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Home My WebLink AboutLAFARGE WEST - INSURANCE CERTIFICATE (8)0ex x A CORDren��a�� s ids DATE MM DD YYYY) \� l l t cy� ti`� 02/13/2009 a_ :. �.� PRODUCER Aon Risk services central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Philadelphia PA Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS one Liberty Place CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 1650 Market street COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 1000 INSURERS AFFORDING COVERAGE NAIC # Philadelphia PA 19103 USA PHONE-(866) 283-7122 FAX- 847 953-5390 INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURER B: American Home Assurance Co. 19380 Lafarge west, Inc 1800 North Taft Hill Road, INSURERC: Insurance Company of the State of PA 19429 Fort Collins Co 80'521 USA INSURERD: Granite State Insurance Company 23809 INSURER E: Illinois National Insurance Co 23817 ��Gfi�ERA"GES. �-?:. o�c�� ,�-. � �....•. • �� ,v . _. , � �........ ��,��ti�� , .F.. ,... ;�... �..r :,h. r': 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. LIMITS SHOWN ARE AS REQUESTED INSR LTR ADDT INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM\DD\YY) POLICY EXPIRATION DATE(MM\DD\YY) LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY GL9723097 (CM) 07/01/08 07/01/09 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $ 500 , 000 . X CLAMS MADE OCCUR PREMISES (Ea occurence) MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $2,000,000 ElGENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 ❑X POLICY ❑ PRO- ❑ LOC CT A A A A AUTOMOBILE LIABILITY X ANY AUTO X ALL OWNED AU7''OS •.. CA1607650 CA1607651 (MA) CA1607652 (OR) CA1607653 (VA) 07/01/08 07/01/08 07/01/08 07/01/08 07/01/09 07/01/09 07/01/09 07/01/09 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY SCHEDULED AUTOS ( Per person) X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC H AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE DOCCUR ❑ CLAIMS MADE AGGREGATE HDEDUCTIBLE RETENTION c D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY wC5145487 AOS wc5145488 (CA) WC5145489 (FL) 07/01/08 07/01/08 07/01/08 07/01/09 07/01/09 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2,000,000 D E C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Ifyes, describe under SPECIAL PROVISIONS below WC5145490 (LA,etc) wc5145491(MI) WC5145492 (NJ) 07/01/08 07/01/08 07/01/08 07/01/09 07/01/09 07/01/09 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: HARMONY & SHIELDS INTERSECTION IMPORVEMENTS / JOB# 74333. CITY OF FORT COLLINS IS ADDITIONAL 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. CRRTiI IACFI®lR »'' ,,, ' „MCA• CITY OF FORT COLLINS SHOULD P.O. 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 80522-0580 USA 30 BUT DAYS WRITTEN NOTICE TO THE 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. I AUTHORIZED REPRESENTATIVE c S4�oy..s:,s� ACf 25 20U1I08 . �.E � 31 �.F.N 11 �: ... ^h... .a �ACOJRD�CORPCQ%RAG�i�si®1V✓1.988 � 0 x Ln M rn N rn O 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 INSURER 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 ADDT INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS WORKERS COMPENSATION A WC5145493 (OR) 07/01/08 07/01/09 C WC5145494 (WI) 07/01/08 07/01/09 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570032963355