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HomeMy WebLinkAboutLAFARGE WEST INC - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE DATE10/ °8°/2200 ) 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 A 19103 USA 6Fac �847) 953-5390 Pxox 28INSURER INSURED A: National union Fire Ins Co of Pittsburgh 19445 Lafarge west, Inc INSURER B: Insurance Company of the State of PA 19429 1800 North Taft Hill Road, INSURERC: Granite State Insurance Company 23809., +: Fort Collins Co 80521 USA INSURER D: Illinois National Insurance Co 23817 d INSURER E: p COVERAGES 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 INSURANCEt1FFORDED 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 ADD' LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DD DATE(MM/DD/YYYY) A GENERAL LIABILITY GL9723097 (CM) 07/01/2009 07/01/2010 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500 , 000 X CLAIMS MADE OCCUR PREMISES occurrence) MED XP (Any one person PERSONAL & ADV INIURY $2,000,000 rr V n GENERAL AGGREGATE $2,000,000 - V GEN'L AGGREGATE LIMIT APPLIES PER: m o PRODUCTS - COMP/OPAGG IIX $2,000,000 ❑X POLICY ❑ PRO- ❑ LOC O JECT A AUTOMOBILE LIABILITY CA1607650 07/01/2009 07/01/2010 COMBINED SINGLE LIMIT < A X ANY AUTO CA1607651 (MA) 07/01/2009 07/01/2010 (Ea accident) $2,000,000 2 A CA1607652 (OR) 07/01/2009 07/01/2010 BODILY INJURY A X ALL OWNED AUTOS CA1607653 (VA) 07/01/2009 07/01/2010 SCHEDULED AUTOS ( Per person) X HIRED AUTOS i L BODILY INJURY - X NON OWNED AUTOS - (Per accident) PROPERTY DAMAGE _ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE - E] OCCUR ❑ CLAIMS MADE �- AGGREGATE BDEDUCTIBLE RETENTION _ B wC 4 4 AOS 7 X WC STATU- OTH- C WORKERS COMPENSATION AND YIN wc5145488 (CA) 07/01/2009 07/01/2010 TORY LIMITS ER E.L. EACH ACCIDENT $2,000,000 D EMPLOYERS'LIABILITY El (FL) 07/01/2009 07/01/2010 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC5145490 (LA,etc) 07/01/2009 07/01/2010 E.L. DISEASE -EA EMPLOYEE $2,000,000 D (MandaroryinNH) wc5145491(MI) 07/01/2009 07/01/2010 E.L. DISEASE -POLICY LIMIT $2,000,000 B Ifyes, describe under SPECIAL PROVISIONS below wC5145492 (NJ) 07/01/2009 07/01/2010 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: East Harmony Rd. widening, Job No. 72308. city of Fort Collins Purchasing Division is included as an Additional Insured with respect to the General Liability policy as respects to operations of the Named Insured where required by written contract. - CERTIFICATE HOLDER CANCELLATION City Of Fort Collins Purchasing Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn: Darin Atteberry DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N . Mason St., 2nd Floor 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, I PO BOX 5 8O BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Fort Collins CO 80522 USA ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE e��On ����—� ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved= The ACORD name and logo are registered marks of ACORD 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) 07/01/2009 07/01/2010 B wc5145494 (wI) 07/01/2009 07/01/2010 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570036477431