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Home My WebLink About102511 LAFARGE NORTH AMERICA - INSURANCE CERTIFICATE. ., A CORUM 3 CERTIFICATE OF LIA 01TY DATE (MM/DD/YYYY) INS 7RANC,E,- 04/17/2009 PRODUCER on 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 Lafarge west, Inc 1800 North Taft Hill Road, INSURER : American Home Assurance Co. 19380 INSURER Insurance Company of the state of PA 19429 Fort Collins CO.80521 USA INSURER : Granite State Insurance,Company 23809 INSURER E: Illinois National insurance Co 123817 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 ADD'L INSRU TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM\DD\YY) POLICY EXPIRATION DATE(MM\DD\YY) LIMITS B GENERAL LIABILITY GL9723097 (CM) 07/01/08 07/01/09 EACH OCCURRENCE $2 , 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500, 000 X CLAIMS MADE OCCUR PREMISES (Ea occutence) MED (Any one person) PERSONAL & ADV INJURY $ 2 , 000 , 000 GENERAL AGGREGATE $2 , 000 , 000 GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ ❑X LOC PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 JECT A A A AUTOMOBILE LIABILITY X ANY AUTO CA1607650 CA1607651 (MA) cA1607652 (OR) 07/01/08 07/01/08 07/01/08 07/01/09 07/01/09 07/01/09 COMBINED SINGLE LIMIT (Ea accident) - $2 , 000, 000 BODILY INJURY A X ALL OWNED AUTOS CA1607653 (VA) 07/01/08 07/01/09 _ _ 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 ❑ OCCUR ❑ CLAIMS MADE AGGREGATE HDEDUCTIBLE RETENTION C D E D E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Ifyes, describe under SPECIAL PROVISIONS below WC AOS WC514S488 (CA) WCS145489 (FL) WC5145490 (LA,etc) wC5145491(MI) wc5145492 (NJ) 07/01/08 07/01/08 07/01/08 07/01/08 07/01/08 07/01/09 07/01/09 07/01/09 07/01/09 07/01/09 X WC STATU- TORY LIMIT OTH- ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE $2,000,000 $ 2 , 000 , 000 E.L. DISEASE -POLICY LIMIT $2 , 000, 000 OTHER 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City Of Fort Collins Purchasing Division is included as Additional Insured (except on workers' compensation) as respects to operations of the named insured where required by written contract. waiver of subrogation is granted a in favor of certificate holder as required by written contract but limited to the operations of the insured under CERTIFIGATEHOLDEIi '.. „ ,.. 3. CANGEILATIUN ,F' , ,... " CityOf Fort Collins Purchasing Division 9 Attn: Darin Atteberr{V 215 N . Mason st 2 nd F I oor PO BOX SHO Fort Collins CO 80522 USA s SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL r 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, sc BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. r AUTHORIZED REPRESENTATIVE ✓ ACURD 25'' 200U08 y., . i ACORD' CORPORATION 1989 c x O m M m O O V m O O n LM 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 ADD'L 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/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS said contract, and always subject to the policy terms, conditions and exclusions. Certificate No : 570034003930