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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (6)JACOI NV-01 LPREWITT ACORD ( CERTIFICATE OF LIABILITY INSURANCE DATEMM/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). CONTACT PRODUCER NAME: PFS Insurance Group PHONE FAX 970 635-9401 4848 Thompson Parkway Suite 200 (A/c, No, Et): (970) 635-9400 (ac, No):( ) Johnstown, CO 80534 E- p^R'L . info@mypfsinsurance.com INSIIRERISI AFFORDING COVERAGE NAIC # INSURED Jacobs Investments LLC dba Colorado Boring Co; Northern Lights Leasing LLC 3813 Canal Dr Fort Collins, CO 80524 B: Travelers Property Cas c : Travelers Indemnity D:Pinnacol Assurance E: F: of America TC .... M. DC\/ICIr%Kl Alt IMDGD• 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 LTIRA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX] OCCUR DT-CO-4H829467-PHX-18 08/01/2018 08/01/2019 DAMAGE TO RENTED PR MI E$lEa occurrence 300,000 $ Blanket Add'I Insd X MED EXP (Any oneperson) $ 10,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY �X JEt° LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) 1,000,000 $ BODILY INJURY Per erson $ X ANY AUTO DT-8104H829467-TIL-18 08/01/2018 08/01/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver PeOaccdentDAMAGE $ -- C UMBRELLA LIAB Xj OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE CUP-7J468879-TIL-18-26 08/01/2018 08/01/2019 $ 2,060,000 X AGGREGATE DED I X I RETENTION $ 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE � I 4211616 08/01/2018 08/01/2019 PER OTH- X I TE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ FFFICER/MEMBFREXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - POLICY LIMIT 1000,000 $ ' If yes, describe under DESCRIPTION OF OPERATIONS below B Leased/Rented Equip QT-660-8137PO08-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 $2,500 Deductible 400,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Cherry Street Duct Bank Tie. 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. RECEIVE® AUG In A ujo CERTIFICATE HOLDER —" " GANGtLLA I IUN C►ty Manager's �FtiC� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins [� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 AGORU GUKPUKA I IUN. Ali rignts reservea. The ACORD name and logo are registered marks of ACORD