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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE - INSURANCE CERTIFICATE (5)/ A`C40R " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6/22/2017 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 CONTACT NAME: Jennifer Winter CISR PHONE (970) 506-3206 A/C No: (970)506-6846 PO Box 578 ADDRESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERA.Union Insurance Company 25844 Greeley CO 80632 INSURED INSURER B :Pinnacol Assurance 41190 INSURERC: Northstar Concrete, Inc. INSURER D : 1220 S . Garfield Avenue INSURER E : INSURER F : Loveland CO 80537 COVERAGES CERTIFICATE NUMBER:CL1762218371 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. I LTR LTR TYPE OF INSURANCE A DL WVD UB POLICY NUMBER MMIDDIYYYY LICY EXP MM IDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrenceI $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded: 1 , 000 CPA316575420 4/26/2017 4/26/2018 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY II PE� 11 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 , 000 , 000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPA316575420 4/26/2017 4/26/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS $ X Drive Other Car X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAR CLAIMS -MADE DED I X RETENTION$ 0 $ CPA316575420 4/26/2017 4/26/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MB (Mandatory in ER EXCLUDED? (Mandatory in NH) NIA A 4108060 7/1/2017 7/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L DISEASE - POLICY LIMIT 1 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GERTIFIGAIt HULUtK I+AN`IrLLAIIUIV 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 (2014/01) INS025 ont4nn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A/CORO® 1r/ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 6/222017 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 Box 578 Greeley CO 80632 CONTACT Jennifer Winter CISR NAME: PHONE t (970) 506-3206 A(AIXNo: (970)506-6846 N ExPO ADMDRIESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Union Insurance Company 25844 INSURED Northstar Concrete, Inc. 1220 S . Garfield Avenue Loveland CO 80537 INSURER B :Pinnacol Assurance 41190 INSURERC: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:CL1762218371 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 ADDL JUM VDBR� POLICY NUMBER EFF MMIDDNYYY DDPOLICY EXP POLICY /YYYY MM/ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR -PREMISES SET Ea OccurrGE ence $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded: 1, 000 CPA316575420 4/26/2017 4/26/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY II JECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COEaMBINED ccidentSINGLE LIMIT a $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPA316575420 4/26/2017 4/26/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS $ X Drive Other Car X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 $ CPA316575420 4/26/2017 4/26/2018 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NI (Mandatory in NH) N/A 4108060 7/1/2017 7/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 H yes, describe under DESCRIPTION OF OPERATIONS below 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: 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. [y:13111IJ y_\1:9:Lei ,1ab City of Fort Collins PO Box 580 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 (2014/01) INS025 onl4nn ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/22/2017 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 CONTACT Jennifer Winter CISR NAME: Flood and Peterson ACNE (970)506-3206 A/C No:(970)506-6846 IN Extl; ADDRESS:JWinter@floodpeterson.com PO Box 578 INSURERS AFFORDING COVERAGE NAIC # INSURERA:Union Insurance Company 25844 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:CL1762218371 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 D B POLICY NUMBER MM DPOL'CDIYYYY MM/L D/ICYYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGET RENTED PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded.1 , 000 CPA316575420 4/26/2017 4/26/2018 PERSONAL R ACV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY II PE T a LOC PRODUCTS - COMP/OP AGG $ 2,000,000 L $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPA316575420 4/26/2017 4/26/2018 F BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NO OWNED X HIRED AUTOS X AUTOS $ X Drive Other Car X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 1 $ CPA316575420 4/26/2017 4/26/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MB (Mandatory in H) EXCLUDED? (Mandatory in NH) N/A 4108060 7/1/2017 7/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 if yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Concrete Maintenance Project, Phase II; 2016 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. l+tK 111-II.A I r HULUrK I,NIYI GLLF1 I Kill jstephen@fcgov.com City of Fort Collins PO Box 580 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 (2014/01) INS0251901401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD