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Home My WebLink About102511 LAFARGE NORTHERN INC - INSURANCE CERTIFICATE (8)=1' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/10/2009 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 Lafarge west, Inc 1800 North Taft Hill Road, INSURER B: Insurance Company of the State of PA 19429 INSURER C: Granite State Insurance Company 23809 Fort Collins Co 80521 USA INSURER D: Illinois National Insurance Co 23817 INSURER E: 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 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 ADD' LTR INSRU TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE MM/DD/YYYY DATE MM/DD/YYYY A ERAL 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 (Ea occurrence) MED EXP (Anyone person) PERSONAL & ADV INJURY S2,000,000 ❑ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ ❑X PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 A A A AUTOMOBILE LIABILITY X ANY AUTO CA1607650 CA1607651 (MA) CA1607652 (OR) 07/01/2009 07/01/2009 07/01/2009 07/01/2010 07/01/2010 07/01/2010 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY AX ALL OWNED AUTOS CA1607653 (VA) 07/01/2009 07/01/2010 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 AUTO OTHER THAN EA ACC HANY AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION B C D C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N N ANY PROPRIETOR / PARTNER / EXECUTIVE (MandaoryinOFFICER/MEMNH) EXCLUDED? WC 5 14 5 4 7 AOS WC1141418 (CA) wc5145489 (FL) wC5145490 (LA,etc) wc5145491(MI) 07/01/2009 07/01/2009 07/01/2009 07/01/2009 07/01/2009 07/01/2010 07/01/2010 07/01/2010 07/01/2010 X WC T RY LIMIT STATU- OTHER- E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 B If es, describe under SPECIAL PROVISIONS below wc5145492 (N3) 07/01/2009 07/01/2010 OTHER ■ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 6113 snow and Ice Removal, Sept. 2009 to 3Uly 2010. City Fort Collins is Additional Insured (expect on workers' Compensation) as respect operations of the Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION 7 City Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Purchasingg Division DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn : Bi 11 Buti n 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 58O BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Fort Collins Co 80522-0580 USA AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD O x W tD V m O O n 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) 7/01/2009 07/01/2010 B wc5145494 (wT) 7/01/2009 07/01/2010 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSENIENT/SPECIAL PROVISIONS Certificate No : 570035462986