HomeMy WebLinkAbout102511 LAFARGE NORTHERN INC - INSURANCE CERTIFICATE (4)..,.._......,..��__...�.. FISs �N 2{ �t Ft {A.I t ('i(I th'
ACORD � CERTTVWIC TE OF LIABILITY
„ .
f.xa. s�� � ilh v "}. �I € lIL M r k{ li btit Ei' i Ifa^ DATE(MM/DD�WVY)
INSURANCE;, R a 10 o4/zoo7
OW
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#
PHONE-(866) 283-7122 FAX-(847) 953-5390
INSURED
INSURER AAmerican Home Assurance Co.
19380
INSURER B'. National Union Fire Ins Co of Pittsburgh
19445
Lafarge West, Inc
1800 North Taft Hill Road,
INSURER C: Insurance Company of the State Of PA
19429
Fort Collins CO 80521 USA
INSURER D: Illinois National insurance CO
23817
INSURER E'.
!fCOVE.,
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 OTFIER 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'
INSRD
TYPE OF INSURANCE:
POLICY NUMBER
POLICY EFFECTI VE
DATE(MNVDDAT)
POLICY EXPIRAT ION
DATE(MMODAY)
LIMITS
A
.NERAIIIARILIFY
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 IX]CUR
PREMISES (Ee occurenee)
MED EXP (Am ene ,Wrs )
75-170
PERSONAL& ADV INJURY
$2,000,000
GENERAL AGGREGATE
$2,000,000
GENT AGGREGATE LIMIT APPLIES PER
I'ROWCTS- COMP/OP AGO
$2,000,000
❑X POLICY ❑ PET ❑ LOC
A
A
B
AII'TOMOBILf;
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 LIMIT
Hnz ac6&.1)
$2,000,000
BODILY INJURY
A
X
ALL OWNED AUTOS
1606934 (VA)
07/01/07
07/01/08
SCHEDULED AUTOS
(Perper n)
X
HIRED ALTOS
BODILY INJURY
X
NON OWNED AUTOS
(Pcr.,,!,n0
PROPERTY DAMAGE
(Per..&d ,)
GARAGE LIABILITY
AUTOONLY -EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
e
AUTO ONLY:
AGE
EXCESS /UMBRELLA LIABILITY
EACH OCCURRENCE
❑ OCCUR ❑ CLAIMS MADE.
AGGREGATE
BDEDUCTIBI_I.
REI'EMIIOM1'
C
A
D
A
D
O
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANYPROPRIETOREXCLUER/EiXECIJTiVE
OF}TCERMEMBER EXCLUDED'
If}ee, describe order SPECIAL PROVISIONS
below
1 ADS
1616289 (CA)
1616291 (FL)
1616291 (LA,etC)
1616292 (MI)
1616293 (NJ)
07101107
07/01/07
07/01/07
07/01/07
07/01/07
07/01/07
07/01/08
07/01/08
07/Ol/08
07/01/08
07/01/08
X
WC STATU-
TORTORY LIMIT.
OTH-
CR
E. L. EACH ACCIDENT'
$2,000,000
E.L. DISEASE -EA EMPLOYEE
$2, 000,000
EL. DISEASE -POLICY LIMIT
$2,000,000
OTHER
DESCRIPTION OF OPERATIONS/IACATIONSI%9 HMCLBS/EXCLIISIONS ADDED BY G,NDORSEMENT/SPECIAL PROVISIONS
RE: 2002 SERVICE AGREEMENT.
CERTIFICA-.., NOliDF.R':4 Dui >F I ,u,! .i�. ;.'!` .. .u' ..,,rS C°NN9STB:� M`--CAN - � UCAT10N, Iy'.Ijy r+ h rwt,� t,,,i,'.rF d h, .....,,1 .��t<. w va`i . ,?_, I
CITY OF FORT COLLINS SI
P.O. BOX 850 DATE
IOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAI ION
I IFREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
FORT COLLINS CO 80522 USA 30
BUT
DAYS WRIT] DN NOTICE TO TI IE CERTIFICATE HOLDER NAMED TO'IHE LEFT,
FAILURE TO DO SO SI TALL IMPOSE NO OBLIGATION OR LIARILITY
OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESEN I A I'I V ES,
AUTHORIZED REPRESENTATIVE
'ACOR62, ...r:h.fi nld, ,'..aIIt'",T,Ju..i..1{,,..�...�iv:,r,dr,.
�rnl Mil ,Isi il,., ,'fn)i I A.. h.;_'.ii,U Ii.M.EG ,: ': O1�C''_ORP TI Nxi �Sg
L
M
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
ADMIONAL POLICIES
INSURER
INSURER
If a policy below does not include
certificate form for policy limits.
to the corresuondine Dolicv on the ACORD
INNS
LEFT
ADD'L
INSRD
TYPE OF INSURANCE
POLICYNLAHER
POLICY DN:SCRIPFION
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/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate No : 570025451150
Aon Risk Services
LoRI VISNIC
Ghent Senue Repnewnlatnve
telephone 847-95 4-7052
tram 866-283-7122
fat 800-363-0105
entail lot umu@ars aot win
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 Visnic
Client Service Representative
Aon Rick Services, Inc
Aon Rnd Sen u < t hie
1000 Alit, auk,, AvUID� GICtvHu' IL60025 • it 866 2b1-7122 • Ln 50-161-010�