HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (12)ACORD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
09;27;2019
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 riqhts to the certificate holder in lieu of such endorsement(s).
PRODUCER
Marsh USA Inc.
100 North Tn Street, Suite 3600
Charlotte. NaC 28202
AtN: CA NON-RESIDENT NO.OB22889
CN102458548-1.MMM-GAWX-19-20 RM201
INSURED
Martin Marietta Materials, Inc.
Attn: Todd Crump
2710 Wydiff Road
PO Box 30013
Raleigh. NC 27622
FAX
I'IVC
Not:
COVERAGES CFRTIFICATF NIIMRFR' ATL-004932668-05 REVISION NUMBER:
TIC
v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTVATHSTAN DING 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.
IN SR
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIALGENERALLIABILITY
HDOG71448368
09/3012019
09/3012020
EACH OCCURRENCE
$ 3,000,000
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 50,000
MED EXP (Any one person)
$
PERSONAL A ADV INJURY
$ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 6,000,000
PRODUCTS - COMP/OP AGG
$ 6,000,000
X POLICY JECT PRO ❑ LOC
OTHER
A
AUTOMOBILE LIABILITY
ISAH25285992
09/30/2019
09130/2020
Ee aBIINdED SINGLE LIMIT
$ 5,000,000
BODILY INJURY (Per person)
6
X ANY AUTO
BODILY INJURY (Per a=clerd)
OWNED SCHEDULED
$
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
$
_.
PROPERTY DAMAGE
Per accidem
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
EXCESS UAB
CLAIMS -MADE
$
OED RETENTION$
$
B
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑N
(Mandatory in NH)
NIA
WLRC66042078 (AOS)
WLRC6604211A CA
( )
09I30/2019
130/2020
09130/2020
X STATUTE ERH
$ 2,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$ 2,ODO,000
I DISEASE -POLICY LIMIT
$ 2,W0,000
It yes, describe under
DESCRIPTION OF OPERATIONS belowE.L.
-
F
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required)
Re: Job'. Asphalt Overlay Project - 2019 Renewal
City of Fort Collins, its officers, agents and employees islare 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
Attn. Purchasing Division
PO 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 Stetani
ACORD 25 (2016/03)
lJ -I U00-LV 10 Ml. MuI IVn. M II I.V I I Ia I cacIvua.
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