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Home My WebLink About267431 NORTHSTAR CONCRETE INC - INSURANCE CERTIFICATE (25)/ A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/24/2017 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 endorsement(s). PRODUCER Flood and Peterson PO Box 578 Greeley CO 80632 CONTACT Jennifer Winter CISR NAME: FA PHONE (970) 506-3206 A/C No: (970)506-6846 ADDRESS:JWinter@floodpeterson.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Union Insurance Company 25844 INSURED NOrthstar Concrete, Inc. 1220 S. Garfield Avenue Loveland CO 80537 INSURER B :Pinnacol Assurance 41190 INSURER C : INSURERD: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER:CL1742417331 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 ADDL TYPE OF INSURANCE SUBR fflaPOLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADEEX-1OCCUR A AGE TO PREM SES Ea occu a nte $ 300,000 X MED EXP (Anyone person) $ 10,000 PD Ded: 1 , 000 CPA316575420 4/26/2017 4/26/2018 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT 17, LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadent $ 1,000,000 BODILY INJURY (Per person) $ `a' X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS CPA316575420 4/26/2017 4/26/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ X Drive Other Car X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 $ CPA316575420 4/26/2017 4/26/2018 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑Y (Mandatory in NH) N / A 4108060 7/1/2016 7/1/2017 X PER OTH- 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 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I 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. L;LK I It IL:A I t HVLUtK %1A114l1GLL A 11VIV jstephen@fcgov.com 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 J winter, CISR/JWINTE ACORD 25 (2014/01) INS025 i nl4nn U 1988-ZU14 AGUKU UUKPUKA I IUN. All rlgnLs reserVea. The ACORD name and logo are registered marks of ACORD