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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (14)AFRO® CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) 06/27/2019 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 have ADDITIONAL INSURED provisions or 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, CISR NAME: Flood and Peterson PHONN Ex - (970) 506-3206 IX No ; (970) 506-6846 E-MAIL JWinter@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Acadia Insurance Company 31325 Greeley CO 80632 INSURED INSURER B : Pinnacol Assurance 41190 INSURER C : Northstar Concrete, Inc. INSURER D : 1220 S. Garfield Avenue INSURER E : INSURER F : Loveland CO 80537 COVERAGES CERTIFICATE NUMBER: CL1962730074 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 MAYBE 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. INLICY TR R TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDNYYY EXP MM IDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7 OCCUR DAMAGE N PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded:1,000 PERSONAL& ADV INJURY $ 1,000,000 A CPA316575423 07/01/2019 07/01/2020 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COBINED SINGLE LIMIT Ea Maccident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CPA316575423 07/01/2019 07/01/2020 BODILY INJURY (Per accident) $ X /� PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY H AUTOS ONLY X $ DOC X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE CPA316575423 07/01/2019 07/01/2020 DEO I X1 RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE (MandatoryIn NH)R EXCLUDED? (Mandatoryin BEE.L. NIA 4108060 07/01/2019 07/01/2020 /� STATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS b3iu,a E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 2019 Fort Collins Misc. Concrete City of Fort Collins is listed as an Additional Insured as respects General Liability, including completed operations, and Auto Liability. Insurance is primary and non-contributory. UhKI II-IUAI t r1ULL&K City of Fort Collins PO Box 580 Fort Collins CO 80522 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. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD