HomeMy WebLinkAbout102511 LAFARGE NORTHERN INC - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE 04/01/2008 03/28/2o 7'
PRODUCER LOCKTON COMPANIES, LLC-1 KANSAS CITY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
444 W. 47th Street, Suite 900 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Kansas City Mo 64112.1906 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(816) 960-9000 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AMERICAN HOME ASSURANCE CO.
1060502 LAFARGE WEST, INC.
NORTHERN PAVING INSURER B: NATIONAL UNION FIRE INS CO.
1800 N. TAFT HILL ROAD INSURER INS CO. STATE OF PA
FORT COLLINS CO 80521 INSURER D ILLINOIS NATIONAL INS. CO.
......�.....�.. T A T-srr,nt nv THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MWDD/YY
POLICY EXPIRATION
DATE MWDDNY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
AlCLAIMS MADE OCCUR
5936153
04/01/2007
04/01/2008
EACH OCCURRENCE
$ 2,000,000
FIRE DAMAGE (Any one fire
$ 500 0O0
MED EXP (Any oneperson)
$ $ 000
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY JECOT LOC
PRODUCTS - COMP/OP AGO
$ 2,000,000
A
A
B
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
6074990 (AOS)
6075856 (MA)
6075857 (OR)
6075858(VA)
04/01/2007
04/0112008
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,000
X
BODILY INJURY
(Per person)
$ XXXXXXX
X
BODILY INJURY
(Per accident)
$ XXXXXXX
X
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
ANY AUTO
NOT APPLICABLE
AUTO ONLY - EA ACCIDENT
$ XXXXXXX
OTHER THAN EA ACC
AUTO ONLY: AGG
$ XXXXXXX
$ XXXXXXX
EXCESS LIABILITY
OCCUR CLAIMS MADE
UMBRELLA
DEDUCTIBLE 1 FORM
RETENTION $
NOT APPLICABLE
EACHOCCURRENCE
$ XXXXXXX
AGGREGATE
$ XXXXXXX
$ XXXXXXX
XXXXXXX
S XXXXXXX
C
B
C
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2921410(AOS)
2921416 (OR)
2921417 (WI)/2921415 (NJ)
2921411 CA
04/01/2007
04/01/2008
OTH-
X WC S7ATU- ER
E.L. EACH ACCIDENT
$ 2,000,000
E.L. DISEASE- EA EMPLOYEE
$ 2,000,000
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
D
D
D
OTHER
WORKERS COMPENSATION
2921412(FL)
2921414 (MI)
2921413 (LA, ND, OH, WA, WV, WY)
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SOUTH LEMAY AVENUE WIDENING PROJECT. RE: CITY OF FORT COLLINS IS ADDITIONAL INSURED (EXCEPT ON WORKER'S COMP)
AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT.
CERTIFICATE HCIt DFR I I AnnITInNAI tNg]tam. tNSt IRFR I FTTFR- CANCFI 1 ATInkl
2603892
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLLINS
- 0
215 NORTH MASON STREET, 2ND FLOOR
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
FORT COLLINS CO 80524
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97) For questions regarding this csdigcats, oontact the number llstad in tha'Produesr sactlon ahow and speciry tha chant cod.'LAFhKKh'. 0 AC005 CORPORATION 1988