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HomeMy WebLinkAboutJACOBS INVESTMENTS LLC DBA COLORADO BORING CO - INSURANCE CERTIFICATE (7)JACOINV-01 LPREWITT AcoRO CERTIFICATE OF LIABILITY INSURANCE D 07/31//2018 ) 31018 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 WOSURED, 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 CONTACTNAME: PFS Insurance Group 4848 Thompson Parkway Suite 200 PHONE Et : (970) 635-9400 FAX No :(970) 635-9401 Johnstown, CO 80534 ADDRESS: info@mypfsinsurance.com City Managers Office INSURER(S) AFFORDING COVERAGE NAIC # 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 D:Pinnacol Assurance Co E: F: _eN111TD A �^CC f l=DTICI!`ATC Al11AAD1i RF\/ISIrIIJ All 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY YXP 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 DAMAGETORENTED PREMISES R MI a occurrence)$ 300,000 X ME EXP (Any oneperson) $ 10,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 jECOT 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 Perperson) $ X ANY AUTO DT-810-4HB29467-TIL-18 08/01/2018 08/01/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY ntDAMAGE $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'[ 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 X I RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) 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 $ _ _ 11000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1000000 ' ' B Leased/Rented Equip QT-660-8137PO08-TIL-18 08/01/2018 08101/2019'$5,000 Deductible 300,000 B Installation QT-660-8137P008-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: Portner Sub Circuit Job #5010052705. 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. CERTIFICATE HO 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. REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD