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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (5),ac - CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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:__--- r PHONE 100 North Tryon Street, Suite 3600 (A/C. No. Ext): I FAX c, No): Charlotte, NC 28202 E-MAIL Attn: CA NON-RESIDENT NO OB22889 ADDRESS: CN102458548-1.MMM-GAWX-18-19 INSURER A: ACE American Insurance Company 22667 INSURED Martin Marietta Materials, Inc. INSURER B : Indemnity Ins Co Of North America 43575 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 : INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-004822417-02 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY HDOG71209659 09/30/2018 09/30/2019 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE 1XI OCCUR AG TOR D PROEM SES (Ea oN ur ence $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 6,000,000 POLICY PRO- JECT D LOC X PRODUCTS -COMP/OP AGG $ 6,000,000 $ OTHER A AUTOMOBILE LIABILITY ISAH25272274 09/30/2018 09/30/2019 COMBINED SINGLE LIMIT Ea accident $ 5.000.000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident _.._ $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY _ X UMBRELLA LIAB X OCCUR G28167581003 09/30/2018 09/30/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in Ni N/A WLRC6543586A(AOS) WLRC65435901 (CA) 09/3012018 09/30/2019 09/30/2019 X PER oTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 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) Re. Asphalt Supply - 8729 Certificate Holder is additional insured under the General Liability and Auto Liability policy, if required by written contract with the named insured, subject to the terms and conditions of the policy. Waiver of Subrogation is included in favor of the Certificate Holder, where required by written contract and subject to policy terms and conditions.The insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to general liability and auto liability, subject to policy terms and conditions. CERTIFICATE HOLDER City of Fort Collins - Purchasing Dept. 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. Annette Stefani _> s.exrC._ ._rw ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD