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Home My WebLink About267431 NORTHSTAR CONCRETE - INSURANCE CERTIFICATE (2)Client#: 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 POLICY EFFECTIICY DATE MM/DD YVE IRAION POLDATE EXPMM/DDT/YY LIMITS A GENERAL LIABILITY CBP8652302 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDI PREMISES (E. ccurrencel $500 QQQ CLAIMS MADE ® OCCUR MED EXP (Any one person) $15 000 PERSONAL & ADV INJURY $1 00O 000 X PCDed:2,000 GENERAL AGGREGATE $2 QQQ QQQ RGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY PROECT LOC J 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) $ Drive Other Car M PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ I ANY AUTO F $ AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY CU8654602 04/26/10 04/26/11 EACH OCCURRENCE $1 000 000 X I OCCUR CLAIMS MADE AGGREGATE $1 000 000 $ DEDUCTIBLE $ X RETENTION $ 10000 B WORKERS COMPENSATION AND 4108060 07/01/09 07/01/10 X WC STATU- 0E, FL EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500 00O E.L. DISEASE - EA EMPLOYEE $500OOO OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500OOO 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) 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 J'tD0=RP(J9l MAIL R0_ ,DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,JpJ(X X AUTHORIZED REPRESENTATIVE AGORD 25 (2001/08) 1 of 3 #S524762/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 3 #S524762/M524744 DESCRIPTIONS (Continued from Page 1): Insureds as their interest may appear as respects General Liability. Insurance is primary and non-contributory. AMS 25.3 (2001/08) 3 of 3 #S524762/M524744 This page has been left blank intentionally.