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Home My WebLink AboutHOLCIM PARTICIPATIONS (US) INC - INSURANCE CERTIFICATEA� �® CERTIFICATE OF LIABILITY INSURANCE DATE(M09/23/2019 Y) M2019 1 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 AOn Risk Services Southwest, Inc. Houston TX Office CONTACT NAME: PHONE (- FAX (A/C. No. Eat):g66) 2837122 (AIC. No.): (800) 363-0105 E-MAIL ADDRESS: 5555 San Felipe Suite 1500 Houston TX 77056 USA INSURER(S) AFFORDING COVERAGE NAIC If INSURED INSURER A: Indemnity Insurance CO Of North America 43575 HOICim Participations (US) Inc. 6211 Ann Arbor Rd Dundee Mi 48131 USA INSURER B: ACE American Insurance Company 22667 INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: American Guarantee & Liability Ins Co 26247 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570078400975 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YWY MM/DD/VYYV LIMITS B X COMMERCIAL GENERAL LIABILITY HDOG 1 EACH OCCURRENCE $2,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE TO RE rren PREMISES Ea occuce $2,000,000 MED EXP (Any one person) $5 , 000 PERSONAL& ADV INJURY $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $10,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: B AUTOMOBILE LIABILITY ISAH25289432 19-20 Auto (ADS) 10/01/2019 10/01/2020 COMBINED SINGLE LIMIT Ea accident)$5,000,000 BODILY INJURY( Per person) B X ANY AUTO ISAH25289390 10/01/2019 10/01/2020 OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY 19-20 Auto (NH only) SIR applies per policy terns & condi ions BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident D X UMBRELLA LIAR X OCCUR AUC014440103 10/01/2019 10/01/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 DED RETENTION A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) DUse, describe under DESCRIPTION OF OPERATIONS below N/A WLRC65890975 WC (A05) WLRC6 LRC65891013 19-20 WC (A7,MA) 10/01 2 119 10/Ol/2019 10/01/2020 10/Ol/2020 X PER STATUTE oTH- R E.LEACHACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 - E.L. DISEASE -POLICY LIMIT $1, 00O , OOO B Excess Auto Lia XSAH2528947A 10/01/2019 10/01/2020 Aggregate $4,950,000 19-20 XS Auto (NH ONLY) SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) insured is self -insured on physical damage for all owned, leased and rented autos. RE: All projects in and near the city of Fort Collins, CO. City of Fort Collins is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability and Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Purchasing Department Po Box Fort Collinsli co 80522 USA i7LlJrO/c0 cC/--Yarn ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD