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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (2)JACOINV-01 LPREWITT ,4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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). PRODUCER CONTACT ,., y. NAME: PFS Insurance Group vwsf PHONE FAX 4848 Thompson Parkway Suite 200 (A/c, No, Ext): (970) 635-9400 (Alc, No):(970) 635-9401 Johnstown, CO 80534 Cit Ao A'E . info@mypfsinsurance.com Y Manager's Office INSURERS AFFORDING COVERAGE NAIC # INSURED Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 Phoenix Insurance Company 25623 Travelers Prooerty Casualtv Company of America 125674 INSURER D : Pinnacol Assurance Co 141190 1 INSURER F : rnVFRArFC rFRTIPIr.ATF NI IMRFR• RFVICICIN 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 LTRA TYPE OF INSURANCE ADDL SUBR, POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F_X] OCCUR DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 DAMAGE TO RENTED PREMI E Ea occurrence 300,000 $ X MED EXP (Any oneperson) $ 10,000 Blanket Add'1 Insd X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a jE ? u LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER. B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ X ANY AUTO DT-8104H829467-TIL-18 08/01/2018 08/01/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ NON -AWNED AUTOS ONLY AUTOS ONLY X HIRED LX X Blanket Add'I InsdBlanket Waiver c UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE CUP-7J468879-TIL-18-26 08/01/2018 08/01/2019 AGGREGATE $ 2,000,000 DED X RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4211616 08/01/2018 08/01/2019 X PER OTH- TAT TE ER E.L. EACH ACCIDENT 1,000,000 $ E.I... DISEASE - EA EMPLOYEE $ 1,DOO,f)0� E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below B Leased/Rented Equip QT-660-8137P008-TIL-18 08/01/2018 08/01/2019 $5,000 Deductible 300,000 B Installation QT-660-8137PO08-TIL-18 08/01/2018 08/01/2019 $2,600 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. 1'CE3-T1C1r`ATC Uf%l r11=11D rAK I I A ritIIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE I zlo__�_ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD