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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (6)Client#: 46343 NORSTI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) F O6/22/2012 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 CONTACTJennifer Winter NAME: Flood & Peterson Ins., Inc. PNONE FAX A/c Na E,t : 970 506-3206 Arc, Na : 970 506-6846 P. O. Box 578 AIL ADDRESS: Jennifer.Winter@floodandpeterson.com Greeley, CO 80632 970 356-0123 CUSTOMER ID N: INSURER(S) AFFORDING COVERAGE NAIC N INSURED INSURER A: Travelers Insurance Company NorthstInc. Conc INSURER B: Pinnacol Assurance 1220 S. Garfield Avenue 1220S.ar Garfield Avenue 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. INS- TYPE OF INSURANCE % DDL UBR POLICY NUMBER MWDONCY YYY) POLICY EXP MM/DDNYYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7X OCCUR X PD Ded:1,000 4TC07858X707COF12 4/26/2012 04126/2013 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMISES (Ea occurrence) $300000 MED EXP (Any one person) $10000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO F7 LOC PRODUCTS - COMP/OP AGO $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car BA7858X70712CNS 4/26/2012 04126/2013 COMBINED SINGLE LIMIT (Ea accitlent) $100D000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 1XXX PROPERTY DAMAGE (Per accident)$ $ S A X UMBRELLA LIAB EXCESS LIAB X OC CUR GlAIM3-MADE 4TSMCUP7858X707TIL 4/26/201204/26/201 EACH OCCURRENCE $1000000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION $ 10000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Mandatory In Ni If yes, describe under DE Ins,OF OPERATIONS below WA 4108060 7/01/2012 07/01/201 X WCSTATU- OTH- ITS HE EL. EACH ACCIDENT S1000000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, & more spatt 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 AUTHOORIIZZEjD. R�E�PRRESE,,NTA••TIVE Qe4w _ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 D( 1 The ACORD name and logo are registered marks of ACORD #S708383/M708370 JZS Client#: 46343 NORSTI ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE""" 06/22/2012 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 970356-0123 CONTACTJennifer Winter NAME: PHONE g70 506-3206 970 506-6646 WC No Ext: A/C, No ADDRESS: Jennifer.Winter@floodandpeterson.com PRODUCER CUSTOMER ID A: INSURER(S) AFFORDING COVERAGE NAIC0 INSURED INSURER A; Travelers Insurance Company Northstar Concrete, Inc. 1220 S. Garfield Avenue 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. INSR LIEL TYPE OF INSURANCE kDDLSUBR POLICY NUMBER LICY SEE PMM/DD/YYYY POLICY EXP MMIDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PD Ded:1,000 4TC07858X707COF12 4/26/2012 04/26/2012 EACH OCCURRENCE $1000000 DAMAGE TO ET Eeoccu ante $300000 MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2 000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PER: PRO LOC PRODUCTS - COMP/OP ADD $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car I BA7858X70712CNS 4/26/2012 04/26/2012 CO BINEDt)SINGLE LIMIT (EdBODILY $1,000,000 X INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB J( EXCESS LIAB OCCUR CLAIMS MADE 4TSMCUP7858X707TIL 4/26/2012 04126/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1 o0O 000 DEDUCTIBLE RETENTION S 10000 $ X S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYFR ANY PROPR ETORIPARTNERUEXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) It yes, tlesonba under DEii SCRIPTION OF OPERATIONS below N/A 4108060 7/01/2012 07/01/201 X WC STATU- orH- E. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1,000,000 EL. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N 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 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD ec�naaR_ M708370 JZS