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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (18)A� �� CERTIFICATE OF LIABILITY INSURANCE DATE 6/19/2015 ' 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 CONTACT Jennifer Winter CISR NAME: PHONE (970)506-3206 FAX (970)506-6846 fAIC,A/C No AIL ADDRESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERABITCO General Insurance Corp 20095 INSURED Northstar Concrete, Inc. 1220 S . Garfield Avenue Loveland CO 80537 INSURERB:Pinnacol Assurance 41190 INSURERC: INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:CL1561903753 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. INTR TYPE OF INSURANCE AN DR WV R NUMBER MM/DD/YYEYYY POLICY DD/YYVY LIMITS GENERAL LIABILITY -POLICY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR CLP3619581 4/26/2015 4/26/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X PD Ded: 1 , 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident if 00,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AP3619580 4/26/2015 4/26/2016 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS E AUTOS PROPERTY DAMAGE Per accident $ X Underinsuredmotonst $ 1,000,000 Drive Other Car X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,00C $ CUP2807774 4/26/2015 4/26/2016 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X WC STATU- OTH- E.L. EACH ACCIDENT $ 1 000,000 ANY PROP RI ETORIPARTNE R/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A /1/2015 /1/2016 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under �108060 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000�000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) %,r_K I IrIL A I t nULUtK UANUtLLA I IUN 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 J Winter, CISR/JWINTE ACORD 25 (2010105) INS095 oninnsi m ©1988-2010 ACORD CORPORATION. All rights reserved. Thn Arnon n— �nri Innn — rnnicfnrnrl mmrke of ACrwn