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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS INC - INSURANCE CERTIFICATE (11)ORD® CERTIFICATE OF LIABILITY INSURANCE DATE 6D"YYY) 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 endorsementts). PRODUCER Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO OB22889 J56965-1. MMM-GAXWX-14-15 INSURED Martin Marietta Materials, Inc. Attn: Todd Crump 2710 Wydd Road R 0. Box 30013 Ralegh, NC 27622 RM201 ACE American Insurance Company Indemnity Ins Co Of North America North American Elite Insurance Company I I INSURER F : I COVERAGES CERTIFICATE NUMBER: ATL-003349507-01 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 LTR TYPE OF INSURANCE A DL UBR POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP fMMIDDIYYYYI uwrs A GENERAL LIABILITY HDOG27338872 09/30/2014 09130/2015 EACH OCCURRENCE $ 3,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR _ PREMI S Ea occurrence $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 3,000,0� GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 6,000,000 X POLICY PRO- LOC $ A AUTOMOBILE LIABILITY ISAH08829615 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT Ea accident 3,000,000 BODILY INJURY (Per person) $ALL ANY AUTO OWNED SCHEDULED AUTOSAUTOSPROPERTY Ix BODILY INJURY (Per accident) $ DAMAGE Per aul�nt $ NON-OWNED HIRED AUTOS X AUTOS $ C X UMBRELLA LIAR X OCCUR UMB200030000 09/30/2014 09/30/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,01XI,000 EXCESS LIAR CLAIMS -MADE DIED RETENTION III$ B WORKERS COMPENSATION WLRC48137970 (ADS) 09/30/2014 09/30/2015 WC STATu- oTH- A AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ] (Mandatory in NH) NIA WLRC41I137982(CA) 09/30/2014 09/3012015 E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE -EA EMPLOYE $ 2,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 2,000,000 A Excess Workers Compensation WCUC48137969 (OH) 09/30/2014 D9130/2015 See additional page text. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE. Project: Asphalt Overlay 2015 Renewal Project City of Fort Collins is/are additional insured under General Liability and Automobile Liability as their interest may appear, if required by written 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. Nerissha Tucker ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: J56965 LOC #: Charlotte A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Martin Marietta Materials, Inc. Alm Todd Crump 2710 Wycliff Road POUCY NUMBER P. 0. Box 30013 Raleigh, NC 27622 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance EXCESS WORKERS COMPENSATION (continued from page 1): Policy #WCUC48137969 (913012014-09/30/2015) ACE American Insurance Company Applicable in the state of Ohio $2,000,000 Empbyers Liability - Each Accident $2,000,000 Employers Liability - Disease - per Employee $2,000,000 Employers Liability - Disease - Policy Limit Excess of $2,000,000 Self Insured Retention ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD