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HomeMy WebLinkAbout109888 INSITUFORM TECHNOLOGIES INC - INSURANCE CERTIFICATE (6)ACORDe DATE (MMIDD/YYYY) �i CERTIFICATE OF LIABILITY INSURANCE 7/1/2011 6i28/2010 PRODUCER Lockton Companies,LLC-1 St. Louis Three City Place Drive, Suite900 St. Louis MO 6314l-7081 (314) 432-0500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Insituform Technologies, Inc. ] 041932 17988 Edison Avenue Chest ChesterFleld MO 63005 INSURER A: Liberty Mutual Fire Insurance Company(64) 23035 INSURER B: Liberty Insurance Corporation (64) 42404 INSURER D COVERAGES INSTE02 29 THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING�R 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADYL INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MMIDDNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED PREMISES Ea ooeurence $ 350 000 A COMMERCIAL GENERAL LIABILITY CLAIMS MADE FxI OCCUR T132-641-004218-030 7/1/2010 7/12011 MED Ei(P (Any one person) $ 10,000 X PERSONAL S ADV INJURY $ 2,000,000 A Independt Contractor BROAD FORM PD/CONTRACTU AL X XCU GENERAL AGGREGATE $ 4,000,000 A PER PROJECT AGG. CAP $20M GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 4000000 PRO - POLICY X JECT F LOC A AUTOMOBILE LIABILITY ANY AUTO AS2-641-004218-020 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Peramideia) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXX}fJ x GARAGE LIABILITY ANY AUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC $ XXXXX}(X AUTO ONLY. AGG $ XXXXXXX EXCESWUMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX OCCUR CLAIMS MADE ❑ UMBRELLA NOT APPLICABLE Is XXXXXXX X E XXXXXX DEDUCTIBLE FORM $ X'xXXxxx RETENTION $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNER/E%ECUTIVE OFFILERMIEMBER E(CLUDED? N WA7-64D-009004-040 WC7-641-004218-010 (WI&OR) 7/1/2010 7/1/2010 7/1/2011 7/1/2011 X WC STATU- OTH- T RV LIMIT R EL EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) if yes. describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS... OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: P-1022 CUPED-IN-PLACE PIPE SANITARY AND STORM SEWERS. THE CITY FORT CLLILNSITS AND EMPLOYEES ARE ADDITIONAL INSUREDS UNDER GENERAL LIABILITY AND AUGTOMOBILE LIABILITY ASFFICERSREQUIRED BYTWRI'ITEN CONTRACT BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE NAMED INSUREDS OPERATIONS. EXCEPTION TO CANCELLAtION PROVISIONS: 10 DAYS FOR NONPAYMENT OF PREMIUM. XX CITY OF FORT COLLINS 215 N. MASON STREET FORT COLLINS CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL BIi1XE.A)MXX MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AI0QJ67 xet=X 1>ZJ:8DJ6/Git ACORD 25 (2009101) Fo ..can ... carc mna this cernifficante. ne AeuttU name and loyro are rregdisetered marks oaf ACORD client ends •INSTEoz. All riahte reeeroed AX— "fill CERTIFICATE OF LIABILITY INSURANCE 7i1/2011 DATE (MMODNYYY) 1 6/28/2010 PRODUCER Lockton Companies,LLC-1 St. Louis THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Three City Place Drive, Suite 900 St. Louis MO 63141-7081 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (314) 432-0500 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Insltuform Technologies, Inc. INSURER A: Liberty Mutual Fire Inswance Company (64) 23035 1041932 17988 Edison Avenue Chesterfield MO 63005 INSURER B: Liberty Insurance Corporation (64) 42404 INSURER C INSURER D' INSURER E : COVERAGES 1NSTE02 29 THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING D THE C RTIF DER. RER A TH R ENTATWE R AED.—NOTWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADVL INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE DATE (MM/DD/1'1') POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FRI OCCUR TB2-641-004218-030 7/1/2010 7/1/2011 DAMAGE(cf ED PREMISES EaEa NTED nce $ 350 000 MED EXP (My one person) $ 10,000 A X Independt Contractor BROAD FORM PD/CONTRACTU AL PERSONAL s ADV INJURY $ 2,000,000 X XCU GENERAL AGGREGATE $ 4,000,000 A PER PROJECT AGG. CAP $20M GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 4000000 PRO- POLICV X JECT LOC A AUTOMOBILE LIABILITY ANY AUTO AS2-641-004218-020 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per amiden0 $ XXXXX) x HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY ANY AUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC $ XXXXXXX AUTO ONLY. AGG $ XXXXXXX EXCESS/UMBRELLA LIABILITY OCCUR F—ICLAIMS MADE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX UMBRELLA NOT APPLICABLE $ XXXXXXX $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORRARTNER/EXECUTIVE OFFICERrNIEMBER EXCLUDED9 N WA7-64D-009004-440 WC7-641-004218-010 (WI BL OR) 7/l/2010 7/1/2010 7/1/2011 7/1/2011 WC STATU- OTH- X TO RY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) N yes, describe under SPECIAL PROVISIONS teal. E. L. DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE: P-763, CIPP SANITARY AND STORM SEWERS (3RD YEAR OF TERM)). THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS AND EMPLOYEES ARE ADDITIONAL INSUREDS UNDER GENERAL LIABIILITY AND AUTOMOBILE LIABILITY AS REQUIRED BY WRITTEN CONTRACT, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE NAMED INSURED'S OPERATIONS. EXCEPTION TO CANCELLATION PROVISIONS: 10 DAYS FOR NONPAYMENT OF PREMIUM. XX CERTIFICATE HOLDER CANCELLATION 3731597 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS 215 N. MASON STREET FORT COLLINS CO 80524 DATE THEREOF, THE ISSUING INSURER WILL I%X%piX)M MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XWyA4XNX0[OA{S0) M OhTt;aEtAlruGXLYA1IkXJ7AttILX9:OF7N1T0SC'14�19DXXHEXN6D0AE6�XtX?1DkTt78X0B AUTHORIZED REPRESE ACORD 25 (2009101) © 1%94QB9`WACORD Z-RPORATION. All rights reserved The ACORD name and let zo are remistered marks of ACORD For amortions n wrento this certificate. mme,t the number 11 it in the 'Rod section above and swci , IM client code'INSTE02'.