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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (13)40? AC1" `../ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIV 9/16/2015 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 and Peterson PO Box 578 Greeley CO 80632 CONT CT Jennifer Winter, CISR NAMEA PHONE (970)506-3206 FAJC.XNql(970)506-6546 No F,fi ADDaess,JT'tinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:BITCO General Insurance Corp 20095 INSURED Northstar Concrete, Inc. 1220 S. Garfield Avenue Loveland CO 80537 INSURERB:Pinnacol Assurance 41190 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL1541602234 REVISION NUmetk: 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 I LTR TYPE OF INSURANCE A D UBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES Ea occurrence 3O0 000 $ r X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 A CLAIMS -MADE OCCUR L 33619581 /26/2015 4 /26/2016 PERSONAL $ADVINJURY $ 1,000,000 X PD Ded:1000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY X PRO LOC ECTAUOMOBILE TLIABILITY (Ea acccdentCOMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AP3619580 /26/2015 /26/2016 BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED X HIRED AUTOS N AUTOS PROPERTY DAMAGE Per accident $ $ X Drwe Other Car X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE CUP2807774 /26/2015 4/26/2016 DELI I X I RETENTION$ 10,00 $ B WORKERS COMPENSATION - X I WC STATU- OTHEEL E.L. EACH ACCIDENT $ 1,000,000 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE, $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) N /A 108060 /1/2014 /1/2015 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) IyaPJa -1� 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 Winter, CISR/JWINTE ACORD 25 (2010/05) V "19aa-LVT V AUmu �Umrvrva I lull. nu I lyuia ro'asn row. INSn25 mmnncl m Th. Ar non of Arnpn