HomeMy WebLinkAboutLAFARGE WEST - INSURANCE CERTIFICATE (3)ACORDTM CERTIFICATE OF LIABILITY INSURANCE 0410112008
DATE
1 04/26/2007)
PRODUCER LOCKTON COMPANIES, LLC-1 KANSAS CITY
444 W. 47th Street, Suite 900
Kansas City Mo 64112-1906ALTERCIES
(816)960-9000
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
BELOW.
INSURERS AFFORDING COVERAGE
INSURED
1060502 LAFARGE WEST, INC.
NORTHERN PAVING
1800 N. TAFT HILL ROAD
FORT COLLINS CO 80521
INSURER A: AMERICAN HOME ASSURANCE CO.
INSURERS : NATIONAL UNION FIRE INS CO.
INSURER C INS CO. STATE OF PA
INSURER D ILLINOIS NATIONAL INS. CO.
COVFRAGFS I APMnOl PV inio�ERnnCA EOrinaURANOe uuEb NUI GUNSIIIUIEAGUNTRAGTSETWEEN 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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATEIMWDDfYYl
POLICY EXPIRATION
DATE M / IVY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
X CLAIMS MADE OCCUR
5836153
04/01/2007
04/01/2008
EACH OCCURRENCE
$ 2,000,000
FIRE DAMAGE (Any one fire
$ 500,000
MED EXP (Any oneperson)
$ $ 000
PERSONAL & ADV INJURY
$ 2 000 000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE
X POLICY D
LIMIT APPLIES
JECT
PER:
LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
A
B
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON-OWNEDAUTOS
6074990(AOS)
6075856 (MA)
6075857(OR)
6075858 (VA)
04/01/2007
04/01/2008
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
OUMBRELLA
DEDUCTIBLE FORM
RETENTION $
NOT APPLICABLE
EACH OCCURRENCE
$ XXXXXXX
AGGREGATE
$ XXXXXXX
XXXXXXX
XXXXXXX
$ 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
X WC STATU-LIMITOTH-
E.L. EACH ACCIDENT
$ 2,000,000
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
E.L. DISEASE -POLICY LIMIT 1
$ 2000000
D
0
D
OTHER
WORKERS COMPENSATION
2921412(FL)
2921414 M )
2921413 (LA, ND, OH, WA, WV, WY)
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF FC ASPHALT OVERLAY 2007 / JOB# 72253.
2849860 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE�FOr�RE THE EXPIRATION
CITY OF FC PURCHASING DIVIDION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ATTN: MAMES O'NEILL
215 N. MASON ST. 2ND FLOOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
P.O. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
FORT COLLINS CO 80522-0580 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE or
ACORD 25-S (7/97) For questions regarding this cerlificate, contact the nureMr listed in the'ProduceY section above and specify the client code'LAFNOOT. dDAEOFM CORPORATION 9ORR