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HomeMy WebLinkAbout580557 NORTHSTAR DEMOLITION & REMEDIATION INC - INSURANCE CERTIFICATE (2)ACoR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/Y(YY) 2/15/2017 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 endorsements . PRODUCER Alliant Insurance Services, Inc. 333 Earle Ovington Blvd. Suite 700 CONTACT NAME: Forward All Certificate Revision Requests to PHONE the Below E-Mail FAX �" E-MAIL . NorthStarGroupServices@alliant.com INSURE S AFFORDING COVERAGE NAIC# Uniondale NY 11553 INSURER A: National Union Fire Ins Co Pittsbur 19445 INSURED INSURERB:NEW HAMPSHIRE INS CO 23841 NorthStar Demolition and Remediation, Inc. INSURERC:ZURICH AMERICAN INS CO 16535 5150 Fox Street Denver, CO 80216 INSURERD:American Guarantee & Liability 26247 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER. 805663488 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I� OCCUR Y Y GL 5388321 (AOS) GL 5388322 (NY) 7/1/2016 7/1/2016 7/1/2017 7/1/2017 EACH OCCURRENCE $2,000,000 $300,000 _ DAMAGE TO RENTED PREMISES Ea occurrence X MED EXP (Any one person) $25,000 Contractual Liab X XCU included PERSONAL & ADV INJURY $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY XI JE C LOC PRODUCTS - COMP/OP AGG _ $4,000,000 OTHER: $ A A AUTOMOBILE LIABILITY X ANY AUTO Y Y CA 5101686 CA 5101687 (MA) 7/1/2016 7/1/2016 7/1/2017 7/1/2017 COMM=INGLE LIMIT Ea accident $ 2,000,D00 BODILY INJURY (Per person) $ AUTOWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ D A X UMBRELLA LIAB CCUR Y Y SXS0195929-00 4840279 7/1/2016 7/1/2016 7/1/2017 7/1/2017 EACH OCCURRENCE $25,000.000 70— AGGREGATE $25,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) "I A y WC 034157306 (AIDS) WC 034157307(IL,KY,NC) WC 034157308 (NJ,PA) WC 034157309 (AZ,VA) WC 034157310 (CA) 7/1/2016 7/1/2016 7/1/2016 7/1/2016 7/1/2016 7/1/2017 7/1/2017 7/1/2017 7/1/2017 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 B If Yes, describe under DESCRIPTION OF OPERATIONS below I WC 034157311 (FL) 7/1/2016 I 7/1/2017 I B C Workers Compensation Prof/Pollution Incl. Mold/Fungus Y Y y WC 034157312 (MA & MONO) PEC 019441400 7/1/2016 5/1/2016 7/1/2017 7/1/2017 WC Limit Statutory E.L. Limit 1,000,000 Ea Claim: $10,000,000 Agg: $15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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. CERTIFICATE HOLDER CANCELLATION 3U Udys 11ULlce UI %-dnceuduUfI 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 f;CJ1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD City of F6rt Collins /100, .eke`we . Va. DM-2501 ifib ceAeiW Ma Northstar Demolition and Remediation, Inc. Gilman Jones is &emed Gry Me City af.tmd eo&inm, ea&we& ao a.• SPECIALIZED CONTRACTOR -- DEMOLITION Date b, ed. January 27, 2017 expn :va&.- January 27, 2019 eow1 c&v sigma 77-, � � .