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HomeMy WebLinkAboutLAFARGE WEST INC - INSURANCE CERTIFICATE (3)A ® CERTIFICATE OF LIABILITY INSURANCE DATE07/01/22010 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Philadelphia PA office CONTACT NAME: PHONE (866) 283-7122 FAX (A/C. No. EXt): FAC. No.): (847) 953-5390 ADDRESS: One Liberty Place Suit Market Street Suite 1000 PRODUCER 570000031880 CUSTOMER ID#: Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins CO Of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA INSURERB: Insurance Company of the State of PA 19429 INSURERC: Granite State Insurance Company 23809 INSURER D: Illinois National Insurance Co 23817 INSURER E: INSURER F: GUVtKACitS CCKIIFICArE Nl1MREK• h/[ 10:1144F471 hh RFV131r1N 1UI IMRFR- THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADD INSR SUBR WVD POLICY NUMBER MWDD EXP MM/DD LIMITS A GENERAL LIABILITY GL(CM) 7771777=67/01/201f EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE ❑ OCCUR PREMISES Ea occurrence $ 500 , 000 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 , 000, 000 X POLICY PRO- ECT LOC A A A AUTOMOBILE X LIABILITY ANY AUTO CA1607650 CA1607651 (MA) CA1607652 (OR) 07/01/2010 07/01/2010 07/01/2010 0710112011 07/01/2011 07/01/2011 COMBINED SINGLE LIMIT Ea accident)$2,000,000 BODILY INJURY ( Per person) A X ALL OWNED AUTOS CA1607653 VA ( ) 07/01/2010 07/01/2011 BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS Per accident X NON OWNED AUTOS UMBRELLA LIAB EACH OCCURRENCE EXCESS LIAB HOCCUR CLAIMS -MADE AGGREGATE DEDUCTIBLE RETENTION B O D C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC5145487(AOS) WC5145488 (CA) WC5145489 (FL) WC5145490 (LA,etc) WC5145491(MI) 07 01 2010 07/01/2010 07/01/2010 07/01/2010 07/01/2010 07/012011 07/01/2011 07/01/2011 07/01/2011 07/01/2011 X I WC Y STATU- OTH- TORY LIMITS R E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2 , 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CITY HALL PARKING LOT OVERLAY / JOB# 72286 City of Fort Collins is Additional insured (except on worker's comp) as respects to operations of the named insured where required by written contract. —J LO LO N 00 a coo O O LO 4 - ti CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ■ EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �i CITY OF FORT COLLINS AUTHORIZED REPRESENTATIVE P.O. BOX 580 FORT COLLINS CO 80522 USA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A wc5145492 (NJ) 0710112010 07/01/2011 A N/A wc5145493 (OR) 0710112010 07/01/2011 B N/A wc5145494 (wr) 0710112010 07/01/2011 Certificate No: 570039482155