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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (8)NORSTI Client#: 46343 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE""""') F 04/15/2013 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 CONTACT Jennifer Winter NAME: PHONE FAX A/C No En : 970 SO6-3206 uc, No : 970 506-6846 AoonESB: JWinter@floodpeterson.com Greeley, CO 80632 970 356-0123 1 CUSTOMER ID e: INSURERS) AFFORDING COVERAGE NAIC If INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER A: Bituminous Insurance INSURER B: Pinnacol Assurance Loveland, CO 80537 INSURER C INSURER 0: 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 2113- DDL D POLICY NUMBER MMODNYY Y EFF MWDDLICYNYP LIMITS A GENERAL LIABILITY IA X COMMERCIAL GENERAL ABILITY CLAIMS -MADE 51OCCUR X PDDed:1,000 CLP3586389 4/26/2013 04/26/2014 EACH OCCURRENCE $1000000 PREM SES Ea occu rD ence $300 000 MED EXP (Any one person) S10,000 PERSONAL $ADVINJURY $1000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOG PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOSBODILY SCHEDULED AUTOS HIRED AUTOS Drive Other Car I CAP3586390 I 4/26/2013 04/26/2014 COMBINED SINGLE LIMIT (Ea accident) $1000000 BODILY INJURY(Per person) $ INJURY (Peraccitlenl) $ 1XXX PROPERTY DAMAGE (Peramden1)NON-OWNEDAUTOS $ $ A WX UMBRELLA LIAB EXCESS LIAB X OCCUR CIAIMS-MADE CUP2802440 4/26/2013 04/26/201 EACH OCCURRENCE $1 000 000 AGGREGATE $1 000 000 RETENTION 10000 $ HDEDUCTIBLE X $ B WORKERS COMPENSATION AND EMPLOYERS' LIASILT' ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4108060 7/01/2012 07/01/2013 X WC STATU- OTH- E.L.IN EACH ACCIDENT $1000000 E.L. DISEASE- EA EMPLOYEEI S1 1000000 E.L. DISEASE -POLICY LIMIT 1 $1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remedies 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 ACORD 25 (2009/09) 1 Off #S778132/M778117 m 1988-2009 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(MMIOD/YYYY) F 04/15/2013 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 CONTACT NAME: Jennifer Winter PNONE 970 506-3206 FAX, A/C No Ext : No):970 506-6846 noORess: J Greeley, CO 80632 970 356-0123 PRODUCER CUSTOMER ID a: INSURER(S) AFFORDING COVERAGE NAIC0 INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER A: Bituminous Insurance INSURERS: Pinnecol 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 TYPE OF INSURANCE DDL UBRI POLICY NUMBER MOLIICY EFF MM/ODNYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PD Ded:1,000 CLP3586389 4/26/2013 04/26/2014 EACH OCCURRENCE $1 00O 000 DAMAGE RENTED PREMISES Ea occu ence $30O 000 MED EXP(Any one person) $10,000 PERSONAL d ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PER: "0- F LOC PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTOS Other Car CAP3586390 4/26/2013 04/26/2014 COMBINED SINGLE LIMIT (Ea accident) $1 OOOOOO BODILY INJURY (Per person) $ BODILY INJURY (Peracaaent) $ 1XXXDrive PROPERTY DAMAGE FeraccidenQNON-OWNED $ $ A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE CUP2802440 4/26/2013 04/26/201 EACH OCCURRENCE $1 00O O00 AGGREGATE $1,000,000 HDEDUCTIBLE RETENTION 10000 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOWPARTNEWEXECUTIVEY OFFICEWMEMBER EXCLUDED? (Mandatory in NH) If yesfdeeorbe under DESCRIPTION OF OPERATIONS below NIA 4108060 7/01/2012 07/01/2013 X `NCSTATU- OTH- E.L. EACH ACCIDENT $1000000 E.L. DISEASE EA EMPLOYEE $1,000,000 E.L. DISEASE POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K mare apace 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 I 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 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S778133/M778117 JZS