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HomeMy WebLinkAbout380591 J2 CONTRACTING COMPANY INC - INSURANCE CERTIFICATE (9)/ A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/16/2016 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 Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT Jennifer Winter CISR NAME: PHOUVC.NENo, (970)506-3206 AICNo:(970)506-6846 ADDRESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Phoenix Insurance Company 25623 INSURED J2 Contracting Company, Inc. PO Box 129 Greeley CO 80632 INSURER B :Travelers Indemnity Company 25658 INSURERC:Travelers Property Casualty Company 25674 D:Pinnacol Assurance 41190 -INSURER INSURER E : INSURER F : COVFRACIFS CERTIFICATE NUMBER:CL16121615097 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 LTR TYPE OF INSURANCE A DL U R POLICY NUMBER POLICY EFF POLICY EXP MWDD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS -MADE I� OCCUR DAMAGE TO RENTED PREMISES Ea occurrence)$ 300,000 X MED EXP (Any one person) $ 5,000 PD Ded: 2 , 500 DTC0325D6576PHX17 1/1/2017 1/1/2018 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY I JE � -1 LOC 1$ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS DT81032506576IND17 1/1/2017 1/1/2018 BODILY INJURY (Per accident) $ PROPERTY ntDAMAGE $ $ X Drive Other Car X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE �DTSMCUP325D6576TIL17 DE X I RETENTION$ 10,000 $ 1/1/2017 1/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N❑ D (Mandatory in NH) NSA 3114522 10/1/2016 10/1/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1 000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is listed as an Additional Insured as respects General Liabillity. Insurance is primary and non-contributory. CERTIFICATE HULUEK City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522-0580 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 (2014/01) INS025 i2m4ntt J Winter, CISR/JWINTE ©1988-2014 ACORD CORPORATIUN. All ngnts reservea. The ACORD name and logo are registered marks of ACORD