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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (8)AC40 �® CERTIFICATE OF LIABILITY INSURANCE DATE( YYYY) lV/ 04119/201912019 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 NAME_ Marsh USA Inc. - - - -_--- -- - - -- - 100 North Tryon Street, Suite 3600 PHONE FAX (A/C. No. Extl:_ _ _ (A/C Charlotte, NC 28202 IL Attn: CA NON-RESIDENT NO. OB22889 ADDRESS: __ INSURERS) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 CN10245850-1.MMM-GAWX-18-19 RM201 INSURED Martin Marietta Materials, Inc. INSURER B : Indemnity Ins Co Of North America 43575 INSURER c : N/A N/A Attm Todd Crump 2710 Wycliff Road PO Box 30013 INSURER D -------- --- INSURER E : Raleigh, INC 27622 INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-004932668-01 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 ADDL SUER- POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR HDOG71209659 09/30/2018 09/30/2019 EACH OCCURRENCE $ 3,000,000 PREMDAMAGE 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 POLICY 171 PRO ❑ JECT LOC GENERAL AGGREGATE $ 6,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER. A AUTOMOBILE LIABILITY ISAH25272274 09/30/2018 09/30/2019 COEaMBINED SINGLE LIMIT ac,^.ident $ 5,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per er accent ( ) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident - $ LIAB OCCUR EACH OCCURRENCE $ FUMBRELLA AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � N/A WLRC6543586A (ADS) WLRC65435901 (CA) 09/30/2018 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 (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) Re: Job: Asphalt Overlay Project - 2019 Renewal City of Fort Collins, its officers, agents and employees is/are additional insured under General Liability (including ongoing and completed ops) 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. A waiver of subrogation applies under General Liability, Automobile Liability, and Workers Compensation in favor of the certificate holder, if required by written contract with the named insured, subject to the terms and conditions of the policies. City of Fort Collins Attw Purchasing Division PO Box 580 Fort Collins, CO 80522 I IUN 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�,rrf._ © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD