The URL can be used to link to this page

Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (3)Client#: 46343 NORSTI ACORD,. CERTIFICATE OF LIABILITY INSURANCE F Da4„o,2o;2YY) 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 NAME: Jennifer Winter PHONE 970 506-3206 FAx 970 506-6846 INC.No Est : AIC, No AIL ADDRESS: Jennifer.Winter@floodandpeterson.com 970 356-0123 )Aii CUSTOMER ID Jr: INSURERS) AFFORDING COVERAGE NAIC Is INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER A: Travelers Insurance Company INSURER e: 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. LTINSR OF INSURANCE kDDTYPE SR D POLICY NUMBER PMM/DDIYYYYCY EXP OLICD/VYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F__x1 OCCUR X PD Ded:1,000 4TC07858X707COF1 104/26/2012 04/26/201 EACH OCCURRENCE $1 OOOOOO DAMAGE TO RENTED PREMISES Ea occurrence) $300000 MED EXP (Any one person) $10,000 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATELIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70712CNS �04/26/2012 04121 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) IS PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAR EXCESS ICLAIMS-MADE X OCCUR 4TSMCUP785BX707T 04/26/2012 04/26/2010 EACH OCCURRENCE $1 OOO 000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION 10000 $ X a B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORJPARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under 0 SCRIPrION OF OPERATIONS below WA 4108060 7/01/2011 07/01/2012 X WCSTATU- DTH- FIR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT 191.000.000 DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 2012 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 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 .