HomeMy WebLinkAboutLAFARGE WEST - INSURANCE CERTIFICATE (9)ACORD.n CERTIT+I6TE 0V, LIABILITII°IIYSUI2ANCE
DATE(MM/DD/YYYY)
' ' 03/12/2009
-
PRODUCER
Aon Risk Services Central, Inc.
TRIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Philadelphia PA Office
AND CONFERS NO RIGDTSUPON TIIE CERTIFICATE ]HOLDER. THIS
One Liberty Place
1650 Market Street
Suite 1000
CERTIFICATE DOES NOTAMEND, EXTEND OR ALTERTIIE
COVERAGE AFFORDED 13Y TIRE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAICN
Philadelphia PA 19103 USA
PHONE.(866) 283-7122 FAX-(847) 953-5390
INSURED
INSURER A: National union Fire Ins Co of Pittsburgh
19445
Lafarge west, Inc
1800 North Taft Hill Road,
INSURERS American Home Assurance Co.
19380
INSURER C: Insurance Company of the state of PA
19429
Fort Collins co 80521 USA
INSURER Granite state Insurance company
23809
INSURERS: Illinois National xnsurance co
23817
COVERAGES
THE POLICIES OF INSURANCE LISTED 131ZLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATLD. NOTWFHS'PANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CON rRACr OR GTIIER, DOCUMENTWI'111 RESPEC"r T'O WHICH'I'131S CER'I IFICALE MAY BE ISSUED OR MAY
PFR-I'AIN, THE INSURANCE AFFORDED BY THIS POLICIES DESCRIBED I IFREIN IS SUB)ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY IIAVE BEEN REDUCED BY PAID CLAIMS, LIMITS SHOWN ARE AS REQUESTED
INSR
CTI(
ADD'L
INSR
'1'YPEOF'INSURANCE
POLICYNUMDER
POI, ICY EFFECTIVE
DAlB(MM\DD\YY)
POLICE EXPIRATION
DATE(M?vRDD\YY)
LIMI"1'S
e
4'F: F:RAI. LIADILITV
GL9723097 (CM)
07/01/08
07/01/09
EACI I OCCURRENCE
$2,000,000
X L'OMMERCIAI. GIiNERN. LIADILITV
DAMAGE"1'0 RENTED
$500,000
X CLAIMSMADE ❑ OCCUR
PREMISES(Eo ocourence)
E ny one person
PERSONAL& ADV INJURY
$2,000,000
❑
GENERAL AGGREGATE
$2,000,000
GFN'L AGGREGATE LIMI r APPLIES P13R'.
❑X POLICY ❑ PRo- ❑ OC
PRODUCTS-COMP/OPAGG
$2,000,000
JrcT
A
A
A
A
AUTOMOBILF,LIABILITY
X
X
ANY AU10
ALL OWNED ANIOS
CA16076SO
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
0311111chk0
$2,000,000
BODILY INJURY
SCHEDULED AUTOS
( Par Person)
X
HIRED AN IDS
BODILY INJURY
)(
NON OWNED AUTOS
(Pcr acciAenp
PROPER'JY DAMAGE
(I'er au:idcm)
GARAGE LIARILI"1'Y
AUTO ONLY - EA ACCIDENT
B ANY AUl'O
O'I'l1EIt THAN IiA ACC
AUTO ONLY-.
AGO
EXCESS/IIMDRELI.A LIABILITY
EACH OCCURRENCE
❑ OCCUR ❑ CLAIMS MADE
AGGREGATE
UEDUCIIBL,
RETENTION
C
D
E
o
E
C
WORKERS COMPENSATION AND
EMPLOVEFS'LIABILrI.Y
ANY PROPRIEl'OR/PARTNER/BXECU 1'IVE
OFI9C.EIt/MIiMi3IiR EXCLUDED'
Ifpes, JesmiLe under Sl'ECIA1, 1'IIOVISIONS
bnlo,.
WC Ao5
WC5145488 (CA)
wcS145489 (FL)
wC5145490 (LA, et<)
C5145491(MI)
WC5145492 (N])
07/01/08
07/01/08
07/01/08
07/1/08
07/01/08
07/01/09
07/01/09
07/01/09
07/01/09
07/01/09
X
\VC 5"TATU-
O i M"
O"I'I i�
F
EL. EACI I ACCIDENT
$2,000,000
EL. DISEASE -RA EMPLOYEE
$2,000,000
P.I,. DISIiASG-POLICY LIMIT
$2, 000, 0001
I
OTHER
DESCRIPTION OF OPERATIONS/LOCA9'IONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: City of Fort Collins Asphalt supply, lob No. 6045. City of Fort Collins is Additional Insured (except on
workers' compensation) as respects operations of the Named Insured where required by written contract. j
i
CERTIFICATE HOLDER
NT LLAT ON
City Of Fort Collins SUOUI,DANYOF'IlirABOVI?DESCRIBEDPOLiC113SRECANCELI,P.DDBFORi3
Administrative services Purchasing Div. DAME
Attn: James B. O'Neill 30
215 North Mason, 2nd Floor BU'I
OF
PO BOX 580
IUEFXPIRA"f1ON
11DiREOFTHE: ISSUING INSURERWILL ENDEAVORTO MAIL
DAYS WIN I EN NO'DCE IO TIIE ci:R 111 CATT HOLDER NAMED TO TIIE LErf, �
IAILURE'10 DO SO SHALL IMPOSE NO OBIAGAUON OR LIABILITY
ANY KIND UPON Tilt INSURER, 1IS AGENTS OR REPRESENTATIVES. I
1
AU'iIiORILED REI'RESIiNTATIVI:
e XY Y
Fort Collins CO 80522-0580 USA
.J�
A > RD 25 200 8 170RD CORPORkrION✓19.5
L
u
4
V
Attachment to ACCORD 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 (Vest, Inc
1800 North Taft Hill Road,
Fort Collins Co 80521 USA
ADDITIONAL POLICIES
If a policy below does no
include limit information, refer to the corresponding policy on
certificate form for policy limits.
INSR
FAR
ADDT,
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY DESCRIPTION
POLICY
EFIT.GLVR
DATE
POLICY
EXPIRATION
DATE.
LIMITS
WORKERS COMPENSATION
A
wC5145493 (OR)
07/01/08
07/01/09
C
wcS145494 (wi)
07/01/08
07/01/09
DLSCi IP HON OF OPFRAI'IONSII.00A'I'IONSIVI!HICLLS/EXCLUSIONS ADDED BY RN DORSEMr;N'rISPEC'IAL PROVI SIGNS
Certificate No : 570033343554