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Home My WebLink About267431 NORTHSTAR CONCRETE - INSURANCE CERTIFICATEClient# 46343 NORSTI ACORD CERTIFICATE OF LIABILITY PRODUCER FIoOd 8 Peterson Ina Inc P O Box 578 4687 W 1 Sth Street INSURANCE °ATE,MM,°DIYYYY, 04/28/OS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY TI1E POL.Imi-Q BELOW INSURERS AFFORDING COVERAGE INSURERA Travelers Insurance Company NAIC # Greeley CO 80632 INSURED Northstar Concrete, Inc Manhole Specialists Inc INSURERS Plnnacoi Assurance_ INSURER C PO BOXY INSURFRD Berthoud CO 80513 0739 INSURER -- VVYGIgV THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THL POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER I It ICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY T HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS rm MIDI LTR INSRI TYPEOPINSURANCE POI ICY IV POUCYE IR TIN POLICY NUMBER E MM D A GENERAL LIABILITY DTC04984CB34 04/26/08 04/26/09 X COMMERCIAL GENERAL LIABILITY CLAIMS 2,50 OCCUR X PO D@d 2.500 LINIT9 EACH OCCUINiLNCr 41,000,000 OAMAz E�Tt PEN 3300.000 MCD CXP(Any one OA son) $5,000 PERSONAL A AOV INJURY $1 000,000 GEN L AGGREGATC I IMIT APPLIES PER X PRO- POLILY LOC GFNERAL AGGREGATE PRODUCTS COMPpP pGG $2 OOOLU00 $2 OOO OOO AJX BILE LIABILITY rqu'ro DT8104984C83 04/26/08 04/26/09 COMBINED SINGLE LIMIT (LaAcdaoni) $1000,000 OWNED AUTOS HEDULCOAUTOS BODILY INJURY (Por Pusan) $ FDAUTOS OWNEDAUTOS 000ILY INJURY(Per AamoM) 19tOPERTY DAMAGE A"'d.ni) $ LIABILITY AUTO _ .___—__(Pe DTSMCUP4984C 0412610$ 04/26/09 AUIOOIAY CAACCIDCNT $ OTHER THAV EAACC ONLYnC><3 HACMOCCURRENCF SAUTO $AUMUIiLLLgLIA01LITY sl.nnn.nnn X OCCUR n CLAIMS MADE DEDUCTIBLE X RETENTION $ 10000 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRICTORJPARTNERIEXECUTIVE OFFICERq&MBER EXCLUDED' II yes JessnOe UM 1ELC-161, PROVISIgNS wIvw OTHER ACORD 25 City of Fort Collins 215 N Mason 2nd Floor Fort Collins CO 80522 1 of 2 #M413432 07/01/07 07/01/00 ISO BY ENDORSEMENT I SPECIAL PROVISIONS r LD ANY OF THE ADOVC DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF THE ISSUNG INSURER WILL ENDEAVOR TO MAIL _31)_ DAYS WRITTEN �E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO 00 30 SHALL X NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR °SPNTATIVCS GRIME, REPRESENT.PTIVE /ooaR w- d'1k10%0d I XA.<.wr.Ae7cn ,TNjG MAE 0 ACORD CORPORATION 1981 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(tes) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements) 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) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s) authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend extend or alter the coverage afforded by the policies listed thereon ACORD 25 S f20a9fl1m n 1. ....... —