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HomeMy WebLinkAbout102511 LAFARGE NORTHERN INC - INSURANCE CERTIFICATE (2)...,� ..Qo.....e,..�.. --(EI tF Fa# U'.t'tiytP FY PI 't'�' gt{.,,t!{P,! ,dr5~t ACORDICERT[FICATE OFII IABILY ry •, ..y ._ , , . , . ,. A . tl 'swl to vE'4v hi ly rt/hR tt sr tz Y,'INS„ nflR`ANCE°, r"•P ,, DATEl0I04/2 O�) i _ . PRODUCERADDRisk Services, Inc. of Pennsylvania THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY One Liberty Place One AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1650 Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAIC# PHONE- 866 283-7122 FAX-(847) 953-5390 INSURED INSURER AAmerican Home Assurance Co. 19380 LaFarge North America, Inc. and its Subsidiaries INSURERB. National Union Fire Ins co Of Pittsburgh 19445 INSURER C. Insurance Company of the state of PA 19429 12950 Worldgate Drive, Suite SOO Herndon VA 20170 USA INSURER D. Illinois National Insurance CO 23817 INSURER E' i ]ZA E '3F..i.. R!ib 3 .,.?1} l.,St2, ,.yn'7t511M. S.terl.� ,tA i 3f .. • 'n.P.. +-, n E ,i nicv:,Ll.M in ,.w.:, nfl 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. USSR LTR ADEPT INSR TYPE OF INSURANCE POLICYNRMBER POLICY EFFECTIVE DATMMM\DD\VFI POLIO' EXPIRATION DATE(MM\DD\YV) LIMITS A ENAL LIABILITYCOMMERCIAL 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGETORENTED $500,000 GENERAL LIABILITY CLAIMSMADE OCCUR P PRE USES EXP77IN oo vnne PcrsonJ S, PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE, $2,000,000 GENE AGGREGATE LIMIT APPLIES PER PRODUCTS - CAMPIOP AGG $2,000,000 LOC POLICY 0 O JECT A A B AUTOMOBILE X LIABILITY ANT. AUTO 1606931 1606932 (MA) 1606933 (OR) 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIMIT (Ea=cide,n) $2,000,000 BODILY INJURY A X ALL OWNED AUTOS 1606934 (vA) 07/01/07 07/01/08 SCHEDULED AUTOS ( Per pe—) X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accidw) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC e ALTO OY' AM EXCESS /UMBRELLA EMMETI'Y EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS WADE AGGREGATE eDEDUCTIBLE RETENTION C A D A O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNP.R/EXECUTIVE OPFICBR/MEMBER EXCLUDED? Byes, describe wder SPECIAL PROVISIONS below 1616288 AOS 1616289 (CA) 1616291 (FL) 1616292 (LA,etc) 1616293 (MI) 1616293 (NJ) 07101107 07/01/07 07/01/07 07/01/07 07/01/07 07/O1/07 07/01/08 07/01/08 07/01/08 07/01/08 07/O1/08 X WC STATU- r RY LIMITS OTH- ER El, EACH ACCIDENT $2,000,000 E L. DISEASEEA EMPLOYEE $2,000,000 EL. DISEASE -POLICY LIMIT $2,000,000 OTHER DESCRIPTION OF OPERATIONS/ MA'TIONS/%TMCLESXXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIOKS CITY OF FORT COLLINS PURCHASING DEPARTMENT IS ADDITIONAL INSURED (EXCEPT ON WORKERS' COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. ,t:14CANCEIsLAT10Nt...M;;aI City Of Fort Collins SHOULD Purchasing Department DATE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI IF.EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N Mason St. 2nd Floor 30 PO BOX 580 BUI Fort Collins CO 80522 USA OFANY DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT', FAILURE TOM SO SHALL IMPOSE NO OBLIGATION OR LIABILITY KIND UPON THE INSURER, ITS AGUNTS OR REPRESENTATIVES_ AUTHORIZED REPRESENTATIVE '•`4 ORD 2i EZ0 OS_!!`_e .., 3.. :':.M�,,,...a!d., r: `;I, ,0?u H;::.?!h•1. , �:t.;t,..r �,+a.r, E Attachment to ACORD Certificate for Lafarge West, Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA ADDITIONAL POLICIES If a policy below does n INSURER INSURER INSURER INSURER INSURER of include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. R LT R AIMEE INSRD TYPE OF INSURANCE POLIC'VNUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POWC'Y EXPIRATION DATE LIMITS WORKERS COMPENSATION D 1616294 (OR) 07/01/07 07/01/08 c 1616295 (wI) 07/01/07 07/01/08 DESCRIPTION OF OPERATIONS/LOCA'IIONS/VEMCLES/EXCLUSIONS ADDED BY ENDORSEMENTSPECIAL PROVISIONS Certificate No : 570025452619 FtF ,' k V'"t1Pi 31 p y pr 1,I ACORD CERTiETCATEaOF LrIABLLITY .� "; vw6 3 n 'I^4.'3t x� , o-= x IIp I fHtt DATE (MM/DD/VYYV) ' INS ` ; CE IIe'ja''i11 r i=,j„u la oa zoo7 ...n exooADD Risk Services, Inc. of Pennsylvania THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY one One Liberty Place AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 16SO Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAICM PxorvE- 866 283-7122 Fnx- 847 953-5390 INSURED INSURERA American Home Assurance Co. 19380 UNSORTED National Union Fire Ins Co of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, INSURER Insurance Company of the State of PA 19429 Fort Collins CO 80521 USA INSURER Illinois National Insurance Co 23817 INSURERE: 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 ADIFT INSRU TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DA'FE(MMVDDAVY) POLICY EXPIRATION DATE(MMVDOAYV) LIMITS A ERAL LIABILITY 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $500,000 COMMERCIALGENERALLIABUITY CIAIMSMADE OCCUR N PRE LSE erson MEDF FAR IAnv one Person) PERSONAL$ ADV INJURY $2,000, 000 ❑ GENERAL AGGRHGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COW/OP AGO $2,000,000 E POLICY PRO- LAC CT A A e AUTOMOBILE LIABILITY X ANY ALTO 1606931 1606932 (MA) 1606933 (OR) 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIMIT (Ea eee;deep $2,000,000 BODILY INJURY A X ALL OWNED AUTOS 1606934 (VA) 07/01/07 07/01/08 SCHEDULED AUTOS ( Per Person) X HIRED ALTOS BODILY INJURY X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ALTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC e ALTO ONLY'. AGG UXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR D CLAIMS MADE AGGREGATE eDEDUCTIBLE RETENTION C A D A D C WORKERS COMPENSATION AND 6MPIAYERS'LIABILITV EXECUTIVE ANY PROPRIETOR EXCLUNER /DED' DFmC'ER/MEMBER LXCLODLD9 If,.,, describe wdo, SPECIAL PROVISIONS below 1616288 AOS) 1616289 (CA) 1616291 (FL) 1616291 (LA,eiC) 1616292 (MI) 1616293 (NJ) 07101107 07/01/07 07/01/07 07/Ol/07 07/01/07 07/01/07 U7713170r 07/01/08 07/01/08 07/Ol/OB 07/01/08 07/01/08 X WC STATU- 1 nI'r. OTH- Te EL EACH ACCIDENT $2,000,000 EL DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2, 000,000 OTHER DESCRIPTION OF OPERATIONS IFOCAT10NSNEHICLES/EXCLUSI ONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS RE: ASPHALT OVERLAY PROJECT. CERTIFICATE HOLDER IS AN ADDITIONAL INSURED (EXCEPT ON WORKERS COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER IS PROVIDED ON THE WORKERS COMP POLICY. CERTTFTCA7'E I70LDETt'r.�.i.,atiird al.,, �1 ,..n5.a :�.4,t. a AN CELL;'ATION-a:I�tT�;v ..?s�..�.,3''."5, z,:fa:lm CITY OF FORT COLLINS SI P.O. BOX 580 DAIE IOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE'I I IF, EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL FORT COLLINS CO 80522 USA 30 BUT DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. FAILURE TO DO SO SHAM IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESINI A I I VES, AUTHORIZED REPRBSEMATIVE •Je7 �""E"'��"�� "'Q1tl9e3"""C�^'•`�' [iACORD! 2 �2001 /OS w!'•!�t, . °+... _...,n .._.1... ;�.... 1 s,,, +. ;, �.. �, .mJsr4,.....ndi' .,, HWe ,lO i..,m,LA- RD` 071.E "H N1L988 Attachment to ACORD Certificate for Lafarge west, Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR ADD'[. INS" TYPE OF INSURANCE WLIC1'NUM RER POLICY' DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS WORKERS COMPENSATION D 1616294 (OR) 07/01/07 07/01/08 C 1616295 (wi) 07/01/07 07/01/08 DESCRIPTION OF OPERATIONS 10CATIONSNEHICLE& EXCLUSIONS ADDED BY ENDORSEMENT/SPFCIAI. PROVISIONS THIS INSURANCE IS PRIMARY AS RESPECTS THE NEGLIGENCE OF LAFARGE/LARFARGE WEST INC. COVERAGE IS EXTENDED ONLY AS RESPECTS NEGLIGENCE OF LAFARGE/LAFARGE WEST INC. Certificate No : 570025451133 �ACORD�CERTIFICATE;,WLI"ILITYrtINSiJRANCE {T tLx(Is>< r 1 I��s171S II A.d 1("n" 1(t T R r�bI `h11 €.frl lLr 4til¢T 4'=� i 7 (I t1{Il d,./ '." i:t DATE(MM/DD/VVVV)� PRODUCER ADD Risk Services, Inc. of Pennsylvania One Liberty Place THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1650 Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAIC# FAX - PHONE 666 283-7122 (847 953-5390 INSURED INSURER A' American Home Assurance Co. 19380 INSURERII. National union Fire Ins Co of Pittsburgh 19445 LaFarge West, Inc. concrete/A�gregate 1800 N. Ta t Hill Rd. Fort Collins CO 80525 USA INsuaeRa Insurance company of the State of PA 19429 INSURER D: Illinois National Insurance Co 23817 INSURER E' u V 'l, �N 4, ,`E11fCNAr 63- AT:1 tdif d..,. ,. , st:aJ:6 T/ at, ..,14,L:4:. 1!?,;+. L:N E ,'(da._.. 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 ADII'1 INSRI TYPF.OFINSURANCE POLICYNUMBER POLICY EFFECTIVE DAIELMMAMPYY) POLICY F_CPIRA'PION DA'TF.(MMU)DOW) LIMITS A 'NERAL LlAtlll.n'1' 1595365 (VA/cM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGE'10 RENTED PREMISES (Ea oeeurwce) $500,000 X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR VIED ESP (Anvune per.M 5, PERSONAL& ADV INJURY $2,000,000 GENERAL AGGREGA I E $2,000 000 GENE AGGREGATE LIMIT APPLIES PER '. PRODUCTS - COXIPIOP AGO $2,000,000 ❑X POLICY ❑ JECOT LOU A p B A AUTOMOBILE X X LIABILITY ANY ALTO ALL OWNED AUTOS 1606931 (MA) 1606933 (OR) 1606934 (VA) 07/01/07 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIMIT (Ea uddem) $2,000,000 BODILY INJURY SCHEDULED AUTOS I Per person) BODILY INJURY X HIRED AUTOS X NON OWNED AUTOS (Per ade.) PROPERTY DAMAGE (Per ecridenl) GARAGE LIABILI'IT AUTO ONLY - EA ACCIDENT OTHER THAN FA ACC ANY AUTO AUTO ONLY: AGG EXCESS/UMRRELIA LIABILITY EACI I OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE BDEDUCTIBLE RETENTION [ p D WORKERS COMPf:NSA'I'ION AND 1' EMPLOYERS' LIABILII' 1 1 ADS 1616289 (CA) 1616290 (FL) 07/01/07 07/01/07 07/01/08 07/01/08 X WC STATU- RI LD "c 0ni E L. EACH ACCIDENT $2,000,000 A D [ ANYPROPRIETOR/PARTNER /EXECUTIVE OFDCERMMBER EXCLUDED' E'yes, Describe wJer SPECIAL PROVISIONS lulow 1616291 CLA,etc) 161629(MI) 1616293 (NJ) 07/01/07 07/1/07 07/01/07 07/01/08 07/1/08 07/001/08 E.1.. DISEASEEAEMPLOYEE E2,000,000 li.L. DISEASE-1'OLICV LIMIT $2,000,000 ZITHER ❑ESCRIPI']ON OF OPERATIONS4.0CA (IONS/VEI IICLIIS/EXCLUSIONS ADDED BY ENDORSEMENT5PT-C1A1. PROVISIONS CERTIFICATE OF INSURANCE PERTAINS TO ANY PARTICULAR LOCATION/CONTRACT/ITEM/VEHICLE OR IF THERE ARE ANY SPECIAL REQUIREMENTS. CITY OF FORT COLLINS IS ADDITIONAL INSURED (EXCEPT ON WORKERS COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT RE: JOB: CITY OF FORT COLLINS LIGHT & POWER 2006 CERTIFICATE HOLDER CITY OF FORT COLLINS SHOULD ANY OFIHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEEXPIRATION ATTN: JOHN STEPHEN PO BOX 580 30 FORT COLLINS CO 805220580 USA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL DAYS WRIITENNOTICE'10'I TIE CERTIFICATE HOLDER NAMED TOTHELEFT. BUT FAT LITRE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON -I HL INSURER. ITS AGENTS OR RGPRESE.TATI VPS. AUTHORIZED REPRESENI'A'11 VP A 497 � �'��'"� '/SE� i7ACORD 24r26I; M'8rl 1 , , ,.ai;:3tPE { _... a... ..r.: RD ORP RA -N•'19.. O x 8 Attachment to ACORD Certificate for LaFarge West, Inc. The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED LaFarge West, Inc. Concrete/A9gregate 1800 N. Taft Hlll Rd. Fort Collins CO 80525 USA ADDITIONAL POLICIES If a policy below does no INSURER INSURER include limit information. refer to the corresoondine nolicv, on the ACORD certificate form for policy limits. INlR LTR ADD'L INSRD Tl'PE OF INSURANCE POLICY NUMSRR POLICI'DESCRIPTION POLICY EFFECTIVE DATE POLICY ESPIRAI'ION DAL LIMITS WORKERS COMPENSATION 0 1616294 (OR) 07/01/07 07/01/08 C 1616295 (WI) 07/01/07 07/01/08 DF.SCRIPIIONOFOPERATIONS40 ATIORStlFIIICLESExCLt1S1ONSADDEDBl'EN'DORSENIEN17SIIECIALPROVISIONS Certificate No : 570025451179 AoN Aon Risk Services LORI VISNR, Client San ice Repieleniatne telephone 847-95 i-7052 main 866-28 f-7122 fin 800-36+-0105 email ion otsnu Gars aan coin October 1,2007 To Whom It May Concern Insurance Certificate Holder Re: Amended Certificate Of Insurance To Whom It May Concern Enclosed please find an amended certificate of Insurance for the current Insurance period This certificate of insurance replaces the certificate previously sent to you Please discard the certificate previously provided Please feel free to contact me with any questions Best Regards, Lori Vismc Client Service Representative Aon Risk Services, Inc Aon Risk Sei 1 u es, On 1000A 11], auk,, As, nu, GlemIce IL 6002i. ni bou0-71'2•Ln 800-',6,-11105 Attachment to ACORD Certificate for LaFarge North America, Inc. The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED LaFarge North America, Inc. and its Subsidiaries 12950 Worldgate Drive, Suite 500 Herndon VA 20170 USA ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS WORKERS COMPENSATION D 1616294 (OR) 07/01/07 07/01/08 C 161629S (WI) 07/01/07 07/01/08 DESCRIPTION OF OPERATIONWLOCATIONS/V Ef IICLESTXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No: 570025446176 x r A_ACORD CERTIEICATE,()FILIAB' );I{T,YrINSURtANCE;It A'S'(tTT4)T)F"Itll. „'r sA' DATE(MM/DD/YYYY) ; ,,! a}' . ll m to/oa/zoo7 mT PRODUCER ADD Risk Services, inc. of Pennsylvania one Liberty Place One 1650 Market Street 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 ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAIC At ruon'E, 866 283-7122 FAX-(847 953-5390 INSURED INSURER A. American Home Assurance Co. 19380 INSURER B. National union Fire ins Co of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, INSURER Insurance Company of the State of PA 19429 Fort Collins CO 80521 USA INSURERD: Illinois National insurance Co 23817 INSURER E. .r.. a "WIN J.. a, :$.+ h I .. .�',.uFa"5'3,,,kd' h ,',3i{t;,,_.i ! , _ f,- i.:b:., .i,�4, e _}'d}4 g,�,. +S .4vb,l.,R:u+,t,7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WTTHSTANDING 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 ADDT INSRU TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATFCHNBDD\W) POLICY EXPIRATION DATE(MM\DD\YY) LIMITS A l:NTHAT LIABILUITY 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $500,000 X COMMERCIAL GENERAL LIABILITY X CLAIMS MADE OCCUR PREMISESoee e D EXP (MAnv one Person) ) PERSONAL @ ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,006 _ GEN. AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $2,000,000 © POLICY PRO [� LOU ECT A A B AUTOMOBILELIABILD'Y X ANY AUTO 1606931 1606932 (MA) 1606933 (OR) 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY A X ALLOWNEDAUTOS 1606934 (VA) 07/01/07 07/01/08 SCHEDULED AUTOS ( Per person) X HIRED AUTOS BODILY INJURY X NON DAWNED AUTOS (Per acddenO PROPERTY DAMAGE (Per scclden) GARAGE LIABI LI'IT AUTO ONLY - EA ACCIDFNT ANY AUTO OTHER THAN EA ACC e ALTO AUTO OHLY'. AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION C A D A D C WORKERS COMPENSAI ION AND EMPLOYERS' LI.ABILI'IN PARTNER /LXECUTIVE ANY FIHCEK EMBER EXCLUDED' OFFlCER/MEMDER LXCLUDEDP I(Yes, describe under SPECIAL PROVISIONS below 1616288 ADS 1616289 (CA) 1616291 (FL) LA, 1616292 CLA,eiC) 1616292 (MI) 1616293 (N)) 07101107 07/01/07 07/01/07 07/01/07 07/01/07 07/01/07 07/01/0$ 07/01/08 07/01/08 07/01/08 07/01/08 X JAC STATU- T RY LIMITS OTH- ER E.L. EACH ACCIDENT $2, 00D, 000 E.1.. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VIiHICLE&BXCI,USIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 2004 MATERIALS SALES. CERTIFICATE HOLDER IS AN ADDL INSURED (EXCEPT ON WC) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER IS PROVIDED ON THE WORKERS' COMP. POLICY. THIS INSURANCE IS PRIMARY AS RESPECTS THE NEGLIGENCE OF LAFARGE WEST, INC/LAFARGE. CANCE LATI N'...-109°rt�,' §;-IN;tl:!c ,=Kj...,MMVEJ is ..3'; ,3;;, ,r, 5,, hR-'Stee l:cs CITY OF FORT COLLINS SHOULD PO BOX 580 DATE. ANY OF HIE ABOVE DPSCIUBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, I'HE ISSUING INSURER WILL ENDEAVOR TO MAIL FORT COLLINS CO 805220580 USA 30 BUNT DAYS WRITTEN NOTICETO THE CERTIRCATE HOLDER NAMED TOTHE FEET, PNLIRE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON I'HE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZEDRF'PRESENTATOT —W-6 k� ..wee-. —, /.�—..y� w. L.?`.N;.;: , (S .Yi..4IPVIPI;i , .J '.ct..(i.ilm . L,.. Crc let 4i F., r ' E4z+i4'�dvC�_., RD 25� 2 1 0 ... t i. ^v l >?>:.. i n, A:: RH _© P TI ONi19 O x Attachment to ACORD Certificate for Lafarge west, Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all teams, conditions, coverages or exclusions contained in the policy. INSURED Lafarge west, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA ADDITIONAL POLICIES INSURER INSURER If a policy below does not include limit certificate form for policy limits. refer to the corresnnndine noliev an the ACORD R LTR ADDT INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LI MIB WORKERS COMPENSATION D 1616294 (OR) 07/01/07 07/01/08 C 1616295 (WI) 07/01/07 07/01/08 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLFS/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS COVERAGE IS EXTENDED ONLY AS RESPECTS LAFARGE WEST/LAFARGE'S NEGLIGENCE. Certificate No: 570025451127 �.— ,.... .,... ... a I � 17 S ,}'- DATE Eoio°DiW W:1az007 " >.mE.ACORDi �a�b.„,. _..._..d........m...a..... ' PRODUCER Ann Risk Services, Inc. of Pennsylvania One Liberty Place THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1650 Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE. Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAIC H PHONE 866 283-7122 FA%-(847) 953-5390 INSURED INSURER A'. American Home Assurance Co. 19380 INSURER B. National union Fire Ins co of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, INSURERC Insurance Company of the State of PA 19429 Fort Collins CO 80521 USA INSURER D. Illinois National Insurance Co 23817 INSURER E'. :9 s ... t _ :. RA ty`i: ..v,�J.A,jsF.x`Y`'� � v lt4Xieii .,_II...�.iP''B 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 ADD1 INSRU TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATMMMVDDAW) POLICY EXPIRATION DATE(MMVDDAYY) LIMITS A INERAL LIABILITY 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED S500,000 X COMMERCIAL GENERAL LIABILITY X CLAIMS MADE DOCCUR PREMISES (Ea enee) e M DEXP (Anv anTparson) PERSONAL& ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GENE AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OP AGO $2,000.000 �X POLICY MPCI LOC A A B .AUTOMOBILELIABILIIY X ANY AUTO 1606931 1606932 (MA) 1606933 (OR) 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIMIT (Ea aedden0 $2,000,000 BODILY INJURY A X ALL OWNED AUTOS 1606934 (VA) 07/01/07 07/01/08 SCHEDULED AUTOS (Perperson) X MUD AUTOS BODILY INJURY X NON OWNED ALTOS (Per accident) PROPERTY DAMAGE (Per sca&d O GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC e AUTO ONLY: AG(i EXCESS NMBRELLA LIABILITY EACH OCCURRENCE ElOCCUR 0 CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION C A D A D C WORFERSCOMPENSATION AND EMPLOYERS' LIABILITY ER/CXECUTIVE ANY PERNE TOR EXCLUDED' OPFICF.R/MEMBER E%CLUUEI}? Ifye, describe under SPECIAL PROVISIONS below 1616288 ADS) 1616289 (CA) 1616291 (FL) 1616292 (LA,etc) 1616292 (MI) 1616293 CNN) 07/01/07 07/01/07 07/01/07 07/01/07 07/O1/07 07/01/07 07/01/08 07/01/08 07/01/08 W/O1/08 07/01/08 X WC STAID- T VLIMIT OTH- F E.1.. EACI I ACCIDENT $2,000,000 EL DISEASEEAEMPLOYEE $2,000,000 EL. DISEASEPOLICYLIMIT $2,000,000 OTHER DESCRIPI ION OF OPERATIONS/LOCATIONS/VEHICLES/BXCLUSIONS ADDED BY HNDORSEMENT/SPECIAL PROVISIONS CITY OF FC ASPHALT OVERLAY 2007 / JOB# 72253. CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORKERS COMPENSATION) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. `' R ICAT ]HOLDEt' LL': .tiUw ,rr .`ZHn'�°_~�4CN' N'a..�. CITY OF FC PURCHASING DIVISION SHOULD ATTN: NAMES O'NEILL ANY OF DIG ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TI IEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N. MASON ST. 2ND FLOOR 30 PO BOX 580 FORT COLLINS CO 805220580 USA DAYS ARMEN 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 REPRESENTATIVIS. AUTHORIZED REPRESENTATIVE ,rA RD 25`2001 Q S...M...+ KLtoI '�T a jl�L'E .{ G Attachment to ACORD Certificate for Lafarge West, Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA ADDITIONAL POLICIES INSURER INSURER INSURER If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate forth for policy limits. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIIIAI'ION DATE LIMITS WORKERS COMPENSATION 0 1616294 (OR) 07/01/07 07/01/08 C 1616295 (WI) 07/01/07 07/01/08 DESCRIPTION OF OPERATIONS/LOCA I IONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROV)SIONS Certificate No : 570025452586 DATE(MM/DD/YYYY) ICI ACORD I CERTIFIGAµTE (JT+LIABILITYINS "5 10/04/2007 1 , CEc,'," ' , PRODUCER Risk ServiInc. of Pennsylvania THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY One Liberty Place One AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1650 Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAIL Pxorve- 866 283-7122 FAX- 847 953-5390 INSURED INSURER A, American Home Assurance Co. 19380 u IN B. National union Fire Ins co of Pittsburgh 19445 Lafarge west, Inc "= 1800 North Taft Hill Road, - w INSURER Insurance company of the state of PA 19429 Fort Collins CO 80521 USA y INSURERD, Illinois National insurance to 23817 a INSURER E. e `LrWHIL SEA_. IRM,"RWNNFIWwF . Nene'.N%t 6, ._. iec.: ry ,i 311l::,dv,d ul.. i� vw,4„79A 1i:.. 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 ADOPT TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIN F. POLICY EXPIRATION LIMITS LTR INSR DATEIMNUDMYY) DATE(MMVDDAYYI A 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 F,N ERAL LIABILrI'V DAMAGEID RENTED $500,000 X COMMERCIAL GENERAL LIABILITY PREMISES (F:a occurence) X CLAIMS MADE. OCCUR MED EX? W, onen wtl $5,006 O PERSONAL &ADV INJURY $2,000,000 b GENERAL AGGREGATE $2,000,000 R GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGO $2,000,000PRO ,n ry �X POLICY LOU O JECT n A AUTOMOBILE LIABILITY 1606931 07/01/07 07/01/08 COMBINED SINGLE LIMIT A ANYALGO 1606932 (MA) 07/01/07 07/01/08 (Ea a,cdre) $2,000,000 Z B X 1606933 (OR) 07/01/07 07/01/08 w BODILY INJURY A X ALL OWNED AUTOS 1606934 (VA) 07/01/07 07/01/08 A SCHEDULED AUTOS ( Per Pereon) I. L BODILYINJURY X MUD AUTOS u X NON OWNED AUTOS (PereMen0 V PROPERTY DAMAGE (Per eeeiden0 GARAGE LIABILOY AUTO ONLY - EA ACCIDENT ANY ALTO OTHER THAN EA ACC e AUIT) ONLY AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE HDEDUCTIBLE RETENTION C 1 1 ADS 1 J( WC STATU- 10THWORKERS COMPENSATION AND 07/01/08 TRY LIMI _ E L. EACH ACCIDENT $2,000,000— D EMPLOYERS' LIABILI TV 1616291 (FL) 07/01/07 07/01/08 A ANY PROPRIETOR 1616291 (LA,2LQ 07/Ol/07 07/01/08 OFFICF,R/MEMBER EXCLUDED' EL. DISEASE -EA EMPLOYEE $2,000,000 D 1616292 (ML) 07/Ol/07 07/Ol/08 EL.DISEASE-POLICY LIMIT $2, 000,000 C If,,,, deunbe under SPECIAL PROVISIONS 1616293 (NJ) 07/01/07 07/01/08 Mew OTHE �R i DESCRIPTION OF OPERATIONS/LOCA'110NS/VEIIICLES/EXCLUSIONS ADDED BY LNDORSEMLNT3PBCIAL PROVISIONS L-1 THE CITY OF FORT COLLINS AND THE CITY OF FORT COLLINS ENGINEERING DEPARTMENT ARE ADDITIONAL INSUREDS (EXCEPT ON ti WORKERS COMP) AS RESPECT OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. RE: ASPHALT OVERLAY PROJECT 2005 IFLZ .,53'L.d„il[CAN LI::ATION CITY OF FORT COLLINS SHOULDANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION ATTN: JAMES O'NEILL DATE THEREOF, THE ISSUING INSURER WILT. ENDEAVOR TO MAIL PO BOX 580 30 DAYS WRITTEN NOT ICE TO'I ULCER I incA HE HOLDER NAMED TO THE LEFT, FORT COLLINS CO SOSZZ USA BUT OF FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATI VES. AUTHORIZED REPRESE,NTATIVF. •���°A"�e"�E"1O"� "%'�'"`�` _,a.__... i1, W14, +' ry1...,_ _..,I.4..._. .....m,=-WRINUnA-- RD'_ORP RATT Nzl9Ram Attachment to ACORD Certificate for Lafarge West, Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA ADDITIONAL POLICIES If a policy below does not include certificate form for policy limits. to the corresnondine nolicv On the ACORD INSR LI R ADDI' INSRD TYPE OF INSURANCE POLICYNUMBER POLICY DESCRIPTION POLICY EFFECT%F DATE POLICY EXPIRATION DATE LIMB Is WORKERS COMPENSATION 0 1616294 (OR) 07/01/07 07/01/08 C 161629S (WI) 07/01/07 07/01/08 DESCRIPTION OF OPERArIONS/LOCXI IONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMEN"I/SPECIAL PROVISIONS Certificate No : 570025452609 _:..,.».,......,.._. w 'rt .-', t hl -P'=' TF ' ACORD CERTIFICATE' OT L`IA$ILT __ IN nit Y#4 x8" S@4't IP I 1 "� DATE MM DD VVVY) YI INSUR�tANCE'E,!iF 1 .,. , E' i ', ?JL _10/04/2007 PRODUCER ARisk Services, Inc. of Pennsylvania One Liberty Place THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1650 Market Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1000 COVERAGE AFFORDED BY THE POLICIES BELOW. Philadelphia PA 19103 USA INSURERS AFFORDING COVERAGE NAICp PHONE (866) 283-7122 FAX- 847 953-5390 INSURED INSURER A. American Home Assurance Co. 19380 INSURERS. National union Fire Ins Co of Pittsburgh 19445 Lafarge West, Inc 1900 North Taft Hill Road, INSURER Insurance Company of the State of PA 19429 Fort Collins CO 80521 USA INSURER D Illinois National Insurance Co 23817 INSURER E. $i !. E, 4.'i'G 9d4.. I. l..a:,rit F »t'.:.. ?As,Fha �.hla'�! .,t H n,_titfl IVJro e Ki.tiil;a?,p«�E.'},,.F I-t{" a v �'t( lir # mroq 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 ADD'[ INS TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE. DATE(MMVDDAVY) POLICY EXPIRATION DA'I E(MMVDEPYlo LIMITS A 'ERAL LIABILITY 1595365 (VA/CM) 07/01/07 07/01/08 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $500,000 X COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR PREMINES(G.o en EXP)X MEN one Person) PERSONAL& ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GENT, AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000 ❑X POLICY ❑ PRO- ❑ LOC A A B AUTOMOBILE X LIABILITY ANY AUTO 1606931 1606932 (MA) 1606933 (OR) 07/01/07 07/01/07 07/01/07 07/01/08 07/01/08 07/01/08 COMBINED SINGLE LIM[ I' (Eo aedde„p $2,000,000 BODILY INJURY A X ALLOWNEDAMOS 1606934 (VA) 07/01/07 07/01/08 SCHEDULED AUTOS ( Per Person) X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS (Pe,.rederU PROPERTY DAMAGE (Per ar.dem) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC e AUTO ONLY AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE eDEDUCTIBLE RETENTION C A D A D C WORKERS COMPENSATION'ANU EMPLOYERS' LIABILITY ANY PROPRIETOR EXCLU F,R/F.XECUDVE oFfICCR/MEMBERExcLuoED? If,, describe under SPECIAL PROVISIONS Wow 1 AOS 1616289 (CA) 1616291 (FL) 1616292 (LA,¢iC) 1616292 (MI) 1616293 (NJ) 07/O1/07 07/01/07 07/01/07 07/O1/07 07/01/07 07/01/08 07/01/08 07/01/08 07/O1/OS 07/01/08 X WC STATU- MI O'ro ER EL EACH ACCIDENT $2,000,000 EL DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VI?HICLESTXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ASPHALT OVERLAY PROJECT BID NO. 5839 2006 RENEWAL. RE: CITY OF FORT COLLINS IS ADDITIONAL INSURED (EXCEPT ON WORKERS COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. CCRTIFIA'i'E'IiOL`DERr r`s,.'.F.::. }}a " i.n. h.l' T,i_!!`,i'.;'M CAN' L'1:"ATl N...,::t:.`'.°#"'i: .n..,.'. "IIC °ti, dE(:::..: Er _,__.".,.:E +R ,t _...: v?.l, .I?,;•, CITY OF FORT COLLINS SHOULD PO BOX 580 DATE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL FORT COLLINS CO 805220580 USA 30 BUT DAYS WRITTEN NOTICE TO'IHE CERTIFICATE HOLDER NAMED TO THE LEFT. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES'. AUI HORILED REPRESEN FAT IVE _W '>A RD2'2061 TBS _'xf�e+•, �+.,....: xTl#a.,,�. .d ..`q'...s;fi.d1,.;E.Mtifi �„hYj.k ,'-..,(,;x;,` a,i+(M:9 L+ ,+'..3r4.4!tti...Io- Yw,. ....al.z1 O 072P RATI NI9B_