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HomeMy WebLinkAbout497786 MARTIN MARIETTA MATERIALS - INSURANCE CERTIFICATE (27),411%, CERTIFICATE OF LIABILITY INSURANCE DATE(YYY) 03I171201712017 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 FAX al o ivc No _ E-MAIL — ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 J56965-1.MMM-GAWX-16-17 INSURED Martin Marietta Materials, Inc. INSURER B : Indemnity Ins Co Of North America 43575 INSURER C : North American Elite Insurance Company 29700 Attn: Todd Crump 2710 Wycliff Road PO Box 30013 INSURER D : Agri General Insurance Company 42757 INSURER E : Raleigh, NC 27622 INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-004159200-01 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. INSIRLTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDYYYYI (MM/DD/YYYYJ 1 LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27857012 09/30/2016 09/30/2017 EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE �� OCCUR PRESESOEa .'T."..) cu oRENTED Mnce $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 X POLICY ❑ PRO- JECT LOC ❑ PRODUCTS -COMP/OP AGG $ 6,000,000 $ OTHER A AUTOMOBILE LIABILITY ISAH09049617 09/30/2016 09/30/2017 COMBINED SINGLE LIMIT Ea accident $ 3,000,000 k BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS FT AUTOS C X UMBRELLA LIAB X OCCUR UMB200030002 09/3012016 09/30/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B D A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY v / N ANY PROPRIETOR/PARTNER/EXECUTIVEBEEXCLUDE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A WLRC49100723 (ADS) WLRC49100735 TN ( ) WLRC49103268 CA ( ) 09/30/2016 09/30/2016 09/30/2016 09/30/2017 09/30l2017 09/30/2017 X STATUTE ERH E L EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under OF OPERATIONS below E.L DISEASE -POLICY LIMIT 2,000,000DESCRIPTION $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re 2017 City of Fort Collins Overlay Project - 1633272577 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. A waiver of subrogation applies under General Liability, Automobile Liability, Workers Compensation, and Umbrella Liability 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. l;tK I IhK;A It HULUtK City of Fort Collins Purchasing Div. 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. Annette Stefani © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD