HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS INC - INSURANCE CERTIFICATE (10)ACORO® CERTIFICATE OF LIABILITY INSURANCE
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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
CONTACT
NAME:
PHONE FAX
A/c..NvINC,No):
E-MAIL
ADORE S:
Charlotte, NC 28202
Attn: CA NON-RESIDENT NO, OB22889
INSURERS AFFORDING COVERAGE
NAIC N
INSURERA: ACE American Insurance Company
22667
J56965.1.MM%GAXWX-13-14 �'--li Q� _
INSURED
Martin Marietta Materials, Inc.
Atin Todd Crump
INSURER B : Indemnity IRS Co Of North America
43575
INSURERC: WA
N/A
INSURER D :
2710 Wycliff Road
P. 0. Box 30013
Raleigh, NC 27622
'INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: ATL-003265413-02 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.
INSR
LTR
TYPE OF INSURANCE
IDOL
SUBR
POLICY NUMBER
LICY EFF
MMIDDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X
HDOG27023927
0913012013
09/3012014
EACH OCCURRENCE
$ 3,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE T RENTED
PREMISES Ea occurrence
$ 50,000
CLAIMS -MADE M OCCUR
MED EXP (Any we person)
$ N/A
PERSONAL 8 ADV INJURY
$ 3,000,000
GENERAL AGGREGATE
$ 6,OOQ000
GEN'L AGGREGATE
LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 6,000,000
$
X POLICY
PRO- LOC
JECT
A
AUTOMOBILE LIABILITY
X
ISAH08722249
09/30/2013
_
09/3012014
COMBINED SINGLE LIMIT
Ea accrtlenl
3,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per amident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
PROPERTY,DAMAGE
Per amnt
$
X X NON —OWNED
MIRED AUTOS AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
I
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION$
I $
B
WORKERS COMPENSATION
WLRC47324518(AOS)
09/30/2013
09130/2014
X VJCSTATu- oTH-
UM TE
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTIVE Q
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
E. L. EACH ACCIDENT
2.000,000
$
E.L. DISEASE - EA EMPLOYE
$ 2,000,000
If ya describe under
DESCRIPTION OF OPERATIONS be.
E.L. DISEASE - POLICY LIMIT
2,000,000
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Reoet Ks schedule, If more apace Is required)
Re: 7377 Asphalt Supply Renewal.
City of Fort Collins - Purchasing Division is included as additional insured (except workers' canpensalion) where required by written contract. A waiver of subrogation applies under Workers Compensation in fawr of
the ceeiflcate holder, it required by written contract with the named insured, subject to the terms and conditions of the policies.
City of Fort Collins -
Purchasing Division
Attn: Gerry Paul
P.O. Box 580
Fort 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 rill 4:2 z) -
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD