HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (15)ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
-.
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
PHONE (970) 506-3206 FAX (970) 506-6846
C N Ex A/C No
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 :
INSURERF:
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 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 INSURANCEADDLSUBR
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE ❑X OCCUR
A A
PREMISES Ea occurrence
300'000
$
X
MED EXP (Any one person)
$ 10,000
PD Ded:1,000
PERSONAL SADVINJURY
$ 1,000,000
A
CPA316575423
07/01/2019
07/01/2020
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ig PRO
JECT LOC
PRODUCTS
2,000,000
$
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
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 /� AUTOS ONLY
X
$
DOC
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESSLIIAB
CLAIMS -MADE
CPA316575423
07/01/2019
07/01/2020
X
DED RETENTION $ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? �
(Mandatory In NH)
NIA
4108060
07/01/2019
07/01/2020
PER OTH-
X STATUTE I ER
E.L. EACH ACCIDENT
$ 1,000, 000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000.000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
RE: Concrete Maintenance Project, Phase II; 2017 Renewal No. 7509
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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins CO 80522
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD