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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (5)JACOINV-01 LPREW ACORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE OT7/31/2018 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 CNA.ONTACT CT PFS Insurance Group 4848 Thompson Parkway Suite 200 (A/C,NNo, Ext): (970) 635-9400 jaC, No):(970) 635-9401 Johnstown, CO 80534 ADDRESS: info@mypfsinsurance.com INSURED 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 : 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 DAMAGE TO RENTED DAMAGE Ea occurrence 300,000 $ X Blanket Add'I Insd MED EXP (Any oneperson) $ 10,000 $ 1,000,000 X Blanket Waiver PERSONAL & ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X jpeT LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER B AUTOMOBILE LIABILITY INE Ea aBcideDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) X ANY AUTO DT-810-4H829467-TIL-18 08/01/2018 08/01/2019 $ BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PeOac RZt AMAGE X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver $ $ `+ 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 / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDEI ( andatory in NH) N/A 4211616 08/01/2018 08l01/2019 X PER OTH- TAT TE E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If es, describe under DESCRIPTION OF OPERATIONS below B Leased/Rented Equip �QT-660-8137PO08-TIL-1 8 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: 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. 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD