The URL can be used to link to this page

Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (4)Client#: 46343 NORSTI ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE"""' O6/17/2011 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 Greeley, CO 80632 970 356-0123 CONTACT NAME: Jennifer Winter PnoNENo Es970 266-7127 970 506-6846 A/C l : A/C, No AODREBB Jennifer.Winter@fpinsurance.com CUSTOMER ID It: INSURER(S) AFFORDING COVERAGE NAIC s INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER A: Travelers Insurance Company 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. LUL TYPE OF INSURANCE POLICY NUMBER MWODNY MM/DONY)' LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABIDTY CLAIMS -MADE 51 OCCUR X PD Ded:1,000 4TC07858X707COF11 4/26/2011 04/26/201 EACH OCCURRENCE $1 000 000 DAMAGE TO PREMISES (Ed occurrence) $300000 MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F X PRO- LOC PRODUCTS-COMP/OP AGO s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70711 CNS 4/26/2011 04/26/2012 COMBINED SINGLE LIMIT (Ed accident) $1000000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X X $ $ A X UMBRELLA LIAR EXCESS LIAR 1( OCCUR CLAIMS -MADE 4TSMCUP7858X707TIL 4/26/2011 04/26/201 EACH OCCURRENCE $1 000000 AGGREGATE $1000000 DEDUCTIBLE RETENTION 10000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYEB ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Us, describe under SCRIPTION OF OPERATIONS below N/A 4108060 7/01/201, 07/01/201 X WCSTATU�OTH- E.L. EACH ACCIDENT $1,000000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASEPOLICYLIMIT $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space 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 F/6ca T 04:4JS0.J INf✓rm_Ai ,T/)L. ACORD 25 (2009/09) 1 of 1 #S623060/M623047 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS Client#: 46343 NORSTI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) O6/17/2011 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 CONTACT Jennifer Winter NAME: Flood III Peterson Ins., Inc. PHONE 970 266-7127 FAX A/c No Er : uc, No): 970 506-6846 El P. O. BOX 578 ADDRESS: Greeley, CO 80632 970 356-0123 CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAICa INSURED INSURER A. Travelers Insurance Company Northstar Concrete, Inc. Pinnacol Assurance 1220 S. Garfield Avenue INSURER a: 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N TYPE OF INSURANCE POLICY NUMBER MWDDNY FF MMDDDNYY LIMIT A GENERAL LIABILITY X COMMERCIAL GENERAL UABIUTY CLAIMS -MADE a OCCUR X PDDed:1,000 4TC07858X707COF11 4/26/2011 04/26/201 EACH OCCURRENCE W DAMA ET RENTED PREMISES Ea o p. r.rce MED EXP (Any one person) PERSONAL&ADVINJURY GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- ,JECTLOG PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70711CNS 4/26/2011 04/26/201 EeaBINEDSINGLELIMIT nt)$1000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 1XXX PROPERTY DAMAGE (Per accident) $ S $ A X UMBRELLA LIAB EXCESS LIA a i X OCCUR CLAIMS MADE 4TSMCUP7858X707TIL 4/26/2011 04/26/2012 EACH OCCURRENCE $1000000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETORIPARTNEP/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It Yap. describe nder DESCRIPTION OF OPERATIONS below WA 4108060 7/01/2011 07/01/201 X We sTAru- oTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT .$1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarlu Schedule, H more apace Is required) RE: 2011 Renewal of 6088 Concrete Maintenance Project - Phase II The City of Fort Collins, and any other entities as required, their respective officers and employees, are (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 F/000t ► O<.felso.IJ srNr.ira w7u , LLee. ACORD 25 (2009109) 1 of 2 #S623061/M623047 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS