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HomeMy WebLinkAboutLAFARGE WEST INC - INSURANCE CERTIFICATE (5)A O® CERTIFICATE OF LIABILITY INSURANCE DATDI311rD1�) 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 (847) 953-5390 INC. No. ExI:INC. No.: One Liberty Place EDJNL ESS 16SO Market Street suite 1000 PRODUCER 570000031680 CUSTOMER ID N: Philadelphia PA 19103 USA INSURERIS) AFFORDING COVERAGE NAICIf INSURED INSURER A National union Fire Ins CO of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins to 80521 USA INSURER B: Insurance Company of the State of PA 19429 INSURERc: Granite State Insurance Company 23809 INSURER D: Illinois National Insurance co 23817 INSURER!: Lexington Insurance Company 19437 INSURER F: COVERAGES CERTIFICATE NUMBER: 570041815121 REVISION NUMBER: 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 requeste INSR LTR TYPE OF INSURANCE INSR MD POLICYNUMBER POLICY MMIDO MINDDIYYYY LIMITS GENERAL LIABILITY % COMMERCIAL GENERAL LIABILITY % CLAIMSMADE ❑OCCUR GL CM EACH OCCURRENCE $2,000,000 PREMISES Ee occurrence $S00,000 MED E%P(Any one person) $S0,000 PERSONAL S ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATELIMIT AP PLIES X POLICY I CT PER LDC PRODUCTS -COMPIOP AGO $2,000,000 A A A A AUTOMOBILE X LIABILITY µY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS CA CA 1607651 (MA) CA 16076$2 (0R) CA 1607653 (VA) 07/01 2010 07/01/2010 07/01/2010 07101120100710112011 07 01 2011 07/01/2011 07/01/2011 COMBINED SINGLE LIMIT ascu m S2,000,000 BODILY INJURYIPer person) BODILY INJURY rynaccident) PROPERTY DAMAGE Per ecudenl E % UMBRELLALIAB EXCESS LUIB X OCCUR CLAIMS -MADE bz785160 0710112010 1 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION B C O C O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PNY PROPRIETOR I PARTNER I EXECUTIVE OFFICERLMEMSER EXCLUDED? IMyyandalory In NH) If OESGResame under IPTION OF OPERATIONS 6elo« N/A we S145487(AOS) WC 5145488 (CA) WC5145489 (FL) WC5145490 (LA,etC) wcS145491(mi) 07/01/2010 071011201007/01/2011 0]/O1/2010 07/01/2010 07101120100710112011 07 01 2011 07/01/2011 07/01/2011 WC GTATU- X TORY LIMITS ERA E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT S2,000,000 PERATIONS / LOCATIONS I VEHICLES (A11ech ACORD 101, AddMonal RemaIXa Schedule, IT more space Is required) r6O45halt Supply Renewal. City of Fort Collins is included as Additional Insured on the General Liability policy as perations of the Named Insured where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD µY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: James B. C' Neill Purchasing Di VI si on PO Box 580, 2nd Fl oor Fort Collins CO Floor USA c.?Qosi ✓L.ld�i e/16LecCl9 (�%6JSL2eiGefnCt ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD m 2 to N V m U Attachment to ACORD Certificate for Lafarge west, Inc The terns, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage alturded by the insureds). 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 ADDITIONAL POLICIES If a policy below does no INSURER INSURER INSURER INSURER INSURER t include linlif infomlation, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR T\'PF. OF INSURANCE ADDL INSR SURR wVD POLICYNUMRERI POLICY DESCRIPTION POLICY EFF INIMIDDAI9 T) POLICY F.xP (\I)I/DD/YVVY) LIMITS WORKERS COMPENSATION e N/A wc5145492 CNI) 7/01/2010 07/01/2011 A N/A wc5145493 (OR) 7/01/2010 07/01/2011 g N/A wc5145494 (wI) 7/01/2010 07/01/2011 Certificate No : 57004181S121 ''4C7oRd CERTIFICATE OF LIABILITY INSURANCE °AT07/0012010 "' 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: N the Cetfilcate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. N 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 One Liberty Place 1650 Market Street Suite 1000 Philadelphia PA 19103 USA CONTACT NAME: PHONE (AO,NP, Fen: (866) 283-7122 (847) 953-5390 E4WL 570000031880 PRODUCERw s: cusTOMER INSURER(S) AFFORDING COVERAGE MAICe INSURED LaFarge West, Inc. Concrete/Aggregate 1800 N. Taft H111 Rd. Fort Collins.CO 80525 USA INSURERA: National Union Fire Ins CO Of Pittsburgh 19445 INSURER B: Insurance Company of the state of PA 19429 INSURERC: Granite state Insurance Company 23809 INSURER D: Illinois National Insurance Co 23817 INSURER E: Lexington Insurance Company 19437 Mum F: -- IRCVmIVIe INYImCCR: 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. LYnhs shown are as requests L R TYPE OF INSURANCE IM0% 3 UB R YVVD POLICY NUMBER MUCT IS. uMITa GENERAL LUIBLITY GL CM EACH OCCURRENCE $2.000,000 X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE ❑ OCCUR PREMISES Ee oxuhanca $500,000 MEO E%P (Any we person) $$,000 PERSONAL a AOV INJURY $2,000,000 GENERAL AGGREGATE 52,000,000 GENL AGGREGATE LIMIT APPLIES PER: % I POLICY PRO- LOC PRODUCTS - COMP/OPAGG $2,000.000 A -A A AUTOMOBILE LIABILITY ANY Auro ALL OWNED AUTOS CA CA1607651 (MA) CA1607652 (OR) CA1607653 (VA) 07/01/2010 07/01/201007/01/2011 07/01/2010 07/01/2011 07/01/2011BODILY COMBINED SINGLE LIMIT- aA BODILY INJURY( Per Person) INJURY (Par amJdent) IX SCHEDULEDAUTOsPROPERTY MAGE HIRED AUTOS Wdent) Poreccl4enlNON OWNED AUTOS E X UMBRELLA LNB X OCCUR EACH OCCURRENCE $1,000,000 EXCESS LMIB CLAIMS -MADE AGGREGATE 51,000,000 DEDUCTIBLE RETENTION C D C D EM�P pYERa'LWBLTfYRS TpN AND ANY PROPRIETOR/PARTNERIE%ECl1TIVE YIM OFFICERIMEMBER EXCLUDED? (Myeeenee°°torY In W nFSCRIVTOU nc r',rRcheT�ns,e ,.-�...., NIA WC 1454 A050710112011X WC5145488 (CA) WC5145489 (FL) WC5145490 (LA,etc) we5145491rMrl 07/O1/2010 07/01/2FIR 010 07/01/2010 m7m mmn 07/Ol/2011 07/01/2011 07/01/2011 m7m nml WORY MITE LITAT OTM E.L. EACH ACCIDENT S2,( 00,000 E.L. DISEASE -EA EMPLOYEE S2,000,000 ... ...,.. _-_ wryr„ wr wre i um r llAiA1 wNe 1 YErR:LES (ARACh AGORD 101, A4dMonal Remerks SehedWe. S neIre apeee M re uYed) CERTIFICATE OF INSURANCE PERTAINS TO ANY PARTICULAR LOCATION/CONTRACT/ITEM/VEHICLE OR IF THERE ARE ANY SPECIAL REQUIREMENTS. CITY OF FORT COLLINS IS ADDITIONAL INSURED (EXCEPT ON WORKERS COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED By WRITTEN CONTRACT. RE: JOB: CITY OF FORT COLLINS LIGHT & POWER 2006. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED B ACCORDANCE WITH THE POLICY PROVIENOXE. CITY OF FORT COLLINS ATTN: JOHN STEPHEN AUTHORD:ED REPRESENTATIVE PO BOX 580 FORT COLLINS CO 805220580 USA eL i /l9„Bliw �L `0I�6988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 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 b the insurers) This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. Y INSURED LaFarge West, Inc. Concrete/A gregate 1800 N. Taft H111 Rd. Fort Collins Co 80525 USA ADDITIONAL POLICIES If a policy below does n of INSURER INSURER INSURER INSURER INSURER include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. yTRTYPE OF INSURANCE �aR BR µVD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A WC5145492 (NJ) 7 01 1 07 1 201 A N/A WC5145493 (OR) 7/01/201 1 07/01/2011 B N/A WC5145494 (WI) J/O1/2010 07/O1/2011 Certificate No: 570039480392 ACORlJO CERTIFICATE OF LIABILITY INSURANCE DA7 07/01/2010 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: It the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endomemenL A statement on this certificate does not Confer rights to the cwMcate holder in lieu of such endoreameld(s). PRODUCER CONTACT NPHONE 'WE. Aon Risk Services Central, Inc. Philadelphia PA Office One Liberty Place AIC.W.EIt): (866) 283-7122 (847) 953-5390 EORL 1650 Market Street Suite 1000 PRODUCER 570000031880 CUSTOMER ID a: Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIL• INSURED INSURER A: National union Fire Ins CO Of Pittsburgh 19445 Lafarge West, Inc 1800 North Taft Hill Road, Fort Collins CO 80521 USA INSURER B: Insurance Company of the State of PA 19429 INSURER C: Granite State Insurance Company 23809 INSURER D: Illinois National Insurance CO 23817 INSURER E: INSURER F: GCIVERAGES GERTIFIGATEE NUMBER: DYUU3U 11111W REVISION NUMBER: 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 TR TYPE OF INSURANCE I WIVD POLICY NUMBER IMINDII UMns GENERAL LIA1311-ITY L CMU//U'/ZU'UEACH OCCURRENCE S2,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES Ea omunence 5500,000 X CLAIMS-IMDE ❑ OCCUR MED EXP (Any one Wrenn) S5,000 PERSONAL a AW INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGO S2,000,000 PR % POLICY JEC- LOC A A A AUTOMOBILE X UABILTTY ANY AUTO CA CA1607651 (MA) CA1607652 (DR) 07/01/2010 07/01/2010 07/01/2011 07/01/2011INJURY INGLE LIMB $2,000,000 Person) p X ALLOWNEDAUTOS CA1607653 (VA) 07/01/2010 07/01/2011RY(PerecciCant) SCHEDULED AUTOS DAMAGEX HIRED AUTOStX NPROPE��GE NONOWNEDAUTOS UMBRELLA LIB OCCUR RRENCE AGGREGATE EXCESS LIB CLAIMS -MADE DEDUCTIBLE RETENTION B c D C WORKEM COMPENSATION AND EMPLOYERS UABILITY YIN ANY PROPRIETORI PPRTNERIE%ECUTIVE OFFICELMEMBEREKCLUDED? (Man"wry In NN NIA WC 14 4 AOS07101120107 WC5145488 (CA) WC5145489 (FL) wcS145490 (LA,etc) 07/01/2010 07/01/2010 07/01/2010 1 07/01/2011 07/01/2011 07/01/2011 X WC STATLL OTH- TORY LIMITS IER E.L. EACH ACCIDENT S2,000,000 E.L. DISEASE -EA EMPLOYEE S2,000,000 D antler Uyee DESCRImcdWPTION DESCRIPTION OF OPERATIONS below WC5145491(MI) 07/01/2010 07/01/2011 E.L. DISEASE -POLICY LIMIT S210001000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIMch ACORD 101, AdtlBbnal RrmrM Schedule, If more space W requhe4) CITY OF FC ASPHALT OVERLAY 2007 / jOBM 72253. CERTIFICATE HOLDER IS ADDITIONAL INSURED (EXCEPT ON WORKERS COMPENSATION) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF FC PURCHASING DIVISION ( AVTKNUD REPRESENTATIVE ATTN: MAMES O'NEILL 215 N. MASON ST. 2ND FLOOR '90:74 1117 OL Po Box 580 FORT COLLINS CO 805205220580 USA I 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 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 ADDITIONAL POLICIES INSURER INSURER If a policy below does not includ certificate form for policy limits. refer to the corresponding volicv on the ACORD LNSR LTR TYPE OF INSURANCE ADDL INSR SUBR wVD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MMR)D/YYYY) POLICY E" (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A WC5145492 (NJ) 7 1 2 1 777 11 A N/A WC5145493 (OR) 7/01/2010 07/01/2011 B N/A WC5145494 (WI) 7/01/201 07/01/2011 Certificate No: 570039481860