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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (10)Client#: 46343 NORSTI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYY) 04/22/2014 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 CONTACT Jennifer Winter Flood & Peterson Ins., Inc. acNNla Eat: 970 506 3206 MC No: 970 506.6846 P. O. Box 578 ADDRESS: JWinter@floodpeterson.com Greeley, CO 80632 IN3URER(3) AFFORDING COVERAGE NAICA 970 356.0123 Bituminous Casualtv Corporation 120095 INSURED INSURER B: Pinnacol Assurance 41190 Northstar Concrete, Inc. �� rr �? 1220 S. Garfield Avenue I J INSURERC: INSURER D : Loveland, CO 80537 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 CONTRACTOR 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. INSLM LTR TYPE OF INSURANCE AODL UB P01-ICY NUMBER MM/ODY EFF MMNDY P DMRS A GENERAL LIABILITY X COMMERCIAL GENERALUABILrrY CLAIMS -MADE O OCCUR X PD Ded:1,000 CLP3603459 4/26/2014 04126/2011 $1 0000 DEgACCHA�OEC7CURRENCE PREMISES ao rence $300000 MED EXP Wy one person) $10 000 PERSONAL $ ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS-COMP/OP AGO s2000000 S A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON-0WNED AUTOS X rive Oth Car CAP3603460 6/2014 04/26/201 COccdiml) GLE LIMIT 1,000,000 BODILY INJURY (Per Person) S cid BODILY INJURY (Per accident) $ PROPERTY AMAGE Per acddant $ $ A X UMBRELLA LAB EXCESS DAB X OCCUR CLAIMS -MADE CUP2804943 I 4/2612014 0412612015 EACHOCCURRENCE $1000000 AGGREGATE $1 OOO 000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) K ym describe under DESCRIPTION OF OPERATIONS below NIA 4108060 7/01/2013 07/0112014 X WC STATU- OTH- ER E.L. EACH ACCIDENT $1 OOO 000 E.L. DISEASE -EA EMPLOYEE $1 00p 000 E.L. DISEASE - POLICY LIMIT $1,000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allach ACORD 101, Additional Remarks Schedule, If more spaw 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 (2010105) 1 Of 1 #S881860/M881857 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JZS