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HomeMy WebLinkAboutLAFARGE WEST - INSURANCE CERTIFICATE (5)a �® CERTIFICATE OF LIABILITY INSURANCE DATE03/30/2010Y) PRODUCER Aon Risk Services Central, Inc. Philadelphia PA Office THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS One Liberty Place CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 16SO 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, INSURERS: Insurance Company of the State of PA 19429 INSURER : Granite State Insurance Company 23809 Fort Collins Co 80521 USA INSURER D: Illinois National insurance Co 23817 INSURER E: COVERACES 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 INSR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS DATE(MM/DD/YYYY DATE(MM/DD/YYYY) A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL9723097 (CM) 07/01/2009 07/01/2010 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $500,000 CLAIMS MADE OCCUR N PREMISES (Ea occurrence) MED EXP (Am, one person PERSONAL k ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $2,000,000 ❑X POLICY ❑ PRO- ❑ LOC JECT A A A AUTOMOBILE LIABILITY X ANY AUTO CA1607650 CA16076S1 (MA) CA1607652 (OR) 07/01/2009 07/01/2009 07/01/2009 07/01/2010 07/01/2010 '07/Ol/2010 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY A X 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 AU1 0 ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: :\GG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE 8 DEDUCTIBLE RETENTION B C D C D B WOR6ERS COMPENSATION AND EMPLOI'ERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (MandafnryinNH) Ifres, desenbetatder SPECIAL PROVISIONS belosc wC 4 A05 wc5145488 (CA) wC5145489 (FL) wC5145490 (LA,etc) wCS145491(MZ) wc514S492 (NJ) 7 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 07/01/2010 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2,000,000: EL. 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: Asphalt supply, job NO. 6045. City of Fort Collins Purchasing Division is Additional Insured (except on workers' Compensation) as respects operations of the Named Insured where required by written contract. CER7'Ih7CA7 E HOLDER CANCELLATION City Of Fort Collins Purchasing Division SHOULD ANY OF TIJE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn: James B. O'Neill DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 North Mason, 2nd Floor 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO BOX 5 8O 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-OS80 USA AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD Attachment to ACO" 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/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570038250546