HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (4)Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
09/12(2018
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 have ADDITIONAL INSURED provisions or 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 CONTACT
Marsh USA Inc. NAME:
PHONE FAX
100 North Tryon Street, Suite 3600 C,No. Ext): (A/c No):
Charlotte, NC 28202 E-MAIL
Attn: CA NON-RESIDENT NO. OB22889 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
CN102458548-1.MMM-GAXWX-18- RM201 _ INSURER A: ACE American Insurance Company 22667
INSURED INSURER B : Indemnl Ins Co Of North America 43575
Martin Marietta Materials, Inc. ty
Attn: Todd Crump INSURER C : ACE Property And Casualty Ins Co 20699
2710 Wycliff Road INSURER D
PO Box 30013
Raleigh. NC 27622 INSURER E :
C0VFRACFR RFRTIC:l All IRAP=D• ATi nnAQ9WAn „
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
ADD L
SUBR-----
WVDPOLICY
----1
NUMBER
— --OLIC
MM/DD YYYY)
(MM/DDtYYYY1
----- -----
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F_V_1 OCCUR
HDOG71209659
09/30/2018
09/30/2019
EACH OCCURRENCE
$ 3,000,000
DAMA E T RENTED
PREMISES Ea occurrence
$ 50,000
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ 3,000,000
GEN'L
X
AGGREGATE LIMIT APPLIES PER:
PRO-
POLICY � JECT LOC
GENERAL AGGREGATE
$ 6,000,000
PRODUCTS - COMP/OP AGG
$ 6,000,000
$
OTHER
A
AUTOMOBILE
LIABILITY
ANY AUTO
ISAH25272274
09/30/2018
09/30/2019
COMBINED SINGLE LIMIT
Ea accident
$ 5,000,00U
X
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
X
PROPERTY DAMAGE
Per accident
$
_
X
UMBRELLALIAB
X
OCCUR
G28167581003
09/30/2018
09/30/2019
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LIAB _
CLAIMS -MADE
DED I RETENTION $
$
B
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? N
N/A
WLRC6543586A (AOS)
WLRC65435901 (CA)
r
09/30/2018
09/30/201
09/30/2019
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 2,000,000
E L DISEASE - EA EMPLOYEE
$ 2,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins I 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.
Annette Stefani
U 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD