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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (2)Client#: 46343 NORSTI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DO/YYYY) 04/19/2011 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(les) must 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 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970356-0123 CONTACT NAME: Jennifer Winter 970 266-7127 we No EL, No : 970 506-6846 ADORE —E.al J:ennifer.Winter@fpinsurance.com R�—E.!E!jtennifer.Winter@fpinsurance.com CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAICA INSURED INSURER A: Travelers Insurance Company Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURERS: Pinnacol Assurance Loveland, CO 80537 INSURER C INSURER O: 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 CONTRACTOR 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. TYPE OF INSURANCE BIL POLICY NUMBER MWDD/YFF POLICY MWDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY _71CLAIMS-MADE 12fl OCCUR X PD Ded:1,000 4TC07858X707COF1 4/26/2011 04/2612012 EACH OCCURRENCE S7000000 DAMAGE TO RENTED PREMISES Ea occurrence s300000 , MED EXP(Any one person) $10,000 PERSONAL &ADV INJURY S1,000,000 GENERAL AGGREGATE $21000 OOO GEN'L AGGREGATE LIMIT APPLIES PER: POULV X PRO-JECT LOC PRODUCTS - COMP/OP AGG s2,000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Other Car BA7858X70711 CNS 4/26/2011 04/26/201 COMBINED SINGLE UMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BOOI LY I NJ TRY (Per accident) $ I!Drive PROPERTY DAMAGE (Per accident) $ $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE 4TSMCUP7858X707T 4/26/2011 04/26/201 EACH OCCURRENCE $1000000 AGGREGATE $1 000 000 DEDUCTIBLE RETENTION S 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVEYJN OFFICEWMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4108060 7/01/2010 07/01/2011 X Vac STATU- OTH- E.L. EACH ACCIDENT 5500000 E.L. DISEASE- EA EMPLOYEE $SOD,000 E.L. DISEASE -POLICY LIMIT '506000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attecb ACORD 101, Additional Remarks Schedule, If mare apace is required) City of Fort Collins 215 N. Mason, 2nd Floor 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 Flacsi 'r A4e jelionJ INf✓r"ol @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 Of 1 #S605785/M605772 The ACORD name and logo are registered marks of ACORD JZS Client#: 46343 NORSTI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DO/YYYY) 04/19/2011 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(les) must 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 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970356-0123 CONTACT NAME: Jennifer Winter 970 266-7127 we No EL, No : 970 506-6846 ADORE —E.al J:ennifer.Winter@fpinsurance.com R�—E.!E!jtennifer.Winter@fpinsurance.com CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAICA INSURED INSURER A: Travelers Insurance Company Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURERS: Pinnacol Assurance Loveland, CO 80537 INSURER C INSURER O: 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 CONTRACTOR 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. TYPE OF INSURANCE BIL POLICY NUMBER MWDD/YFF POLICY MWDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY _71CLAIMS-MADE 12fl OCCUR X PD Ded:1,000 4TC07858X707COF1 4/26/2011 04/2612012 EACH OCCURRENCE S7000000 DAMAGE TO RENTED PREMISES Ea occurrence s300000 , MED EXP(Any one person) $10,000 PERSONAL &ADV INJURY S1,000,000 GENERAL AGGREGATE $21000 OOO GEN'L AGGREGATE LIMIT APPLIES PER: POULV X PRO-JECT LOC PRODUCTS - COMP/OP AGG s2,000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Other Car BA7858X70711 CNS 4/26/2011 04/26/201 COMBINED SINGLE UMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BOOI LY I NJ TRY (Per accident) $ I!Drive PROPERTY DAMAGE (Per accident) $ $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE 4TSMCUP7858X707T 4/26/2011 04/26/201 EACH OCCURRENCE $1000000 AGGREGATE $1 000 000 DEDUCTIBLE RETENTION S 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVEYJN OFFICEWMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4108060 7/01/2010 07/01/2011 X Vac STATU- OTH- E.L. EACH ACCIDENT 5500000 E.L. DISEASE- EA EMPLOYEE $SOD,000 E.L. DISEASE -POLICY LIMIT '506000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attecb ACORD 101, Additional Remarks Schedule, If mare apace is required) City of Fort Collins 215 N. Mason, 2nd Floor 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 Flacsi 'r A4e jelionJ INf✓r"ol @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 Of 1 #S605785/M605772 The ACORD name and logo are registered marks of ACORD JZS Client#: 46343 NORSTI ACORD.,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDJYYYY) F 04/19/2011 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 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 Flood & Peterson ins., Inc. P.O.Box 578 CO 80632 970 356-0123 CONTACT NAME, Jennifer Winter PHONE 970 266-7127 970 506-6846 A/C No EMA: A/C, No -AL Jennifer.Winter@f insurance.com ADDRESS: ennifer.Winter@fpinsurance.com CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAIC A INSURED INSURER A: Travelers Insurance Company Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER B: Pinnacol Assurance Loveland, CO 80537 INSURER C INSURER D: 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. N611L TYPE OF INSURANCE POLICY NUMBER MMIDDNYY M,NDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABIUTY CLAIMS -MADE OGGUR X PD Ded:1,000 4TC07858X707COF1 4/26/2011 04126/2012 EACH OCCURRENCE $1 OOD 000 DAMAGETO RENTED ES(Ea cccur occurrence) $3OO DDD MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE PODGY LIMIT APPLIES PER: PRO 71 LOC X JECT PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTOMOBILE UABILMY ANVAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70711CNS I 4/26/2011 04/26/2012 COMBINED SINGLE UMIT (Ea accident)$1 ODD 000 BODILY INJURY(Per Person) $ BODILY INJURY(Per accitlent) $ 1XXX PROPERTY DAMAGE (Per accident) S $ $ A X UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE 4TSMCUP7858X707T 4/26/2011 04/26/2012 EACH OCCURRENCE $1000000 AGGREGATE $1 00O 000 DEDUCTIBLE RETENTION 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE[—] OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If Dyes, descrlte antler DESCRIPTION OF OPERATIONS bar N/A 4108060 7/01/2010 07/01/2011 X wO srnru- OTH- E.L. EACH ACCIDENT s5000OO EL DISEASE - EA EMPLOYEE $SOO,000 EL DISEASE -POLICY LIMIT $SOD OOO DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional RemaM Schedule, if more space is required) RE: Concrete Maintenance Project - Phase II, Bid No. 6088 City of Fort Collins (Owner), and any other persons or entities as (See Attached Descriptions) City of Fort Collins PO 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 Fl000t '* 10A-J9 SO4Q INf✓rdll AJCA , TNC. 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009(09) 1 Of 2 #S605786/M605772 The ACORD name and logo are registered marks of ACORD JZS Client#: 46343 NORSTI ACORD.,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDJYYYY) F 04/19/2011 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 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 Flood & Peterson ins., Inc. P.O.Box 578 CO 80632 970 356-0123 CONTACT NAME, Jennifer Winter PHONE 970 266-7127 970 506-6846 A/C No EMA: A/C, No -AL Jennifer.Winter@f insurance.com ADDRESS: ennifer.Winter@fpinsurance.com CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAIC A INSURED INSURER A: Travelers Insurance Company Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER B: Pinnacol Assurance Loveland, CO 80537 INSURER C INSURER D: 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. N611L TYPE OF INSURANCE POLICY NUMBER MMIDDNYY M,NDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABIUTY CLAIMS -MADE OGGUR X PD Ded:1,000 4TC07858X707COF1 4/26/2011 04126/2012 EACH OCCURRENCE $1 OOD 000 DAMAGETO RENTED ES(Ea cccur occurrence) $3OO DDD MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE PODGY LIMIT APPLIES PER: PRO 71 LOC X JECT PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTOMOBILE UABILMY ANVAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70711CNS I 4/26/2011 04/26/2012 COMBINED SINGLE UMIT (Ea accident)$1 ODD 000 BODILY INJURY(Per Person) $ BODILY INJURY(Per accitlent) $ 1XXX PROPERTY DAMAGE (Per accident) S $ $ A X UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE 4TSMCUP7858X707T 4/26/2011 04/26/2012 EACH OCCURRENCE $1000000 AGGREGATE $1 00O 000 DEDUCTIBLE RETENTION 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE[—] OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If Dyes, descrlte antler DESCRIPTION OF OPERATIONS bar N/A 4108060 7/01/2010 07/01/2011 X wO srnru- OTH- E.L. EACH ACCIDENT s5000OO EL DISEASE - EA EMPLOYEE $SOO,000 EL DISEASE -POLICY LIMIT $SOD OOO DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional RemaM Schedule, if more space is required) RE: Concrete Maintenance Project - Phase II, Bid No. 6088 City of Fort Collins (Owner), and any other persons or entities as (See Attached Descriptions) City of Fort Collins PO 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 Fl000t '* 10A-J9 SO4Q INf✓rdll AJCA , TNC. 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009(09) 1 Of 2 #S605786/M605772 The ACORD name and logo are registered marks of ACORD JZS