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HomeMy WebLinkAboutJANSMA BROS EXCAVATING & TRUCKING CORP - INSURANCE CERTIFICATE (8)­__811i JANSBRO-01 RCAMPBE .44!7"j?" F DATE (MMIDD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 03/31/2017 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 _ __. _ PFS Insurance Group APHONE ( o, Exty (970) 635-9400 A/c, -9401 No):(970) 635 4848 Thompson Parkway Suite 200 //cc, Johnstown, CO 80534 E-MAIL info@mypfsirmurance.com INSURED Jansma Bros. Excavating & Trucking Corp. 1475 Backhoe Road Loveland, CO 80537 INSURER F : Mutual COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 190 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 100,000 $ CLAIMS -MADE , X, OCCUR PKGO19028302 04/01/2017 04/01/2018 DAMAGE TO RENTED _PREM)$€$ Ea occurren MED_EXP An one person)$ 59000 PERSONAL & ADV INJURY $ 1,000,006 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRp LOC JECT PRODUCTS - COMP/OP AGG 2'000,000 �I OTHER. B AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1r000r000 BODILY INJURY Per erson $ X ANY AUTO 4E90700 04/01/2017 04/01/2018 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PPBOPPERdTT �tDAMAGE $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ EXCESS LIAB 1 CLAIMS -MADE �UMB019028402 04/01/2017 04/01120IJ 1,000,000 DIED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY r/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED. ( andatory in NH) M 2342390 06/01/2016 N/A X PER OTH- _ . STATUTE _. 06/01/2017 � E.L. EACH ACCIDENT � E.L. DISEASE - EA EMPLOYEE - 1001000 $ _. _ _ 100 000 $ 500,000 H yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT i DESCRIPTION OF OPERATIONS / 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