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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (5)Client#: 46343 NORST1 ACORD.. CERTIFICATE OF LIABILITY INSURANCE F Do4„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 970 356-0123 NAME: Jennifer Winter PHONE FAX ucNo. Ell: 970S06-3206 uc,No:970506-6846 ADDRESS: Jennifer.Winter@floodandpeterson.com VHUUUUEK CUSTOMER ID N: INSURERS) AFFORDING COVERAGE NAIC# INSURED Northstar Concrete, Inc. W� 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. IN R LTH TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICV EFF MM/DD/VVYY POLICY E%P MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X PDDed:1,000 4TCO7858X707COF1 4/26/2012 04/26/2013 EACH OCCURRENCE S7 OOOOOO DAMAGE TO RENTED PREMISES Ea occurrence) S300 OOO MED EXP (Anyone person) $10,000 PERSONAL& ADV INJURY SIOO0000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POUCV X PRO- n LOG PRODUCTS - COMP/OP AGO $2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70712CNS 104/26/2012 04/26/2012 1 o BINEDlSINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4TSMCUP7858X707T b4/26/2012 04/26/201 EACH OCCURRENCE $1 OOO OOO AGGREGATE $1,000,000 HX DEDUCTIBLE RETENTION S 10000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORJPARTNER/EXECUTIVE —1 OFFICEWMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below WA 4108060 07/01/2011 07/01/201 X WC STATU 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 (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins 215 N. Mason, 2nd Floor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZZE�EDD, REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 Oft The ACORD name and logo are registered marks of ACORD #S689439/M689426 JZS