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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS INC - INSURANCE CERTIFICATE (9)A�RD ® CERTIFICATE OF LIABILITY INSURANCE DATE YYYV) 0410212014 zo14 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 Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO.OB22889 CONTACT NAME;_ PHONE 6 No FAk E-ML AooAIRE INSURERSAFFORDING COVERAGE NAICi INSURER A: ACE Amencan Insurance Company 22667 J56965-1.MMMGAXWX-13-14 RIX101 INSURED Mahn Marietta MaterialI s, rc. 4q �� Alin: Todd Crump N' INSURER B : IndenMllly Ins Co Of North America 43575 INSURERC: WA WA INSURER D 2710 Wycli6 Road R 0. Box 30013 Raleigh, NC 27622 INSURER E: i INSURER F - I COVFRAGFS CERTIFICATE NUMBER: ATL-003257373-01 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. INSR L TYPE OF INSURANCE POLICY NUMBER M POLICY EFy D Y EXP IMMIYYYYI LIMIT8 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR HDOG27023927 09130/2013 0913012014 EACH OCCURRENCE $ 3,00Q000 DAMAGE TO RENTED $ 50,000 MED EXP (Any OnePerson) $ WA PERSONAL a ADV INJURY S 3,000,000 GENERAL AGGREGATE $ 6.000,000 GENL AGGREGATE POLICY LIMIT APPLIES PER X '0- LOC PRODUCTS-COMP/OP AGG $ 6,000.000 S A AUMMICIBILELIABILITY ANY AUTO ALLOWMED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS Ix ISAH08722249 091WO13 =02014 COMBINED SINGLE LIMIT a accident 3000000 BODILY INJURY(Per person) S BODILY INJURY(Per accdeanhaccoson WPERTYOAMAGE P. $ $ UMBRELLA Ll" EXCESS LWB OCCUR CLAIMS -MADE EACHOCCURRENCE S AGGREGATE $ DEO I I RETENTIONS S g WORKERS COMPENSATION AND EMPLOYERS' LIABILITYVI ANY PROPRIETOR/PARTNERIEXECUTIVE ❑NN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yea descrl0e under DESCRIPTION OF OPERATIONS helm NIA WLRC47324518(AOS) 091301 13 09/30/2014 X I WC STATU- I OTH- E.L. EACH ACCIDENT $ Z000Ogg E.L DISEASE - EA EMPLOYEE S 2,000,000 E.L. DISEASE- POLICY LIMIT S 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES plA sch ACORD 101, Additional Remarks Schedule, If more apace la rogW M) Project: Asphalt Overlay - 2014 Renewal # 7222 City of Fort Collins islare additional insured under General Liability as their interest may appear, if required by written contract with the names insured, subject to the tens and Conditions of the policies. rconcrrATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N Mason Street 2nd Floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Marilyn F Burns �'✓i �^'�� 7' � ©1988.2010 ACORO CORPORA I ION. All rlgnts reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A�Ro® CERTIFICATE OF LIABILITY INSURANCE DA11V201l00YYYY) 01;11!20,4 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 Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO.OB22889 CONTACT NAME: HONE FAX No PUk/C No. ExH Jr q D E-MAIL ESs: INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Irsurance Company 22657 J56965-1.MMM4AXWX-13.14 RM201 INSURED Manin Marietta MaterialsInc. , INSURER B: Indemnity Ire Co Of North America 43575 INSURER C : WA NIA Attn Todd Crump 2710 Wydi6 Road P. 0. Box 30013 INSURER D INSURER E: Raleigh, NC 27622 _ INSURER F: COVERAGES CERTIFICATE NUMBER: ATLM3257373-02 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. ILSR TYPE OF INSURANCE A L U WVn POLICY NUMBER M POLICY EFF POUCY EXPSR LIMITS A GENERAL LIABILITY HDOG27023927 091302013 09/3012014 EACH OCCURRENCE $ 3,000,000 X COMMERCIAL GENERAL LL481LITY CLAIMS -MADE M OCCUR PREMISES $ 50,000 MED EXP (Any oneperson) $ WA PERSONAL a AOV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6.000,D00 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 6,000,000 POLICY F X I PRO- LOC S A AUTOMOBILE UABILITY ISAH08722249 09/30/2013 09/30,2014 COMBINED SINGLE LIMIT(E. accidenu 3,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident $ XVMED HIRED AUTOS X NAO.NOS PROPERTY DAMAGE rat $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS -MADE DELI I I RETENTION $ B WORKERS COMPENSATION WLR 1 ) OV=13 09/=14 XWCSTATU- OTH- AND EMPLOYERS' LIABILITYLIM ANY PROPRIETORIPARTNEWEXECLITIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, desaibe under DESCRIPTION OF OPERATIONS below NIA E.L. EACH ACCIDENT 2,000,000 $ E.L DISEASE - EA EMPLOYEE $ 2,000.000 E.L DISEASE -POLICY LIMIT S 2•DD0•000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ABach ACORD 101, Additional Remarks Sehedure, If more space Is required) Project: Asphalt Overlay - 2014 Renewal # 7222 City of Fort Collins is/am additional insured under General Liability as their interest may appear, if required by written contract with the names insured, subject to the terms and conditions of the polices, A waiver of subrogation applies under Workers Compensation in favor of the certificate holder, if required by written contract with the named insured, Subject to the terms and conditions of the polices. City of Fort Collins 215 N Mason Street 2nd Floor Fart Collins, CO 80522 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 REPRESENTATIVE of Marsh USA Inc. Marilyn F Burns _` 7vl 7 - la� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORO ® CERTIFICATE OF LIABILITY INSURANCE OA4/1401OD YYY ) TE oan41zo14 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 Marsh USA Inc. 100 North Tryon Street Suite 3600 Charlotte, NC 28202 Ath: CA NON-RESIDENT NO.0822669 CONTACT NAME: _ PHONE FAX N EMAIL ADORE INSURE S AFFORDING COVERAGE NAICIs INSURERA: ACE American Insurance Company 22667 J56965-1.MMfAGA%WX-13-14 RM201 INSURED Martin Marietta Materials, Inc. Atkin Todd Crump INSURER B : Indemnity Ins Co Of North America 43575 INSURER C : NIA WA INSURER D 2710 Wyclilf Road R 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F rna.ee aeee CERT!F!CATE NUMBER: An m375737f1-m3 REVISION NUMBER: V 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. IN8R L TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF YWDDY/YExYV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEIT] OCCUR HDOG27023927 09/30/2013 DVJW2014 EACH OCCURRENCE $ 3,000,000 PREMISES Ea ocourn,mv)S 50'DDO MED E%P(Any are person) S WA PERSONAL S ADV INJURY S 3,000.000 GENERAL AGGREGATE $ 6A04000 GENL AGGREGATE LIMIT APPLIES PER: POLICY X PR0. LOC PRODUCTS - COMP/OP AGG S 6,000,000 S A AUTOMOBILE LIABILITY ANY AUTO SSCHHEEDULED �O AUTOS X NON-OWNEDS IX AUTOS ISAH06722249 09/3012013 09/3012014 COMBINED SINGLE LIMIT 3D00000 BODILY INJURY(PrPanon) s BODILY INJURY(ParacciM) S PROPERTYOWNED DAMAGEHIRED (Per acc4entil $ UMBRELLA LIAS EXCESS LIMB OCCUR CVJMS-MADE EACH OCCURRENCE $ AGGREGATE $ DELI I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICEWMEMBER E%CLUDE07 (Mandatory In Hint a yes desr+Ibe Jr.laf OESCRIPTION OF OPERATIONS below NIA R 7 516(AOS) 1 09/301201 WRYISTATUIMM- OTRI E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYE S 2,000,000 E.L. DISEASE -POLICY LIMIT S 2,000,0W DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACORD 101, Additional Remarks Schedule, P mom sPsce Is requlradf Project: Asphalt Overlay - 2014 Renewal # 7222 City of Fat Collins is additional insured under General Liability and Alto Liability as their interest may appear, it required by written contract with the names insured, suhject to the leans and Conditions of the policies. A waiver of subrogation applies under Workers Compensation in favor of the certificate holder, if required by wnflen contract with the named insured, subject to the terms and conditions of the policies. Cry of Fort Collins 215 N Mason Street 2nd Floor Fort Collins, CO 60522 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 REPRESENTATIVE of Marsh USA Inc. Marilyn F Bums 7V7 w -ZII' '6 — CC) 119911l ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD