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HomeMy WebLinkAboutLAFARGE WEST - INSURANCE CERTIFICATE (6)® -`�� �CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/06/2010 PRODUCER Aon rusk 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 INSURERA: National Union Fire ins co of Pittsburgh 19445 •• Lafarge West, Inc 19429 tG INSURER : Insurance Company of the State of PA 1800 North Taft Hill Road, INSURERC: Granite State Insurance Company Fort Collins Co 80521 USA 23809 0 INSURER D: Illinois National Insurance Co 23817 L d b INSURER E: j 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 LTR DD' INSRU TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE(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 MADE OCCUR N PREMISES (Ea occurrence)CLAIMS MED EXP (Am one person) PERSONAL & ADV INJURY $2 , 000, 000 ❑ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ ❑X LOC- IECT 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 A )( ALL OWNED AUTOS CA1607653 (vA) 07/01/2009 07/01/2010 SCHEDULED AUTOS ( Per person) X HIRED AUTOS BODILY INJURY J( 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 ❑ OCCUR ❑ CLAIMS MADE AGGREGATE HDEDUCTIBLE RETENTION B C D C D EMPLOYWORKERS COMPENSATIONIABILI.4NU EMPLOYERS' LIABILITY �' / N ANY PROPRIETOR/PARTNER/EXECUTIVE N❑ OFFICER/MEMBER EXCLUDED? (Mandatory inNll) WCS 454 7 AOs WC5145488 (CA) wc5145489 (FL) WC5145490 (LA,etc) wc5145491(MI) 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 STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2 , 000 , 000 E.L. DISEASE -EA EMPLOYEE $2 , OOO , OOO E.L. DISEASE -POLICY LIMIT $2,000,000 Yves. describe under SPECIAL PROVISIONS belowB WC5145492 (NJ) 07/01/2009 07/01/2010 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: STU M455-077 Colldge-Harmony intersection, Job No. 72311. City of Fort Collins and Colorado Department of Transportation are included as Additional insured on the General Liability policy as respect operations of the Named Insured where required by written contract. ULR1 Ir ICAIE HOLDER CANCELLATION • City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Purchasing Division DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn : James O'Neill 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 215 North Mason St. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Fort Collins CO 80522 USA OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD V 00 00 rn r» O 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 (WI) 7/01/2009 07/01/2010 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570038758441