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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (22)ACOROCERTIFICATE OF LIABILITY INSURANCE DATE/DD/YYYY) 0612/21 1 /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 PHONE (g70} 506-3206 FAX (970) 506-6846 AIC No Ext : FAXNo): PO Box 578 E-MAIL JWinter@floodpeterson.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURERA: Union Insurance Company 25844 INSURED INSURER B : Plnnacol Assurance 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 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO RENTET_ PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 PD Ded:1,000 BADVINJURY $ 1,000,000 A CPA316575422 07/01/2018 07/01/2019 GEN'LAGGREGATE LIMIT APPLIES PER: -PERSONAL GENERAL AGGREGATE $ 2,000,000 POLICY PRO ElLOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY CPA316575422 07/01/2018 07/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ 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 $ 01 1 $ 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4108060 07/01/2018 07/01/2019 PER X STATUTE ERH 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 I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Concrete Maintenance Project, Phase 11; 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. LA IV U CLLAI IUIII 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 Oc 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD