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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE�-� JACOINV-01 LPREWITT ACORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 07/31/2018 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). CONTACT PRODUCER NAME' _ PFS Insurance Group RECEIVED (A/CNNo, Ext): (970) 635-9400 ac, No►:(970) 635-9401 4848 Thompson Parkway Suite 200 E-MAIL Johnstown, CO 80534 AUGA RE : info@mypfsinsurance.com U0 6 2018 INSURERS AFFORDING COVERAGE NAIC # INSURED ((����}} pp����,,,,,,,, , Jacobs Investments C'CC�& I16i'WEr &Qffe*ONorthern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 �MM ICHIATC GII IAIICC1D. A: Phoenix Insurance Company 25623 B: Travelers Property Casualty Company of America 25674 c:Travelers Indemnity Company 25658 D: Pinnacol Assurance Co 41190 E F: QF\/ICIn KI All 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR Blanket Add'I Insd DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE5( RENTED PREMI E Ea_ ccurren e 310,000 $ X MED EXP An one person)$ 1O'000 X _ Blanket Waiver PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY j R LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NIN OWNED AUTOS ONLY _1 AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver DT-810-4H829467-TIL-18 08/01/2018 08/01/2019 Ea accciden SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PeOPERTntDAMAGE $ $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP-7J468879-TIL-18-26 08/01/2018 08/01/2019 EACH OCCURRENCE $ _ 2,000,000 $ 2,000,000 X AGGREGATE DED I X I RETENTION $ 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROP RIETOR/PARTNER/EXECUTIVE (FLIC o/MEMBER EXCLUDED? ❑ If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4211616 08/01/2018 08/01/2019 X PTRT T ORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 1,000,000 E.L. DISEASE - POLICY LIMIT g B Leased/Rented Equip Installation QT-660-8137PO08-TIL-18 QT-660-8137PO08-TIL-18 08/01/2018 08/01/2018 08/01/2019 08/01/2019 $5,000 Deductible $2,500 Deductible 300,000 400,000 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. City of Fort Collins 300 LaPorte Ave. Fort Collins, CO 80522 UA 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 zle-4— ACORD 25 (2016/03) © 1988-2015 ACORD CORPORA I IUN. Au ngnts reservea The ACORD name and logo are registered marks of ACORD