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HomeMy WebLinkAboutNORTHSTAR CONCRETE INC MANHOLE SPECIALISTS - INSURANCE CERTIFICATEClient#: 46343 NORSTI ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE 04/26/2010YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: P 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 578 Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED Northstar Concrete, Inc. and Manhole Specialists, Inc. 1220 S. Garfield Avenue Loveland, CO 80537 INSURER A: Colorado Casualty Insurance INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER ICY EFFECTIVE DATEPOLMWDD/YY POLICY EXPIRATION DATE MWDD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR X PC Ded:2,000 CBP8652302 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED $500OOO MED EXP (Any one person) $15 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO POLICYFI JECT LOC PRODUCTS - COMP/OP AGG s2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA8653402 04/26/10 04/26/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X m PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE -X RETENTION $ 10000 CU8654602 04/26/10 04/26/11 EACH OCCURRENCE $1 OOO 000 AGGREGATE $1 OOO 000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4108060 07/01/09 07/01/1 O TH- X OR STATU- Ef E.L. EACH ACCIDENT $5OO OOO E.L. DISEASE - EA EMPLOYEE $500000 E.L. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS IL" 3;1117L9it11;V;LP]14@l_q; �fLVP]aIII +L\IILIA 9,f`1y"[•]7Cr•]1I3;:Pri1T:dil 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, THE ISSUING INSURER WILL ENDEAVOR TO MAIL gyp_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #S524761/M524744 KLB 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 (2001/08) 2 of 2 #S524761/M524744 Client#: 46343 NORSTI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDr Y) 06/15/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: P 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 578 Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED Northstar Concrete, Inc. and Manhole Specialists, Inc. 1220 S. Garfield Avenue Loveland, CO 80537 INSURER A: Colorado Casualty Insurance INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE D M DD POLICY EXPIRATION MM D LIMITS A GENERAL LIABILITY CBP8652302 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 000 MED EXP (Any one person) $15 000 CLAIMS MADE Q OCCUR PERSONAL & ADV INJURY $1 000 000 X PD Ded:2,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO- JECT 'A AUTOMOBILE LIABILITY X ANY AUTO BA8653402 04/26/10 04/26/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ X Drive Other Car PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE CU8654602 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 AGGREGATE $1 00O 000 $ $ DEDUCTIBLE $ X RETENTION $ 10000 B WORKERS COMPENSATION AND 4108060 07/01/10 07/01/11 X WC STATUIMIT- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $5OO OOO OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s500 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Concrete Maintenance Project - Phase II, Bid No. 6088 City of Fort Collins (Owner), and any other persons or entities as required, their respective officers and employees, are listed as Additional (See Attached Descriptions) ,,r-rs I Irm A I c nULUtP{ GANGtLLA I IUN 1 U UBVS Tor Non-ravment 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, THE ISSUING INSURER WILL WA7§M=X§t MAIL _-AfI DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT AUTHORIZED REPRESENTATIVE J0=76c ok *r ,44.-f�sookj ,�N�✓r aa.eiJG3t „�i�l�, ACORD 25 (2001/08) 1 of 3 #S535122/M535103 JZS © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 (2001/08) 2 of 3 #S535122/M535103 DESCRIPTIONS (Continued from Pagel), Insureds as their interest may appear as respects General Liability. Insurance is primary and non-contributory. AMS 25.3 (2001/08) 3 of 3 #S535122/M535103 Client#: 46343 NORSTI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DAT Y' 06/15/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: p 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 578 Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED Northstar Concrete, Inc. and Manhole Specialists, Inc. 1220 S. Garfield Avenue Loveland, CO 80537 INSURER A: Colorado Casualty Insurance INSURER B: Pinnacol Assurance INSURER C: INSURER D: INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE D M DD POLICY EXPIRATION ATE M Y LIMITS A GENERAL LIABILITY CBP8652302 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 000 CLAIMS MADE a OCCUR MED EXP (Any one person) $15 000 PERSONAL & ADV INJURY $1 000 000 X PD Ded:2,000 GENERAL AGGREGATE $1 OOO QQQ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO LOC JECT A AUTOMOBILE LIABILITY X ANY AUTO BA8653402 04/26/10 04/26/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ X Drive Other Car PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY CU8654602 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 X OCCUR CLAIMS MADE AGGREGATE $1 000 000 $ HDEDUCTIBLE _ $ X ..RETENTION $ 10000 B WORKERS COMPENSATION AND 4108060 07/01/10 07/01/11 C STATULJMIT.- I CFTH- X I TWOR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L. EACH ACCIDENT $5UU ODU E.L. DISEASE - EA EMPLOYEE $500 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Fort Collins 215 N. Mason, 2nd Floor Fort Collins, CO 80522 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -A0_ DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE A(;UHU 25 (2001/U8) 1 of 2 #S535121/M535103 JZS © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 (2001/08) 2 of 2 #S535121/M535103