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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC/ COLORADO BORING CO - INSURANCE CERTIFICATEJACOINV-01 LPREW ACORO FDA.TE;2812017 CERTIFICATE OF LIABILITY INSURANCEMM/DD/YYYY) 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 : INSURER F : 635-9400 Travelers rance.com of America COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 635-9401 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUP,ED 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 MM! D/YYYY MM/ DIYYYY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR Blanket Add'1 Insd EACH OCCURRENCE DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED P occurrence MED EXP (Any oneperson) PERSONAL& ADV INJURY i GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 1,000,000 300,000 X $ 10,000 X Blanket Waiver AGGREGATE LIMIT APPLIES PER: POLICY X JECT I LOC OTHER Limited Pollution 1,000,000 GENT $ 2,000,000 2,000,000 X $ B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NpN-OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver COMBINED SINGLE LIMIT 1Ea accident) _ DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Per arson BODILY INJURY Per accident PPReOa�d� AMAGE 1,000,000 $ $ $ $ B UMBRELLA LIAB X OCCUR EXCESS LIAS CLAIMS -MADE DED I X ! RETENTION $ 10,000 EACH OCCURRENCE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE . $ 2,000,000 $ 2,000,000 X A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / ry QFFICER/MEMBER EXCLUDED? u N /A (Mandatory in NH) � If Yes describe under DESCRIPTION OF OPERATIONS below � UB-4H86628A-17-26-G X PERT TE OTH- ER 08/01/2017 108/0112018 E.L. EACH ACCIDENT �. E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT 1,000,000 $ 1,000,000 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: 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 IIL10JC 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 LPREWITT ACORO ( CERTIFICATE OF LIABILITY INSURANCE DATEMM/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 970 635-9400 4848 Thompson Parkway Suite 200 PA/C, No, Ext : ( ) FAX No):(970) 635-9401 Johnstown, CO 80534 M,,9, info@mypfsinsurance.com 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 INSURERE: !`nveGA�`_ee f`c DTICIf`ArC All IM[ =0— RFVICI(_1N Fill 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. ADDLSUBRINSR TYPE OF INSURANCE INSD WVO LTR POLICY NUMBER POLICY EFF tPIO� ICY EXP LIMITS A 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 r PREMISES (Ea o c re c 300,000 $ $ 10,000 X Blanket Add'I Insd MED ExPlnny one rson X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE O LOC PRODUCTS - COMP/OP AGG X OTHER: Limited Pollution B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY _tEaaccident) $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ n X HIRED .I X NON -OWNED PROPERTY AMAGE $ AUTOS ONLY .AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver B UMBRELLA LIAB X OCCUR EACH OCCURRENCE 4 $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2,000,000 RETENTION $ 10,000 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N Ug-4H86628A-17-26-G OS/01/2017 08/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ - OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 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 08/01/20171 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: 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. 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 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 PIPS 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 INSURER D : INSURER E : INSURER F : 635-9400 (FAXAIC , No):(970) 635-9401 Phoenix Insurance Company Travelers PrODerty Casualtv Company of America COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 25615 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 LTRIDDIYYYYI POLICY NUMBER POLICY EFF MMUCY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F7X OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED 300,000 PREMISES (Ea occurrence) $ Blanket Add'I Insd MED EXP operson) $ 10,000 Y_ne X PERSONAL & ADV INJURY 1,000,000 X Blanket Waiver 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY X PE LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X OTHER: Limited Pollution B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) _ - $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Per person) ,.$ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident__ HIRED NON -OWNED X X PROPERTY AMAGE accident $ AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver _Per OCCUR B UMBRELLA LIAB ��_CLAIMS-MADEI EACH OCCURRENCE $ 2,000,000 $ 2,000,000 X EXCESSLIAB DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE DED X RETENTION $ 10,000 A WORKERS COMPENSATION X PERTU OTH- AND EMPLOYERS' LIABILITY YIN UB-4H86628A-17-26-G 08/01/2017 08/01/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatoryin NH) 0 E L DISEASE -EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below 1,000,000 E.L. DISEASE -POLICY LIMIT $ C Leased/Rented Equip QT-660-8137P008-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: 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. 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 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREW ACORD DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 7/28/2017 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 111635-9400 INSURER B : Travelers Properly Casualty Company of America INSURER C: Travelers Insurance Group INSURER D : INSURER F : rnvGoer_Gc CERTIFIC'ATF NUMBER: REVISION NUMBER: 635-9401 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 SINSD UBR LTRA POLICY NUMBER fPIOLICY EFF MMLICY EXP LIMITS IA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RMSETO RENTED currencM $ 300,000 X Blanket Add'I Insd MED EXP (Any one erson $ 10,000 PERSONAL & ADV INJURY _J Blanket Waiver S 1,000,000 2,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ $ 2,000,000 �X JE 0 LOC PRODUCTS - COMP/OP AGG HPOLICY X $ OTHER: Limited Pollution B COMBINED SINGLE LIMIT 1 �000�000 AUTOMOBILE LIABILITY (Ea accident) _ __ $ X ANY AUTO DT-810-4HB29467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Per arson $ _ OWNED SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ _AUTOS HIRED X NON -OWNED (PROPE.cdTYrlt AMAGE $ �X AUTOS ONLY AUTOS ONLY X Blanket Add l Insd Blanket Waiver B UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 2,000,000 EXCESSUA13 CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2,000,000 X DED X RETENTION $ 10,0001 $ A WORKERS COMPENSATION PER OTH- X I TAT T E ER AND EMPLOYERS' LIABILITY YIN _ UB-4H86628A-17-26-G 08/01/2017 08/01/2018 1,000,000 ANY ARTNE /E ECUTIVE E E.L. EACH ACCIDENT $ OFFICER/MEMBPROPRIETOR/PARTNER/EXECUTIVE ER/ NSA 1,000'000 (Mandatory in NH) E.L. DISEASE_ - EA EMPLOYEE._____ $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 C Equip QT-660-8137P008-TIL-17 08/01/2017 08/01/2018 ',a5,000 Deductible 300,000 ILeased/Rented C lInstallation 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: 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 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 1988-ZU15 ACUKU GUKNUKA I IUN. Au rlgnts reservea. The ACORD name and logo are registered marks of ACORD �-- 4,111, JACOINV-01 LPREW ACORO DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE o7/2812017 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 RAi11E[ PFS Insurance Group 4845 Thompson Parkway Suite 200 UvCONN Ext): (970) 635-9400 1 (F c, No):(970) 635-9401 Johnstown, CO 80534 ��. info@mypfsinsurance.com INSURED INSURER B: Travelers Property Casualty Company of America 25674 Jacobs Investments LLC dba Colorado Boring Co; Northern ,NsuRERc:Travelers Insurance Group 125615 Lights Leasing LLC 3813 Canal Dr INSURERD: Fort Collins, CO 80524 INSURER E:_ COVERAGES CERTIFICATE NUMBER: KtVISIVN NUM11:31=11: 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 poV�r NUMBER POLICY EFF POLICY EXP LIMITS MM/DDY1 YY 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 DAMAGE TO RENTED 300,000 PREMISES (Ea occurrence $ tXfflanket Add'I Insd nnEO Ex�An�one rson $ 10,000 nket Waiver ococnuei a ern, ,u a iov m 11000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY �X JE p LOC X OTHER: Limited Pollution B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X AUOTOS ONLY X Blanket Add'I Insd X Blanket Waiver B UMBRELLA LIAR X OCCUR X EXCESS LIAB CLAIMS -MADE DED X ' RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' a N/A (Mandatoryin NH) If yes describe under DESCRIPTION OF OPERATIONS below C Leased/Rented Equip C Installation GENERAL AGGREGATE 1 $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,0001 COMBINED SINGLE LIMIT (Ea_accident). DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 2,000,000 EACH OCCURRENCE $ $ 2,000,000 DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE X PER OTH- STAT�T ER UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E L. EACH ACCIDENT $ 1,000,000 I 1,000,000 EL DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ 1,000,000 QT-660-8137P008-TIL-17 1 08/01/2017 08/01/2018 $5,000 Deductible 300,000 QT-660-8137P008-TIL-17 08/01/2017 08/01/2018 $2,500 Deductible 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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. r,rA— u^l .,moo !`A41r^CI I ATlr%Ki SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins t THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/VYYY)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 970 635-9400 FAx 970 635-9401 4848 Thompson Parkway Suite 200 (A/C, No, Ext): ( ) _ i (A/C, No):( ) Johnstown, CO 80534 A&,,.._info@mypfsinsurance.com INSURED Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 INSURER D : INSURER E . 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 ADDL SUBR LT POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 $ CLAIMS -MADE L;�, OC r X Blanket Add'I Insd DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 DAMAGE TO RENTED PREMISES-CEa ow urrence MED EXP (Any one arson s 3001000 10,000 $ 1,000,000 X ,Blanket Waiver PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X SEC ] LOC GENERAL AGGREGATE PRODUCTS -COMP/OPAGG $ 2,000,000 X OTHER. Limited Pollution B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident. _ _ - 1,000,000 $ $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 i 08/01/2018 BODILY INJURY (Per erson $ OWNED I ISCHEDULED AUTOS ONLY _ AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'Ilnsd X ,Blanket Waiver BODILY INJURY Per accident PeOPPEERdTYDAMAGE $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 $ 2,000,000 _ EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE �X DED X RETENTION $ 10,0001 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X STATUTE OTH- UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E.L. EACH ACCIDENT 1,000,000 $ 1,000 OOO $ ' OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A [:ELL DISEASE - EA EMPLOYEE 1,000,000 $ If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT C Leased/Rented Equip QT-660-8137PO08-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: 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. City of Fort Collins 300 LaPorte Ave Fort Collins, CO 80522 LGJD 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) © 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 FDATEMM/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 riqhts 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 635-9400 635-9401 INS11FIM a Travelers Property Casualty Company of America 125674 1 INSURER D : INSURER E : INSURER F : rnV1=0AnGc C-ERTIF!C-ATE NUMBER: REVISION NUMBER: 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 IADDL SUER INSDD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11000,000 DAMAGMLSE TO RENTED RE ES MED EXP (Any oneperson) CLAIMS -MADE � OCCUR X Blanket Add'l lined DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 $ 300,000 $ 10,000 X Blanket Waiver PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jE� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 $ XI OTHER Limited Pollution B AUTOMOBILE LIABILITY COMaBIINE�D�SINGLE LIMIT _tEaX $ 1,000,000 ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver BODILY INJURY Per accident PROPERTY accident) $ $ B UMBRELLA LIAR X OCCUR EACH OCCURRENCE 2,000,000 EXCESS LIAR CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE X $ 2,000,000 DED X RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WN NIA FICER/MEMBER EXCLUDED? _ andatory in NH) If yyes, describe under DESCRIPTIONOFOPERATIONS below PER OTH- XTUTE STA UB-4H86628A-17-26-G 08/01/2017 08/01/2018 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L DISEASE -POLICY LIMIT $ 1,000,000 $ 1,000,000 1,000,0 00 C Leased/Rented Equip QT-660-8137P008-TIL-17 1 08/01/2017 08/01/2018 $5,000 Deductible 300,000 C Installation QT-660-8137PO08-TIL-17 08/01/2017 08/01/2018 I$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. City of Fort Collins Transfort/Parking Serivices 215 N. Mason Fort Collins, CO 80524 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 1988-2015 ACUKU UUKNUKA I IUN. An rlgnts reservea. The ACORD name and logo are registered marks of ACORD JACOINV-01 LPREWITT ACORO DATE (MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE FoE(MMID NY 17 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 NAME CT - PFS Insurance Group A/Co,NN , E:tt): (970) 635-9400 I F,A/k No :(970) 635-9401 4848 Thompson Parkway Suite 200 E-MAILJohnstown, CO 80534 .info mypfsinsurance.com INSURER A: rnoenix INSURED I INSURER B: Travelers Jacobs Investments, LLC Colorado Boring CO; Northern Lights Leasing, LLC 3813 Canal Drive Fort Collins, CO 80524 F: of America �[� f^L �TICII^ATC u"AAMMo. CC11114 I All IAA92C0- 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 LNSD SWVDR POLICY NUMBER LTRA POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGESA RENTED P a occurrannc $ g00,000 CLAIMS -MADE X OCCUR DT-CO-4H829467-PHX-17 08/01/2017 08/01/2018 MED EX Any oneperson) $ 10,000 X Blanket Add'I Insd PERSONAL & ADV INJURY $ 1,000,000 X Blanket Waiver GENERAL AGGREGATE $ 2,000,000 L AGGREGATE LIMIT APPLIES PER: �71❑X PRO- PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT LOC $ X OTHER Limited Pollution B I�i COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident)_ -_ $ X ANY AUTO DT-810-4H829467-TIL-17 08/01/2017 08/01/2018 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY Per accident).$ PAOPP.ER� X HIRED X NON -OWNED tDAMAGE _ AUTOS ONLY AUTOS ONLY X Blanket Add] Insci X Blanket Waiver . $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE DTSM-CUP-4H829467-TIL-17 08/01/2017 08/01/2018 AGGREGATE $ 2,000,000 DIED X RETENTION $ 10,000 $ A WORKERS COMPENSATION X PERTU ORTH- AND EMPLOYERS' LIABILITY Y� UB-4H86628A-17-26-G 08/01/2017 08/01/2018 1,000,000 ANY PROPRIETOR/PlEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A 110001000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes,. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 UUU,QQQ 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. :491aLy_\130k, City of Fort Collins Financial Services 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. REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD