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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (9)Client#: 46343 NORSTI ACORDTn CERTIFICATE OF LIABILITY INSURANCE DYY) 06/19/2013 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 Greeley, CO 80632 970 356-0123 I t NAMEJennifer Winter : PHONE 970 506-3206 FAX 970 506-6846 A/C No Ext : A/C, No ADDRESS: JWinter@floodpeterson.com PRODUCER CUSTOMER to INSURER(S) AFFORDING COVERAGE NAIC If INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURERA: Bituminous Insurance INSURER BPinnacol 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. R LM/DDNYYV TYPE OF INSURANCE SR D POLICY NUMBER POLICY MM/DD/YYYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PD Ded:1,000 CLP3586389 4/26/2013 04/26/201 EACH OCCURRENCE $1,000,000 PREM SS E Eaocowence $300000 MED EXP(Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY X LIMITAPPLIES PER: PRO -LOG PRODUCTS - COMP/OP ADD $2,000,000 $ A AUTOMOBILE LIABILITY ANVAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Other Car CAP3586390 4/26/2013 04/26/2014 COBINEDt)SINGLE LIMIT $1 DDD DDD BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ I!Drive PROPERTY DAMAGE (Per accitlent)$ $ $ A - X UMBRELLA LIAR EXCESS UAB X OCCU CLAIMSR -MADE CiUP280244D 4/26/2013 04/26/201 EACH OCCURRENCE $1 00D 000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION IS 10000 $ X Is WORKERS COMPENSATION AND EMPLOYERS' LIABILITYLIMITS YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) I es, describe under DESCRIPTION OF OPERATIONS below N/A 4108060 7/01/2013 07/01/201 X WC $TATU- OTH- TORYB E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it 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 AUTHORIZED REPRESENTATIVE @1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 oil The ACORD name and logo are registered marks of ACORD #S796817/M796723 JZS Cliantff: 46343 NORSTI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) O6/19/2013 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 Greeley, CO 80632 970356-0123 CONTACT Jennifer Winter NAME: F Arc No El : 970 506-3206 Arc, No : 970 506-6846 AODREss: JWinter@floodpeterson.com ES PRODUCER CUSTOMER ID #; INSURER(S) AFFORDING COVERAGE NAIC# INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER A: Bituminous Insurance INSURERS: 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 LILL TYPE OF INSURANCE ODL UBRI POLICY NUMBER POLICY EFF MWDWYYY POLICY P MWDDIY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY TCI NIMS-MADE 51OCCUR X PD Ded:1,000 CLP3586389 4/26/2013 04/26/2014 EACH OCCURRENCE S7 OOO OOO PREMISES Ea occurrence) s3000OO MED EXP (Anyone person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATELIMIT APPLIESPER: POLICY X PRO- n LOC PRODUCTS-COMP/OP AGO $2000000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car I CAP3586390 4/26/2013 04/26/2014 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per ercio nt) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAR LIAB X OCCUR CLAIMS -MADE CUP2802440 4/26/2013 04/26/201 EACH OCCURRENCE $1 000000CESS AGGREGATE $1 000 000 4XEX DEDUCTIBLE RETENTION 10000 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY f N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, descnbe under OESCRIPTION OF OPERATIONS below WA 4108060 7/01/2013 07/01/201 X srnZ' OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H 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 ACORD 25 (2009/09) 1 of 2 #S796818/M796723 IV4..,,4cs /__ @1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS