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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (18)o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/30/2016 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 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:_ PHONE FAX 100 North Tryon Street, Suite 3600 A/c No): Charlotte, NC 28202 E-MAIL Attn: CANON -RESIDENT N0, OB22889 ADDRESS:-- INSURER(S) AFFORDING COVERAGE _ . NAIC II J56965-1.MMM-GAXWX-15-16 RM201 INSURER A: ACE American Insurance Company 22667 INSURED INSURER B : Indemnity Ins Co Of North America 43575 Martin Marietta Materials, Inc. Attn: Todd Crump INSURER C : North American Elite Insurance Company _ 29700 2710 Wycliff Road INSURER D : Agri General Insurance Company 42757 PO Box 30013 -- Raleigh, NC 27622 INSURER E INSURER F : f%CDTILIr"ATC kit 1IU0II=D• ATI _nnw7AAq-n6 RFVISIr1N NI IMRFR- 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 ADD- SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY HDOG27400425 09/30/2015 09/30/2016 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE � OCCUR DAMAGE TO TED PREMISES (Ea ocicur ence $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 6,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 X POLICY1:1 PRO ❑ LOC JECT $ OTHER: A AUTOMOBILE LIABILITY ISAH08860701 09/30/2015 09/30/2016 OEaMBINED ccident SINGLE LIMIT (CEO, a $ 3,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB X OCCUR UMB200030001 09/3012015 09/30/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED FFETENTION $ $ B A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YNN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) A NIA WLRC48592430 (AOS) WLRC48592429 (CA) WLRC48592417 TN ( ) 09/30/2015 09I30/2015 09/30/2015 09/30/2016 0913012016 09/30/2016 H X STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is/are 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, CERTIFICATE HOLDER II ANI.tLLA I IUN City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N Mason Street 2nd Floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Annette Stefani.vr.x- xfiT U 1988-2014 ACORD GURF'URA I IUN. All rlgnts reservea. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ® A�ORi� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/01/2015 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 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 Marsh USA Inc. 100 North Tryon Street, Suite 3600 Charlotte, NC 28202 Attn: CA NON-RESIDENT NO.OB22889 CONTACT NAME: PHONE): l A/C No E-MAIL ADDRESS: INSURER AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 J56965-1.MMM-GAWX-15-16 INSURED Martin Marietta Materials, Inc. Attn: Todd Crump INSURER B : Indemnity Ins Co Of North America 43575 North American Elite Insurance Company INSURER C : Pa y 29700 INSURER D : NIA N/A 2710 Wycliff Road P. 0. Box 30013 Raleigh, NC 27622 INSURER E : _ INSURER F : COVFRAGES CERTIFICATE NUMBER: ATL-003916691-01 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 YTYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD/YY MM/DD/Y YY LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27400425 09130/2015 09/30/2016 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE lxl OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ PERSONAL & 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 PRO ❑ LOC JECT $ OTHER A AUTOMOBILE LIABILITY ISAH08860701 09/30/2015 09130/2016 COa accidentMBINED SINGLE LiDd!T E $ 3,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED AUTOS AUTOS rx PROP RTY DAMAGE $ $HIRED $ C X UMBRELLA LIAB X OCCUR UMB200030001 09/30/2015 09/30/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DE I RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Ya OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) N/A WLRC48592430 (AOS) WLRC48592429(CA) WLRC48592417 TN ( ) 09130/2015 09130/2015 09/30/2015 09/30/2016 09130/2016 09/30/2016 X STATurE OERH E,L.EACHACCIDENT - $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 2015-2016 Snow Removal City of Fort Collins - 1633272523, 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. 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. CERTIFIGAit HOLUtK 1,ANt rLLAIIUN City of Fort Collins Attn: Purchasing Dept 215 N. Mason St. 2nd Floor 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. Nerissha Tucker ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD