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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS INC - INSURANCE CERTIFICATE (12),acoizv® CERTIFICATE OF LIABILITY INSURANCE °0901201�DYYYY) 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 endorsements . PRODUCER Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Add: CA NON-RESIDENT NO.OB22889 CONTACT NAME: UVC. N FAX AD No: E-MAIL ADDRESS, INSURE S AFFORDING COVERAGE NAIGtl INSURER A: ACE American Insurance Company 22667 J56965-1.MWGAXWX-14-15 RM201 INSURED Martin Materials, Inc. AW:Todd ToddCrump INSURER B : Indemmty Ire Co Of North America 43575 INSURERC: WA WA INSURER D: 2710 Wyditf Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003086073-12 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 ADOL UBR POLICY NUMBER MIDDPOLICY EFF POLICY EXP M DD/YYYY LIMITS A GENERAL LIABILITY HDOG27338872 09/30/2014 09/3912015 EACH OCCURRENCE $ 3A 0,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED PREMISES Ea ocarrence $ 50000 MED FXP (Arty are person) $ CLAIMS -MADE a OCCUR PERSONAL B ADV INJURY It 3J000.000 GENERAL AGGREGATE $ 6,000,000 GENT AGGREGATE LIMN APPLIES PER: PRODUCTS - COMPIOP AGG It 6,000,000 $ X POLICY PRO- LOG JECT A AUTOMOBILE LIABILITY ISAH08829615 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT Ea accident It 3,000,000 BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accidem) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED AUTOS X AUTOS Ix PROPERTY DAMAGEHIRED Per accidera $ UMBRELLA LIAR OCCUR EACH OCCURRENCE It AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ $ B WORKERS COMPENSATION WLRC48137970 (ADS) 09130I2014 0913012015 wG sraru- OTH- A AND EMPLOYERS' LIABILITY YON ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N/A WLRC48137982 (CA) 09130I2014 09/3012015 E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE -EA EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT 2,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES ~h ACORD 101, Additional RemuMs Schedule, If more apace Is required) Re: Project: Harmony Road Maintenance Project; Bid No. 7366 The Omer, (City of Fort Collins), engineer, and engineer's consultants and their respective officers and employees are additional insured under General Liability and Automobile Liability as their interest may appear, if required by when contract with the named insured, subject to the terms and conditions of the policies. Contractual Liability— Railroad is added to the GL policy in favor of the certificate holder. The general liability policy does not have an exclusion or limitation for any work being done within 50 feet of the railroad track. CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 Laporte Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fart Coffins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manlyn F Bums�►7''� 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ,acoRbr CERTIFICATE OF LIABILITY INSURANCE °09I29/20140rcYm 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 Ab: CA NON-RESIDENT NO.OB22889 CONTACT NAME: IAIC. No. Ent,PHONE FAX AC No: E-MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAICN INSURER A: ACE American Insurance Company 22667 J56965-1.MMM-GAXWX-14-15 INSURED Martin Marietta Materials, Inc. Atln: Todd Crump INSURER S : Indemnity Ins Co Of North America 43575 INSURER C : NIA WA INSURER D : 2710 Wyolitf Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003089523-08 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. INSLTR TYPE OF INSURANCE AODL IM UBR Mn POLICY NUMBER MM/DDY/Y M/DDvYYYY UNITS A GENERAL LIABILITY HDOG27338872 09/3012014 09/3012015 EACH OCCURRENCE $ 3,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES F. occurrence $ 50,000 MED EXP (Any are person) $ CLAIMS -MADE rx I OCCUR PERSONAL aADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6,000,000 GERL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 6,000,000 $ X POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY ISAH08829615 09130/2014 09/30/2015 COMBINED SINGLE LIMIT Ea accident 3,000,000 BODILY INJURY(Per person)$ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED AUTOS Os NON-OWNEDPROPERTYDAMAGEHIRED AUTOS X AUTOS Ix Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION$ $ B WORKERS COMPENSATION WLRC48137970 (ADS) 0913012014 09/3012015 WC STATU- OTH- A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER E%CLUDEO? F_N] (Mandatory in NH) N/A WLRC48137982 (CA) 09/30/2014 09/30/2015 E.L. EACH ACCIDENT $ 2,000,000 E L. DISEASE- EA EMPLOYE $ 2,000,000 E L DISEASE- POLICY LIMIT $ 2,000,000 If yes desm1he ender DESCRIPTION OF OPERATIONS talow DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES fAUach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: Project: Annual Asphalt Overlay Renewal 2012 Omer (City of Fort Collins), engineer, engineers consultants, their respective offices and employees is/are additional insured under General Liability (including Completed Ops) and Automobile Liability as their interest may appear, it required by wnden contract with the named insured, sublect to the tens and conditions of the policies. CFRTIFICATF HOI nFR CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 Laporte Ave 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 Bums 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORD® �. CERTIFICATE OF LIABILITY INSURANCE DATE (MMMWYYYY) 09/29I2014 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 endorsemen s . PRODUCER Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO.OB22889 CONTACT NAME:PHONE I FAX ac Not, E-MAIL ADDRESS: INSURERIS) AFFORDING COVERAGE NAIC r INSURER A: ACE American Insurance Company 22667 J56965-1.MMWGAXWX-14-15 RMMI INSURED MartINSURER Ahn: dMaterials, Inc. tN: Todd d Cwmp B: Indemnity In Cc Of North America 43575 INSURER C : WA WA INSURER D 2710 Wyd ff Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003085657-08 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 DD UBR POLICY NUMBER MMIDDYEFF /YYYY MM/DDYUP /YYYY OMITS A GENERAL LIABILITY HOOG27338872 0913012014 D913012015 EACH OCCURRENCE E 3,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE + PREMISES Ea occurrence $ 50,000 MED UP (Any onePerson) E CLAIMS -MADE 1!1 OCCUR PERSONAL a ADV INJURY $ 3,000,000 GENERAL AGGREGATE E 6,000,000 GEN-L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO S 6,000,000 E X POLICY 7 PRO- LOC A AUTOMOBILE LIABILITY ISAH08829615 0913012014 09/30/2015 COMBINED SINGLE LIMIT Ea accident 3,000,000 BODILY INJURY(Per person) _ S ANY AUTO BODILY INJURY(Per accident) S ALL OVINEO SCHEDULED AUTOS OS X NON -OWNED HIRED AUTOS AUTOS Ix PROPERTY DAMAGE Peraccidt e $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIKE CLAIMS -MADE DED I I RETENTIONS I $ B MRRERSCOMPENSATION WLRC48137970(ADS) 09/30/2014 09MO15 X IWCSTATILIM - 1 onJ- FR A AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN (MandaOFFICEtory in N R EXCLUDED9 (Mandatory in NH) N / A WLRC48137982 GA ( ) 09/3012014 09YJ012015 E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYE S 2,000,000 E.L. DISEASE - POLICY LIMIT E 2,000,000 Ir ya,. dasuil» urwer DESCRIPTION OF OPEMTIONS Eebx DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ARach ACORD 101, AddlUonal Remarlu Schedule, Itmora space Is required) Re: Asphalt Supply - Bid #7377 Asphalt Supply City of Fort Collins islars additional insured under General Liability and Automobile Liability as their interest may appear, if required by written contract vAth the named insured, subject to the terms and conditions of the policies. As respects General liability Coverage any additional insured with whom you haw; agreed to provide such noncontdhutory insurance, pursuant to and as required under a written contractexecuted prior to the date of loss. City of Fort Collins PO Box 580 Fat 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 Bums ©1988-2010 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A4�oR& CERTIFICATE OF LIABILITY INSURANCE °009/29Y10114° YYYI 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(les) 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 Alth: CA NON-RESIDENT NO.OB22889 CONTACT NAME: PRONE FAX. No: EMAIL ADDRESS, INSURERS AFFORDING COVERAGE NAICS INSURER A: ACE American Insurance Company 22667 J56965-1.MMM-GAXWX-1415 RM201 INSURED Mahn Marietta Materials, Inc. Attn: Todd Crump INSURER B : Indemnity Ins Cc Of North America 43575 INSURER C: WA WA INSURER D : 2710 Wyddf Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F COVE Re GEE CFRTIFICATE NUMBER: ATL-003257373-06 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 TR LS TYPE OF INSURANCE ADDL UBR POLICY NUMBER MMIUDDY� MMIDDY/YYYY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR HDOG27338872 09130/2014 09/302015 EACH OCCURRENCE S 3,000,000 AMA PREMISES IE. ocanrence $ 50,000 MED EXP one ) $ PERSONAL 3ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PRO- LOC PRODUCTS-COMP/OP AGOX HS6,000,000 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOSX NON-OWPIED HIRED AUTOAITOS S AUTOS ISAHD8829615 09/302014 OgrA 2015 COMBINED SINGLE LIMITacNa 1 BODILY INJURY (Per person) BODILY INJURY(Per accdent)X PROPERTY DAMAGE r eM f UMBRELLA LIAB EXCESS DAB OCCUR CLAIMS -MADE EACH OCCURRENCE f AGGREGATE S DIED RETENTION$ S B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/ ECUTWE OFFICEWMEMDER EXCLUDED? (Mandatory in NH) If ye: desvibe „Neer DESCRIPTION OF OPERATIONS belay NIA WLRC48137970(ADS) WLRC48137982 (CA) 09I302014 09/30/2014 091302015 09/302015 WC sI IMIT OR E. L. EACH ACCIDENT 2,000,000 $ E.L. DISEASE -EA EMPLOYE $ 2,000,01)0 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space is required) Project: Asphalt Overlay - 2014 ReneAal # 7222 Cry of Fort Collins is additional insured under General Liability and Auto Liability as their interest may appear, if required by Milan contract with the names insured, subject to the tens and conditions of the policies. A waiver of subrogation applies under Workers Compensation in favor of the Certificate holder, if required by vmUen contract with the named insured, subject to the terms and conditions of the policies. City of Fort Collins 215 N Mason Street 2nd Floor 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 Burns4�e^'s� V 1933-2010 AGORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE L./ DATE 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(les) 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.OB22889 CONTACT NAME: PHONE FAX AD No: EaeAIL ADORES : INSURERS AFFORDING COVERAGE "Co INSURER A: ACE American Insurance Company 22667 J56965-1.MMM-GAXWX-Wl5 RM201 INSURED Martin Marietta Materials, Inc. Alb: Todd Crump INSURER B: Indemnity Ire Go Of North America 43575 INSURER C : North American Elite Insurance Canparry 29700 INSURER D: 2710 W7dlff Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-003171504-06 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 ADDL UBR POLICY NUMBER MMDDY/YYYY UP MEFF M/DDY /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR HDOG27338872 09/30/2014 09/30/2015 EACH OCCURRENCE $ 3•01)0'000 DAMAGE TO RENTED PREMISES Ea ominence $ 50,000 MED UP (Any one person) $ PERSONAL S ADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6,000,000 GENE AGGREGATE X POLICY LIMIT APPLIES PER: PRO- LOC PRODUCTS-COMP/OP AGG S 6,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS TOS X NON —OWNED MIRED AUTOS AUTOS Ix ISAH08829615 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT Ea accident 3000 000 BODILY INJURY(Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB200030000 09/30/2014 09/30/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER E%CLUDED9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I WLRG48137970 (ADS) WLRC48137982 (CA) 0913012014 0913012014 09/3012015 09/30/2015 X I WC STATU- OTH- E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE- EA EMPLOYEE $ 2,000,000 EL DISEASE- POLICY LIMIT $ 2.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Amch ACORD 101, Additional Remarks Schedule, If mom space Is required) RE: Project: Asphalt Overlay 2013 Renewal Project City of Fort Collins is/am additional insured under General Liability and Automobile Liability as their interest may appear, if required by written mnuact with the named insured, subject to the terms and conditiDns of the policies. CM of Fort Collins 215 N Mason Street 2nd Flom 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 7Yff. - zee-c+Ma 1933.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE `�" °09112291200140nYYY) 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(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 endorsemen s . PRODUCER Marsh USA Inc. WO NoM Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO.OB22889 CONTACT NAME: PHONE FAY AC No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE HARD INSURER A; ACE American Irlsaance Company 22667 J56965-I.MMMIGAXWX-14-15 INSURED Martin Marietta Malanals, Inc. Attn: Todd Crump INSURER B : Indemnity Ina Go Of North America 43575 INSURER C: WA WA INSURER D: 2710 Wydiff Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-003265413-05 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 TYPEOFINSURANCE ADDL UBR POLICYNUMBER EFF MM/DD/YfYY MCY MIODYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR X HDOG27338872 0913012014 09/30/2015 EACH OCCURRENCE $ 3,000,000 DAMAGE TO RENTED PREMISES Ea ocwnence $ 50000 MED EXP (Any one Person) $ PERSONAL$ ADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6,000,000 GEWL AGGREGATE X I POLICY LIMIT APPLIES PER: PRO- LOC PRODUCTS-COMP/OP AGG $ 6,000,000 $ A AUTOMOBILE UABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOS NON -OWNED Ix X ISAH08829615 09/3012014 09r,012015 COMBINED SINGLE LIMIT Ea scadent 3000000 BODILY INJURY(Per person) $ BODILY INJURY(Per amdem) $ Pe'. DAMAGE $ $ UMBRELLA DAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS cal. N/A WLRC48137970 (AOS) WLRC48137982 (CA) 09/3012014 0913012014 09130/2015 09130/2015 X WC STATU- oTH- 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 I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remand, Schedule, If mom apace Is mqulrad) Re: 7377 Asphalt Supply Reneival. City of Fort Collins - Purchasing Division is included as additional insured (except makers' compensation) where required by written contract. A waiver of subroga on applies under Workers Compensation in favor of the cer6flcate holder, if required by written contract with the named insured, subject to the terms and conditions of the policies. CERTIFICATE HOLDER CANCELLATION City of Fat Coffins- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Purchasing Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Gerry Paul ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fat Collins, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Marilyn F Bums 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORD® � CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDIYYYY) 09129/2014 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 Norm Tryon Street, Suite 3600 Charlotte, NC 28202 Attu: CA NON-RESIDENT NO.OB22889 CONTACT NAME: PHONE FAX ac No: AE-MAIL DDRE : INSURE S AFFORDING COVERAGE NAICtl INSURER A: ACE American Insurance Company 22667 J569WI.rM%GAXWX-14-15 RM201 INSURED Martin Marietta Materials, Inc. Attn: Todd Crump INSURER B : Indemnity Ins Co DI North America 43575 INSURERC: WA WA INSURER D : 2710 Wyciiff Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-003104327-09 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. t�TRR TYPE OF INSURANCE AD L UBR POLICY NUMBER MM/DDPOLICYEFF /YYYY MMIODYEXP A`YYY LIMIT? A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR HDOG27338872 09/30/2014 09/3012015 EACH OCCURRENCE S 3,000,000 _ N PREMISES Ea occunence $ 50,000 IVIED EXP (My one son) $ PERSONAL$ ADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: 7 PRO- LOC JECT PRODUCTS-COMP/OP AGG $ 6,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED ITOS X AUTOS X NON OWNED HIRED AUTOS AUTOS ISAH08829615 09/3012014 09/3012015 COMBINED SINGLE LIMIT Ea ecciden 3,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per amidenl) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA UAS EXCESS UAB OCCUR CWMS44ADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B A WORKERS COMPENSATION AND EMPLOYERS'LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑NN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N yes, describe under DESCRIPTION OF OPERATIONS below NIA WLRG48137970(ADS) WLRC48137982 (CA) 09130/2014 09130/2014 09130/2015 09130/2015 X I WCSTATU- oTH- E.L. EACH ACCIDENT $ 2'0'0 E.L. DISEASE - EA EMPLOYEE $ 2 DO E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Athch ACORD 101, Additional Remarks Schedule, H mars apace Is required) RE: Project Snow 81ce Removal City of For(Collins Were additional insured under General Liability and Automobile Liability as their interest may appear, if required by written contact with the named insured, subject to the terms and conditions of the policies. City of Fort Collins Alm: Purchasing Department PO Box 580 Fat 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 Bums 7Yq-411— 7 - 4-54 • ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD