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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (23)ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) o'127/z018 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 (970) 506-3206 FAX (970) 506-6846 AIC No Ext : AIC, No E-MAIL JWinter@floodpeterson.com ADDRESS: PO Box 578 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Union Insurance Company 25844 Greeley CO 80632 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: CL1842723059 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 INSD SU13R WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR PDDedA,000 CPA316575421 04/26/2018 07/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT Er5- PREMISES(Ea occurrence $ 300,000 X ME D EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY I PRO � LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 J A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED H NON -OWNED AUTOS ONLY AUTOS ONLY X DOC CPA316575421 04/26/2018 07/01/2018 COMBINED SINGLE LIMIT Ea accident s 1,000,000 BODILY I NJ URY (Per person) $ BODILY INJURY (Per accident) $ PPReOPPEcRdTnDAMAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS MADE CPA316575421 04/26/2018 07/01/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I X1 RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY CPRO PR I ERIMEMB RlPARTNER/E?ECUTIVE OFFICER/MEMBER EXCLUDED. (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4108060 07/01/2017 07/01/2018 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ 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. rGaTIGIreTF unl nPR CANCELLATION 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 (9 1938-2015 ACORD GURPURAI IUN. All rights reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD