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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (23)A ® DATE /YYYY) CERTIFICATE OF LIABILITY INSURANCE os/2s/2017/2o17 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 INSURERS), 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: PHONE FAX 100 North Tryon Street, Suite 3600 A/c A/c Not. Charlotte, NC 28202 E-MAIL Attn: CA NON-RESIDENT NO.OB22889 ADDRESS: J56965-1. MMM-GAXWX-17-18 INSURED Martin Marietta Materials, Inc Attn: Todd Crump 2710 Wycliff Road PO Box 30013 Raleigh, NC 27622 ACE American Insurance COVFRAGFS CERTIFICATE NUMBER- ATL-004339045-10 REVISION NUMBER: 22667 43575 N/A 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 INSD WVD SUER POLICY NUMBER MM/DD/YYYY) (MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X HDOG27871525 09/30/2017 09/30/2018 EACH OCCURRENCE $3,000,000 _ fDAMAGE CLAIMS -MADE lX I OCCUR T R N PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 3,000,000 I 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 X ISAH09063717 09/30/2017 09/30/2018 CEa OMaccidentBINED SINGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) NIA WLRC64619457 (ADS) WLRC64619792 (CA) 09/30/2017 09/30/2018 09/30/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 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 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 7377 Asphalt Supply Renewal. City of Fort Collins - Purchasing Division is additional insured (except Workers' Compensation) 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 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. GtK I It-IGA I t MULUtK k ANIL r_LLA I IUN City of Fort Collins - Purchasing Division Attn: Gerry Paul P.O. 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 Stefani_rsx�t�'cFe.c. © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD