HomeMy WebLinkAboutLAFARGE WEST - INSURANCE CERTIFICATE (10)Fax Server 1/20/2006 1:22:15 PM PAGE 2/002 Fax Server
ACOR&M CERTIFICATE OF LIABILITY INSURANCE oarol/zoob
01(200//2006
PRODUCER
Loddrn C an� P
444 W.4Rh Street, Suite 900
Kansas CNy * 641124906
%0.9000
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
ALTER THE COVERAGE AFFORDED BY(816)
INSURERS AFFORDING COVERAGE
INSURED LAFARGE WEST INC
1060502 CONCRETEAGGREGATE
1800 N. TAFT HILL RD,
FORT COW NS 00 805Z
INSURER A: RICAN HOME ASSURANCE CO.
INSURER B: NATIONAL UNION FIRE INS CO
INSURER c INS CO. STATE OF P
INSURER D
COVERAGES LAFN001 FK
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FORTHE POLICY PERIOD IND)CATED. 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
DATE MMIDDIY
POLICY EXPIRATION
DATE MMIDDN
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
X1 CLAIMS MADE E OCCUR
GL3314756
04/012005
04/012006
EACH OCCURRENCE
$ 2,000,000
FIRE DAMAGE (Any we fire
$ 500 WO
MED EXP (Any me erson
$ 5.000
PERSONAL &AOV INJURY
$ 2,000,000
GENERA- AGGREGATE
$ See Below
GENL AGGREGATELIMIT
POLICY
APPLIES
JECIT
PER:
L C
PRODUCTS- COMPIOP AGG
$ 2,000,000
A
A
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
CA2651851 (AOS)
CA2651853 (MA)
CA2651852 (TX)
CA2651854 (VA)
CA2651855 (OR)
04/01/2005
04/01/2006
COMBINED SINGLELIMIT
(Eaacddent)
$ 2,000,000
X
BODILY INJURY
(Per persp^)
XXXXXXX
BODILYINJURY
(Perraaltlent)
$ XXXXXXX
PROPERTY DAMAGE
(Per aaidertt)
$ XXXXXXX
GARAGE LIABILITY
ANY AUTO
NOT APPLICABLE
AUTO ONLY - EA ACCIDENT
$ XXX)CKXX
OTHER THAN EA ACC
AUTO ONLY: AGG
$ XXXXXXX
$ XXXXXXX
EXCESS LIABILITY
OCCUR F1 CLAIMS MADE
UvLgmJA
DEDUCTIELE 0 FOAM
RETENTION $
NOT APPLICABLE
EACH OCCURRENCE
$ XXXXXXX
AGGREGATE
$ XXXXXXX
$ XXRXXXX
$ XXXXXXX
$ XXXXXXX
C
B
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC3599065 (AOS)
WC3599067 (CO)
WC3599068 (OR)
WC3599066 MVWC3599069 NJ
04/012005
04/012006
X WC S7ATU- H.
E.L. EACH ACCIDENT
$ 2,000 OW
E.L. DISEASE- EA EMPLOYEE
$ 2,000,000
E.L, DISEASE. POLICY LIMIT
$ 2.000.000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
***THE AGGREGATE LIMIT IS: NIL. THE GENERAL LIABILITY POLICY IS SUBJECT TO ARRODUCTS-COMPLETED OPERATIONS AGGREGATE
ONLY. NO GENERAL AGGREGATE APPLIES AS THE POLICY WILL RESPOND TO EACH AND EVERY OCCURRENCE WITH A LIMIT OF LIABILITY
SHOWN. CERTIFICATE OF INSURANCE PERTAINS TO ANY PARTICULAR LOCATION/CONIRACTIITEM/VEHICLE ORIF THERE ARE ANY
SPECIAL REQUIRMENTS. CITY OF FORT COLLINS IS ADDITIONAL INSURED (EXCEPT ON WORKER'S COMP) AS RESPECTS OPERATIONS
OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. RE. JOB: CITY OF FORT COLLINS LIGHT& POWER 2006,
CERTIFICATE HOLDER ADDITIONAL INSURED: INSURER LETTER: — CANCELLATION
201751
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF FORT COLUNS
3�
ATTN: JOHN STEPHEN
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
PO BOX 90
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
FORT COW NS CO 80522-M
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97) Fer9aasaommpMinglNacediF le,conbcttb mmWrl6tWInlly-P meesocfion a bowsncl*Wifythecli,dcods'LAFNCaf'. O ACCIROCCbkPORAT1O iM