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Home My WebLink About497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (10)® AC CERTIFICATE OF LIABILITY INSURANCE lliw� DATE 03/2912019 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 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES 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). CONTACT PRODUCER Marsh USA Inc. NAME: PHONE FAX 100 North Tryon Street, Suite 3600 C Ext) A/C No E-M AIL ADDRESS: Charlotte, N 28202 INSURER(S) AFFORDING COVERAGE NAIC # Attn: CA NON-RESIDENT NO. OB22889 INSURER A: ACE American Insurance Company 22667 CN102458548-1.MMM-GAWX-18-19 - INSURED INSURER B : Indemnity Ins Co Of North America 43575 INSURER C : ACE Property And Casualty Ins Co 20699 Martin Marietta Materials, Inc. Attn: Todd Crump 2710 Wycliff Road INSURER D : INSURER E : — PO Box 30013 Raleigh, NC 27622 INSURER F : GOVtKAUt, VCR I Ir RIM 1 L "Unn UL.,. - - --' -' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY THE INSURED OR OTHER DOCUMENT DESCRIBED PAID CLAIMS. NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, rA RANCE rCOMMERCIALGENEIRALLIABIUTY OCCUR ADDL SUER POLICY NUMBER HDOG71209659 POLICY EFF MM/DD/YYYY 09/30/2018 POLICY EXP MM/DD/YYYY 0913012019 LIMITS EACH OCCURRENCE $ 3,000,000 DAMA E T RENTSO,000 PREMISES Ea occurrence $MED EXP (Any one person) $PERSONAL & ADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 6,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC X JECT PRODUCTS - COMP/OP AGG $ 6,000,000 A OTHER AUTO MOBILELIABILITY ISAH25272274 09/30/2018 09/3012019 Ea aocdentSINGLE LIMIT $ S,OOC,OCO BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE G28167581003 09/30/2018 09/30/2019 1 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X PER OTH- STATUTE ER $ B WLRC6543586A(ADS) 09730/2019 DED RETENTION $ WORKERS COMPENSATION - E.L. EACH ACCIDENT $ 2,000,000 A AND EMPLOYERS' LIABILITY Y / N ANYPitOPRIETOR/PARTNER/EXECUTIVE OFF ICER/MEMBEREXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WLRC65435901 (CA) ) 09/30/2018 09/30/2019 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 EL DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is 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. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions General Liability and Automobile Liability insurance apply on a primary and non-contributory basis, if required by written contract, and subject to policy terms and conditions. It: Hu City of Fort Collins PO Box 2047 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 A1111i.+I-66- n i+I1nnA�AT1A►1 All .;-M rnco 1 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD