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Home My WebLink About486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (4)ACC>Rtr CERTIFICATE OF LIABILITY INSURANCE lh.� 8/1r014 DATE(MMIOD/YYYY) 1 3/3/2014 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(its) 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 Lockton Companies 444 W. 47th Street, Suite 900 Kansas Cittyy MO 64112-1906 (816)960-9000 CONTACT Rght AIC No Ext : AIC No E-MAIL ADDRESS INSURER A: Zurich American Insurance Com am; 16535 INSURED LAYNE INLINER, LLC 26 7915 CHERRYWOOD LOOP 48 6 9 s `t KIOWA, CO 80117 INSURER B: INSURER C INSURER D COVERAGES LAY NOl CERTIFICATE NUMBER: 11412295 REVISION NUMBER: XXXXXXX 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. IN R TYPE OF INSURANCE AD L SUSR IND POLICY NUMBER P ICY fF 5/1/2013 LIM ICY EXP 8/1/2014 LIMITS A x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CONTRACTI JAI, Y N GLO 5817438-00 EACH OCCURRENCE S 2,000.000 PAMM E TO RENTED noel $ SOO OOO MED EXP (Any one rson 10,000 X CI J COVFRAGF PERSONAL a ADV INJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY JEC LOC OTHER GENERAL AGGREGATE 55000000 PRODUCTS - COMP/OP AGG $ 5,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AALLOWNED X A�TEppDULED X AUTOSWNED N N BAP5817437-00 5/1/2013 8/1/2014 COMBINED ISINGLE LIMIT $5000000 1xx BODILYINJURY(PerPerson) $ XXXXXXX BODILY INJURY(Per evident $ XXXXXXXHIREDAUTOS PROPERTY DAMAGE ?Per acodentI $ XXXXXX�A• $ XXXXX3 x UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XX)C)Cx x AGGREGATE $ XX700OCX DED I I RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AN PROPRIETORPARTNERIEXECUTIVE YIN OFFICER/MEMBERE%CLUDEDt N❑ IManAeterr In NH) DESCRIPTION OF OPERATIONS WIN, NIA N WC 5817439-00 AOS) WC 5817440-DD STOPGAP(ND,O A,WY) 5/1/2013 5/1/2013 8/1/2014 8/If2014 v R OTM X srgruTEFR E.L. EACHACCIDENL s5,000,000 EL.DISEASE-EAEMPLOYEE s 5000000 E.L. DISEASE - POLiLT LIMIT 5.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) RE: FT. COLLINS, CO. 7106 CIP SANITARY SEWER STORMWATER MAINS REHAB. CERTIFICATE HOLDER IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. 11412295 CITY OF FT. COLLINS PURCHASING DIVISION PO BOX 580 FT. 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. The ACORD name and logo are registered marks of ACORD ACCW& CERTIFICATE OF LIABILITY INSURANCE �i 8/1/2014 DATE(MM/DDIYYYY) 1 3/3/2014 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyIes) 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 endomement(s). PRODUCER LOCkton Companies 444 W. 47th Street, Suite 900 Kansas Cittyy M0 64112-1906 (816)960-9000 CONTACT ac No EXe : FAX Not, E-MAIL ADDRESS AFFORDINGINSURERISI INSURER A: Zurich American lnsurancc Companv 16535 INSURED LAYNE INLINER, LLC 1054252 1775 EAST 69TH AVENUE DENVER CO 80229 INSURER B: American Guarantee add Liab. Ins. Co. 26247 INSURER C: INSURER F COVERAGES LAYINOI CERTIFICATE NUMBER: 10726004 REVISION NUMBER: XXXXXXX 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 Im TYPE OF INSURANCE IADUL NSO BR POLICY NUMBER P LICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMSWADE ® OCCUR CONTRACTUAL Y N OLD 5817439-00 5/1/2013 8/1/2014 EACH OCCURRENCE 2000000 DAMA E TO RENTED n 500 000 X MED EXP An ane arson 10 000 X X CII COVERAGE PERSONAL S ADV INJURY $ 2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: X POLICV0JECT �LOC OTHER GENERAL AGGREGATE $S000000 PRODUCTS - COMPIOPAGG $ 5000000 $ A AUTOMOBILE LIABILITY ANY AUTO AA�L OWNED X A�HEppDULED HIRED AUTOS X AUTTOOgSWNED N N BAP 5817437.00 5/l/2013 8/1/2014 COMBINED Ea acadent)SINGLE LIMIT $ 5 OOO OOO X BODILY INJURY (Per person) $ XXXXXXX X BODILY INJURY (Per accident $ XXXXXXX X PerracE.cIden DAMAGE $ XXXXXXX $XXXXXXX B X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE N N AUC 3907886-09 5/1/2013 9/1/2014 EACH OCCURRENCE s 1 000 000 AGGREGATE $ 1000 000 DED I I RETENTION $ s XXXXXXX A A A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? N IMndttory In NNI If as dascalas Under DESCRIPTION OF OPERATIONS Gel. NIA N WC 5817439-00 (jA�OOS) WC 58174/4A0rt-1DD :/. STOPGAP(NDO WA,WY) 5/1/2013 5/l/2013 8/1/2014 8/1/2014 P R TM X STATUTE E.L EACH ACCIDENT $ 5.000.000 E.L. DISEASE - EA EMPLOYEE 5.000,000 E.L. DISEASE- POLICY DMn t5000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Scheduk, may be attached R more space is required) CITY OF FORT COLLINS COL,ORADO IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. 10726004 CITY OF FORT COLLINS. COLORADO 4316 LAPORTE AVE. 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. ACORD 25 The ACORD name and logo are registered marks of ACORD ACC>Ro' CERTIFICATE OF LIABILITY INSURANCE 16.� 8/1/2014 DATE(MM/DDNYYY) 1 3/3/2014 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 Lockton Companies 444 W. 47th Street, Slate 900 Kansas City M0 64112-1906 (816) 960-9000 CONTACT ac NO E:e : (AID, Ne E-MAIL ADDRESS NAIC INSURER A: Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC 26 7915 CHERRYWOOD LOOP KIOWA, CO 80117 INSURER B: INSURER C : COVERAGEs LAYINOI CERTIFICATE NUMBER: 12249603 REVISION NUMBER: XXXXXXX 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. IN R TYPE OF INSURANCE IADDL NSD WVD SUBR POLICY NUMBER P LICVIM EFF PO 1 V EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMSLMDE Ex] OCCUR CONTRACTUAL Y N GLO 5817438-00 5/12013 8/1/2014 EACH OCCURRENCE 2,000,000 DAMA TO ENTED FMED 500,000 2L EXP (My onePenton) 10.000 X X C.0 COVERAGE PERSONAL A ADV INJURY s 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY[:]PRO-LOC OTHER GENERAL AGGREGATE s 5 0 00 000 PRODUCTS - COMP/OP AGG s 5,000,000 $ A AUTOMOBILE LIABILITY ANY AUTOfO(X' AUTOBNED X SUTEppRULED HIRED AUTOS X UTpSWNED A Y N BAP 5817437-00 5/1/2013 8/1/2014 MBINED SINGLE LIMIT $ 5,000,000 X BODILY INJURY person) $ YY_Y_V X BODILY INJURY (Per accident $ XXXXXXX X PROPERTYDANIA E $ XXXXXXX $XXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXX3IX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEIVEXECUTnE YIN OFFICERIMEMBEREXCLUDE09 N❑ IMendclo In NH)Is u yee, IPTOe Omer DESCRIPTION OF OPERATIONS telwr NIA N WC 58t7439-00 SAOS) WC 5EI74/4wD1-DD lWI) STOPGAP`..D,GH,WA,WYj 5/1/2013 5/I/2013 8/1/2014 8/I/2014 OTH- X STATUTE FR E.L. EACH ACCIDENT $ SOOO OOQ E.L. DISEASE.EAEMPLOYEE 5.000.000 E.L. DISEASE -POLICY LIMIT 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: LAYNE JOB NO. 23603, 7106 CURED IN PLACE SANITARY SEWER STORMWATER MAINS REHABILITATION — FORT COLLINS CO' CITY OF FORT COLLINS IS INCLUDED AS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILIIFY AS REQUIRED BY SIGNED, WRITTEN CONTRACT. 12249603 CITY OF FORT COLLINS PURCHASING DIVISION PO 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. The ACORD name and logo are registered marks of ACORD All rights reserved