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HomeMy WebLinkAbout102511 LAFARGE NORTHERN - INSURANCE CERTIFICATEACORO10 CERTIFICATE OF LIABILITY INSURANCE DATEO(MIIMID01NYYY) 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 FAX INC. No. Eu): (866) 283-7122 NO Ne o (84]) 953-5390 E-MAIL ADDRESS: One Liberty Place 1650 Market street INSURER(5) AFFORDING COVERAGE NAICY suite 1000 Philadelphia PA 19103 USA 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 O: Illinois National Insurance Co 23817 INSURER E: Lexington Insurance Company 19437 INSURER F: COVERAGES CERTIFICATE NUMBER: 570042217308 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDO MMI➢OM"]Y LIMITS GENERAL LIABILITY GL CM EACH OCCURRENCE $2,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500, 000 X CLAIMS -MADE ❑OCCUR MED EXP(Any one person) $50,000 PERSONAL a ADV INJURY $2,000,005 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPICP AGO $2,000,000 X POLICY El PRo-T El LOC - A A AUTOMOBILE L01911-ITY CA 1607650 CA 1607651 (MA) 07/01/2010 07/01/2010 07/01/2011 07/01/2011 COMBINED sINGLE LIMIT amundern $2,000,000 BODILY INJURY(Par Person) A ANY AUTO CA 1607652 (OR) 07/01/2010 07/01/2011 BODILY INJURY (Per accident) AALL OWNED SCHEDULED CA 1607653 (VA) 07/01/2010 07/01/2011 AUTOS AUTOS No." HIRED AUTOS AUTOS I PROPERTY DAMAGE PeracdEenl E X UMBRELLA UAB X OCCUR 62785160 07/01/2010 0710112011 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $1,000,000 IDEDI IRETENTION B O D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR I PARTNER I EXECUTIVE OFFICER.EMBER EXCLUDED] (Mandatory In NH) NIA WC5145487 A05 WC 5145488 (CA) WC5145489 (FL) WC5145490 (LA,et C) 07 01 2010 07/01/201007/01/2011 07/01/2010 07/01/2010 07/01/2011 07/01/2011 07/01/2011 % WC STATU OTH- TORY LIMITS ER El, EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 O If yea, deardbeunder DESCRIPTION OF OPERATIONS below WC5145491(MI) 07/Ol/201007/Ol/2011 E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Peach ACORD 101, Memoir] Rem&&. Schedule, V more space is required) RE: City Of FC 2011 Overlay Project, Job No. 72322. m N QJ CERTIFICATE HOLDER CANCELLATION =w SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Fort Collins AUTHORIZE) REPRESENTATIVE Attn: James O'Neill Purchasing Division e �� 215 N. Mason Street, 2nd Floor Po Box 580 CO If e41C19'/ faCl Collins CO 80522-0580 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 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 If a policy below does no INSURER INSURER include limit information, refer to the corresponding policy on certificate form for policy limits. INSR LTR TVPE OF INSURANCE ADDL INSR SUBR WVD POLICV NUMBERI POLICY DESCRIPTION POLICY EFF (MMIDD/1'19'Y) POLICY E[P (MMIDDIYVVV) LIMITS WORKERS COMPENSATION e N/A wC5145492 (NJ) D 7 01 201 C 07 01 2011 A N/A wcS145493 (OR) 7/01/201 07/01/2011 8 N/A WC5145494 (WI) 07/01/2010 07/01/2011 Certificate No : 570042217308 /1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) N12012011 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: (NGNNo. E.n; (866) 283-7122 (NOFAXNo : (84]) 953-5390 E-MAIL ADDRESS: One Liberty Place 1650 Market Street INSURER(S) AFFORDING COVERAGE NAIC# suite 1000 Philadelphia PA 19103 USA 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 Granite state Insurance Company 23809 INSURER D: Illinois National Insurance Co 23817 INSURER E: Lezi ngton Insurance Company 19437 INSURER F: COVERAGES CERTIFICATE NUMBER: 570042228702 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 LTR TYPE OF INSURANCE INSR MD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY GL CM EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500, 000 X CLAIMS -MADE ❑ OCCUR MED EXP (Any one person) $50, 000 PERSONAL B ACV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $2.000,000 % POLICY PRa LOC A AUTOMOBILE LIABILITY CA 1607650 0710112010 0710112011 COMBINED SINGLE LIMIT Ea aeeidem $2,000,000 A CA 1607651 (MA) 07/01/2010 07/01/2011 BODILY INJURY (Per person) A ANY AUTO CA 1607652 (OR) 07/01/2010 07/01/2011 AALL OWNED SCHEDULED CA 1607653 (VA) 07/01/20100710112011 BODILY INJURY (Per accident) AUTOS AUTOS NON -OWNED I PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) E % UMBRELLA LIAR X OCCUR 62785160 07/01/2010 07/01/2011 EACH OCCURRENCE $1,000,000 E%CESS LIAR CI -AIMS -MADE AGGREGATE $1,000,000 DED RETENTION B WORKEREMPLOYCOMPENSATION AND WC5145487(A05) 0710112010 0710112 11 y, WC LSTATIMITS ERH C IABILY YIN WC 5145488 (CA) 07/01/2010 ---------- E.L. EACH ACCIDENT $2,000,000 D ANV PROPRIETOR I PARTNER I EXECUTIVE NIA WC5145489 (FL) 07/01/2010 07/01/2011 C OFFICERIMEMBER EXCLUDED? (Mandator, in NH) WCS145490 (LA,etc) 07/01/20100710112011 E.L. DISEASE -EA EMPLOYEE $2,000,000 D 1(ySCRIP ION under DESCRIPTION under OPERATIONS below WCS145491(MI) 07/01/2010 07/01/2011 E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: City of FC 2011 Overlay Project, Job No. 72322. City of Fort Collins is included as Additional Insured on General Liability policy as respects to operations of the Named Insured where required by written contract. CERTIFICATE HOLDER City of Fort Collins Attn: James O'Neill Purchasing Division 215 N. Mason street, 2nd Floor PO BOX 580 Collins CO 80522-0580 USA 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. AUTHORIZED ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment to ACORD Certificate for Lafarge West,Inc The tenns, conditions and provisions noted bcloe 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 INSURER INSURER INSURER If a policy below does not includ certificate form for policy limits. to the corresponding, policy on the ACORD INSR 1:1R 1'YPI] 0 F INS I I RANCF. ADDL INSR SURR N'VD POLIC.YNUNIDER/ POLICYDFSCRIPTION POLICYEFF (\IM/DD/YYYY) POLICYECP (NIMID oil I)'Y) LIM I'IS WORKERS COMPENSATION g N/A WC5145492 (NI) 07/01/2010 07/01/2011 A N/A WC5145493 (OR) 07/01/2010 07/01/2011 13 N/A WC5145494 (WI) 07/01/2010 07/01/2011 Certificate No : 570042228702