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HomeMy WebLinkAbout580557 NORTHSTAR DEMOLITION & REMEDIATION INC - INSURANCE CERTIFICATE (3)ACoRo® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F6/26/2017 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 endorsements . PRODUCER Alliant Insurance Services, Inc. 333 Earle Ovington Blvd. Suite 700 CONTNAME: Forward All Certificate Revision RegUests t0 PHONE , the Below E-Mall FAX IALQ No)" E-MAIL AD.RESS, NorthStarGroupServices@alliant.com INSURERS AFFORDING COVERAGE NAIC u Uniondale NY 11553 INSURERA:National Union Fire Ins Co Pittsbur 19445 INSURED INSURERB:American Guarantee and Liability In 26247 North Star Demolition and Remediation, Inc. INSURER C:Navi ators Insurance Company 42307 5150 Fox Street Denver, CO 80216 INSURER D:New Hampshire Insurance Company 23841 INSURER E:Zurich American Insurance Company 16535 INSURER F COVERAGES CERTIFICATE NUMBER: 1235770623 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 MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR Y Y GL7468697(AOS) GL 7468698 (NY) 7/1/2017 7/1/2017 7/1/2018 7/1/2018DAMAGE EACH OCCURRENCE $2,000,000 TO RENTED PREMISES Ea occurrence $300,000 X MED EXP (Any one person) $25,000 Contractual Liab X XCU included PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $4,000,000 POLICY 7 PE� F LOC PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: A A AUTOMOBILE LIABILITY ANY AUTO Y Y CA 3194561 CA 3194562 (MA) 7/1/2017 7/1/2017 7/1/2018 7/1/2018 Ea accident LIMITCOMBINED SINGLE $2,000,000 X BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) s HIRED AUTOS X NON -OWNED AUTOS X PROPERDAMAGE Per accidenTY t $ $ B C X UMBRELLA LIAB EXCESS LU1B X OCCUR CLAIMS -MADE Y Y SXS0195929-01 1S17EXC9032381V 7/1/2017 7/1/2017 7/1/2018 7/1/2018 EACH OCCURRENCE $25,000,000 X AGGREGATE $25,000,000 DED RETENTION $ $ D D D D D D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA y WC 014629471 (AOS) WC 014629472 (IL,KY,NC) WC 014629473 (NJ,PA) WC 014629474 (AZ,VA) WC 014629475 (CA) WC 014629476 (FL) 7/1/2017 7/1/2017 7/1/2017 7/1/2017 7/1/2017 7/1/2017 7/1/2018 7/1/2018 7/1/2018 7/1/2018 7/1/2018 7/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000.000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 D E Workers Compensation Prof/Pollction incl. Mcld/Fungus Y Y Y WC 014629477 (MA & MONO) PEC')194414-01 7/1/2017 7/1/;.017 7/1/2018 7/1/20111 WC Limit Statutory E.L. Limit 1,000,000 Ea Claim: $10,000,000 Agg: $15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 203 East Vine Drive, Fort Collins, CO 80524, Project No. 5517013 The City of Fort Collins, Its Officers, Agents and Employees are included as Additional Insureds on a Primary and Non -Contributory basis as respects General Liability, Automobile Liability, and Umbrella Liability as required by written contract. Waiver of Subrogation is included and applies in favor of the Additional Insureds as required by written contract. CERTIFICATE HOLDER GANGELLAI ION oU Uays INOtice OT t-anceuatlon City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD