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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (3)JACOINV-01 LPREWITT ACORO FM/DD/YYYY) 018 E (M CERTIFICATE OF LIABILITY INSURANCE 0DATE(M / DNY 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 a L INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject tot r I)nditions 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 AUG NAME: PFS Insurance Group O z��p 4848 Thompson Parkway Suite 200 (AIC, N , Exq: (970) 635-9400 jac, Noi:(970) 635-9401 DRJohnstown, CO 80534 GE-MAIL : info@mypfsinsurance.com Manager's Q ffC, INSURERS AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company 25623 INSURED I INSURER B: Travelers Property Casualty Company of America 25674 Jacobs Investments, LLC Colorado Boring CO; Northern INSURER C: Travelers Indemnity Company 25658 Lights Leasing, LLC 3813 Canal Drive INSURER D : Pinnacol Assurance Co 41190 Fort Collins, CO 80524 INSURER E : INSURER F : r.1HRAo00. DC\/ICIIIAI KII IRADFD- 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 POLICY NUMBER POLICYLTR EFF POLICY EXP fMMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Blanket Add'I Insd DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTED PREMI ES NTE occurrence) 310,000 $ X MED EXP An one person)$ 0,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PE� LOC OTHER. GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPlOP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver DT-810-4H829467-TIL-18 08/01/2018 08/01/2019 IEO aBIIc.NEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ $ BODILY INJURY Per accident PRrOPERTniDAMAGE _ $ 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 X AGGREGATE $ 2,000,600 DED I X I RETENTION $ 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE � pFFICER/MEMBER EXCLUOED� '(Mandatory in NH} It yes describe under DESCRIPTION OF OPERATIONS below N /A 4211616 08/01/2018 08/01/2019 X PER OTH- TAT T R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ B Leased/Rented Equip QT-660-8137PO08-TIL-18 08/01/2018 08/01/2019 $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. CERTIFICATE HOLDER GANGtLLA I IUN 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD