Loading...
HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (4)JACOINV-01 LPREWITT Al� �RO FYY) M/DDNY 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 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 COME:NTACT PFS Insurance Group 4848 Thompson Parkway Suite 200 (A//co,NN , Ext : (970) 635-9400 (FAX No):(970) 635-9401 Johnstown, CO 80534 E-M R'E : info mypfsinsurance.com INSURED Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 Travelers ProDertv Casualtv Comaanv of America INSURER D : Pinnacol Assurance Co 141190 1 F: l�fler^nAf_C r"CMTIL1/1ATC W1 RA011=0. DC\/ICInKI AllIRAQ9=0- 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 POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [X] OCCUR Blanket Add'I Insd DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 DAMAGE TORENTED MI E a occurrence PREMISES 300�QQQ $ X MED EXP (Any oneperson) $ 10,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY FX� JECT LOC $ OTHER. B AUTOMOBILE LIABILITY EOaccden SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO DT-810-4HB29467-TIL-18 08/01/2018 08/01/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS Pe�acatlentDAMAGE $ X AUTOS ONLY X AUUTOS ONL� X Blanket Add'I Insd X Blanket Waiver C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE CUP-7J468879-TIL-18-26 08/01/2018 08/01/2019 X AGGREGATE $ 2,000,000 DED I X I RETENTION $ 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N4211616 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMRFREXCI_UDED� (Mandatory in NH) N/A 08/01/2018 08/01/2019 X PER OTH- TAT E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYE 1,000,000 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 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. RECEIVED AUG a b ?q18 CERTIFICATE HOLDER iii IVian;;ninr'c r, lffl,� CANCELLATION 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 Z4-,�— ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD