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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (12)Client#: 46343 NORSTI ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATEIYYYV) 106/211201I2014 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 g70 506-3206 FAX 970 506-6846 AIC No Ert : A/C, No E-MAIL ADDRESS: JWinter floodP eterson.com Greeley, CO 80632 INSU0.Ef(5)AFFORDING COVERAGE NAICO 970 356-0123 INSURER A: Bituminous Casualty Corporation 20095 INSURED - Northstar Concrete, Inc. 1220 S. Garfield Avenue INSURER B: Pinnacol Assurance 41190 NSURER C Loveland, CO 80537 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 LTR TYPE OF INSURANCE ADOLSUB INSR MD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MWDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51OCCUR X PD Ded:1000 CLP3603459 041261201404/261201 EACH $1000000 ��OCCURRENCE PREMISES(EaENTED o=mence) s3000OO MED EXP (Any one person) $10 000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMPX)P AGG s2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS XI X HIRED AUTOS X NONNED IX rive Oth Car CAP3603460 4/2612014 0412612015 COaccident)MBINED SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILYBODILY INJURY (Peramdem) $ PROPERTY DAMAGE Per accident $ $ A )( UMBRELLA LIAS EXCESS LIAB X OCCUR CLAIMS -MADE CUP2804943 4/26/2014 0412612015 EACH OCCURRENCE $1 000 000 AGGREGATE $1000000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) If yes, descnEe under DESCRIPTION OF OPERATIONS below NIA 4108060 D710112014 07/01/201 X WCSTATU- OTH- ER E.L. EACH ACCIDENT $1 00O 000 E. L. DISEASE - EA EMPLOYEE $1 000000 E. L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Cityof Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason, 2nd Floor ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S901774/M901770 JZS