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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (22)ATE ,4c�oRo0 CERTIFICATE OF LIABILITY INSURANCE D09/29/2017DnYvr) 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 Marsh USA Inc. NAME: 100 North Tryon Street, Suite 3600 IA. -N EXtl: FAA/C. Noll: Charlotte, NC 28202 ADDRESS: Attn: CA NON-RESIDENT NO.OB22889 -- INSURER S AFFORDING COVERAGE NAIC # J56965- 1.MMM-GAWX-1 7-18 NOC INSURER A: ACE American Insurance Company 22667 INSURED INSURER B : IndemnityIns Co Of North America 43575 Martin Marietta Materials, Inc.- - - Attw Todd Crump INSURER C : ACE Property And Casualty Ins Co 20699 2710 Wycliff Road PO Box 30013 INSURER D Raleigh, NC 27622 INSURER E : COVERAGES CERTIFICATE NUMBER- ATL-004700792-04 RFVISIOPJ NIIMRFR- 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 SUBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY - LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27871525 09/30/2017 09/30/2018 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE OCCUR DAMA E 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 POLICY ❑ PRO JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER. A AUTOMOBILE LIABILITY ISAH09063717 09/30/2017 09/30/2018 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X BODILY INJURY (Per person) _ $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR G28167581002 09/30/2017 09/30/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA WLRC64619457(ADS) WLRC64619792 (CA) 09/30/2017 09/30/2018 09/30/2018 X IPER OTH- STATUTE ER EL. $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 E. DESCRIPTION OF OPERATIONS / 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. 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. General liability and auto liability insurance apply on a primary and non-contributory basis, if required by written contract, and subject to policy terms and conditions. Please see additional page for Notice of Cancellation information City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Annette Stefani,-,, icc�E_.7�casz.c, ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: J56965 LOC #: Charlotte A " ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Martin Marietta Materials, Inc. Attn: Todd Crump 2710 Wycliff Road POLICY NUMBER PO Box 30013 Raleigh, NC 27622 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Notice of Cancellation for General Liability and Auto Liability: If the insurer cancels the policy prior to its expiration date by notice to the insured for any reason other than nonpayment of premium, the insurer will endeavor to send written notice of cancellation to City of Fort Collins, P.O. Box 580, Fort Collins, CO 80522. The insurer will endeavor to send or deliver such notice at least 30 days prior to the cancellation date applicable to the Policy. This notice is intended only to be a courtesy notification. The insurer has no legal obligation of any kind to City of Fort Collins, P.O. Box 580, Fort Collins, CO 80522. The insurer's failure to provide advance notice of cancellation to City of Fort Collins, P.O. Box 580, Fort Collins, CO 80522 shall impose no obligation or liability of any kind upon the insurer, its agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the policy. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD