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HomeMy WebLinkAbout267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (21)� ACORO►� CERTIFICATE OF LIABILITY INSURANCE �...�' DATE (MM1DD/YYYY) 06/21 /2018 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 HONE AICC, Ext : (970) 506-3206 AlC, No ; (970) 506-6846 PO Box 578 E-MAIL JWinter@floodpeterson.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: Union Insurance Company 25844 Greeley CO 80632 INSURED INSURERB: PlnnacolAssurance 41190 INSURER C : Northstar Concrete, Inc. INSURER D : 1220 S. Garfield Avenue INSURER E : INSURER F : Loveland CO 80537 COVERAGES CERTIFICATE NUMBER: CL1862123940 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDYYYY MMIDD YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE o OCCUR DAMAGE TO RENTE7_ PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded:1,000 PERSONAL BADVINJURY $ 1,000,000 A CPA316575422 07/01/2018 07/01/2019 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER. AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT (Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CPA316575422 07/01/2018 07/01/2019 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 CPA316575422 07/01/2018 07/01/2019 DED I X1 RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PRO FRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? tMandatory in NH) NIA 4108060 07/01/2018 07/01/2019 X PER STATUTE ERH E.L.EACH ACCIDENT _ $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 L` 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 li; 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. UtK I H-IUA I t MULUtK 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD