HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE - INSURANCE CERTIFICATE (4)DEC-29-2003 MON 03:43 PM SIX & GEVING
FAX NO. 18008240896 P. 01/01
ACORD CERTIFICATE OF LIABILITY INSURANCE oPID B DAT6lMNubpmr1j
1�►rlxo-1 12 a9 D3
-
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRObUCER
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Six & Geving/Deriver Office
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
390 Union Blvd. #650
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lakewood CO 80228
Phox)ez720-962-0930 Faxt720-962-0942
INSURERS AFFORDING COVERAGE - NAIC#
INSURED
INSURER A. LrMC insurance Companies
INSURER B; - California Indemnity
Northstar Concrete, Xna.
INSURFRC
P. 0. Box Y
Berthoud CO 80513-0739
INSURCRb;
-- --- —
INSURER E;
COVERAGI=S
THE POI ICICS OF INSURANCE LISTED BELOW HAVE BEEN 1,,,,Su[o TO TI IE INSI NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REOUIRLMENT, TERM OR CONDITION OF ANY CONTRACT OROTIIGR DOCUMENT WITH
RESPECT 10 WHICH THIS CERTIFICATE MAY DC ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY TI IF POLICIES DESCRIBED HERON IS SIIIIJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICICS. AGGRFCAT E LIMITSSI TOWN MAY I IAVE BEEN REDUCED 9Y PAID CLAIMS.
INSR a _..._....., ,—___.... -- I. -._—__,..._
LTR NSR TYPEOFINSURANCE POLK-YNUMBER
POLICYEFFFCTIVE'FOLZI `.YE7(PIMTI N .
pgTE MMIDDIYY DATE MMIOD LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $1, 000, 000
A X cOMM[rtcuLGEN[RALUABiLITY 2X89468
DAmKCE'TD-RENT EO—
04/26/03 04/26/04 PREMISES.(Faoccuranpo 5100000
CLAIMS MADE IX OCCUR
MED EXP (Any one pm4n) $ 5 , _0 0 0
PFRSONAL B ADV INJURY 51, 000, 000
GENERAL AGGREGATE S2,000,000
GCN'LAIIGRCGAI E LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGO 52,000, 000-_
IRO- LOC
..'_�
POLICY
...
AUfOMODILE L IASILITY
COMBINED SINGLE LIMIT
11,000,000
A
X ANYAUTO
2X89468
04/26/03
04/26/04
(CaacCII
ALL OWNFD AUTOS
BODILY INJURY
$
- -
SCI ICDULE0 AUTOS
X HINLUAUTOS
BODILY INJURY
5
(Per oaidcn)
X NON OW NEO AUTOS
_
PROPERTY DAMAGE
5
- — - ---- ---"
(Per acddml)
GAR AGABILITY E LI
AUTO ONLY - EA ACCIDENT_
S _
ANY AU 10
OTHER THAN , EA ACC
S
tXCFSS1UUBRhL1-A LIABILITY
J OCCUR CLAIMS MADE
UEDUCTIDLE
RGTCN'IION S _
WORKERS COMPENSATION AND
D EMPLOYERS'LIARILITY C1078178F
ANY PROPRW TORIPARI NITJEXLCU TIVE
OFI:ICTR.'MLMHER [XCLUUE07
A
2XB9468
All prcjQCCs all locations- VAX 970-533-0805
City of Ft. Collins
Engineering Department
281 N. College AV'e
PO Box 580
Ft Collins CO 80522-OS80
AUTO ONLY: AGG S
FACH OCCURRCNCE 5 _
AGGREGATE S
S
09/02/03 09/02/04 1 EX, EACH ACCIDENT
.5100,000
DSMCAOYS 100, 000
OLICC__DISEAE•PYLIM
5 500, 000
04/26/03I 04/26/04I Scheduled $154,500
kk Leased/Re 9150.000
CTTYF - 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DECANCELLED BEFORE THE EXPIRATIOI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 - DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE! TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LUILULITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
ACORD 2S (2001108) f)WRD COO�SRATION 1988