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HomeMy WebLinkAbout580557 NORTHSTAR DEMOLITION & REMEDIATION INC - INSURANCE CERTIFICATEACYOR'L> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/15/2018 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 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 NAME: Forward All Certificate Revision Requests to Alliant Insurance Services, Inc. PHONENo, the Below E-Mail FAX No 333 Earle Ovington Blvd. E-MAILtIVC, ADDRESS: NorthStarGroupServices@alliant.com Suite 700 INSURER(S) AFFORDING COVERAGE NAIC0 Uniondale NY 11553 INSURER A: National Union Fire Insurance Company of Pittsburg19445 INSURED INSURER B : American Guarantee and Liability Insurance 26247 North Star Demolition and Remediation, Inc. 5150 Fox Street INSURERC: Navigators Insurance company 42307 INSURER D: New Hampshire Insurance Company 23841 Denver, CO 80216 INSURER E: Zurich American Insurance Company 16535 INSURER F : COVERAGES CERTIFICATE NUMBER: 303144078 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. INSEFF LTR R TYPE OF INSURANCE IN52 SWVD UER POLICY NUMBER MM DIDY/YYYY MMLDDIYYYY LIMITS A A X COMMERCIAL GENERAL LIABILITY �X� � CLAIMS -MADE OCCUR Y Y GL 7468697 (AOS) GL 7468698 (NY) 7/12018 7/12018 7/12019 7/1/2019 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $300,000 X MED EXP (Any one person) Contractual Liab $ 25,000 X XCU included PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY r PROJ CT LOC PRODUCTS -COMP/OP AGG $ 4,000,000 $ OTHER A A AUTOMOBILE LIABILITY Y Y CA 3194561 CA 3194562 (MA) 7/1/2018 7/1/2018 7/1/2019 7/1/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X HIRED AUTOS X NON -OWNED AUTOS $ B C X UMBRELLA LIAB X OCCUR Y Y SXS 0195929-02 IS18EXC9032381V 7/1/2018 7/1/2018 7/1/2019 7/12019 EACH OCCURRENCE $ 25,000,000 - --- AGGREGATE X EXCESS LIAB CLAIMS -MADE $25.000,000 DED 1 1 RETENTION $ I $ p D D D D D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Y I WC 014629471 (AOS) WC 014629472 (IL,VT,NC) WC 014629473 (NJ, PA) WC 014629474 (AZYA) WC 014629475 (CA) WC 014629476 (FL) I 7/12018 7/12018 7/12018 7/12018 7/12018 7112018 7/1/2019 7/1/2019 7/1/2019 7/1/2019 7/1/2019 7/1/2019 H X 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 D Workers Compensation Y WC 014629477 (MA & MONO) 7/1/2018 7/1/2019 WC Limit Statutory E Prof/Pollution Incl. Mold/Fungus Y Y PF-C 0194414 02 7/1/2018 7/1/2019 E.L. Limit 1,000,000 Ea Claim: $10.000,000 Agg: $15,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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. CERTIFICA I E HULULK CANGELLA I IUN 3U UaVS NOUce OT t ancellation 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