 08/01/2017 DAMAGE O RENTED PR TO R occurrence 300,000 $ Blanket Add'I Insd MED EXP An one arson $ 10,000 X X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X PRO- LOC JECT GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000 $ 2,000,000 $ X OTHER: Limited Pollution B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea_a_ccident 1,000,000 $ _ X ANY AUTO - IDT-810-4H829467-TIL-16 08/01/2016 , 08/01/2017 BODILY INJURY Perperson) $ BODILY INJURY Per accident OWNED SCHEDULED.. AUTOS ONLY AUTOS $ PROPERTY DAMAGE (Per accident) X HIRED X NO 16SWNED AUTOS ONLY �AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver $ B X UMBRELLA LIAB X ' OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-16 08/01/2016 08/01/2017 AGGREGATE _ $ 2,000,000 DED X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PRO PRI ETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) NIA UB-4H86628A-16-26-G 08/01/2016 08/01/2017 X PER OTH- T T R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS bel, I E.L. DISEASE - POLICY LIMIT 1,000,000 $ B Leased/Rented Equip -660-8137P008-TIL-16 08/01/2016 1 08/01/2017 Limit 300,000 B Installation F-660-8137P008-TIL-16 08/01/2016 08/01/2017 400,000 DESCRIPTION OF OPERATIONS I 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. 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. I The ACORD name and logo are registered marks of ACORD