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HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (5)ACCMI • CERTIFICATE OF LIABILITY INSURANCE �i snnols DATE(MM/DD/YYYY) 7/23/2014 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, Suite 900 Kansas Cityy M0 64112-1906 (816) 960-9000 I Q \Q�O�cs Cl CONTACT INC.No EXt :INC.No EMAIL INSURER A: Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC 1054252 1775 EAST 69TH AVENUE DENVER CO 80229 INSURER B: American Zurich Insurance Company 40142 INSURER C : American Guarantee and Liab. Ins. Co 26247 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 TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF POLICY EXP1111 LIMITS A X COMMERCIAL GENERAL LIABILITY Y NI OLD 5817438-01 8/1/2014 8/1/2015 EACH OCCURRENCE 2,000,000 CLAIMS -MADE T OCCUR DRAALM4I E TO aENMTEO nce 500,000 X MEDEXP(Any oneDemon) 10000 CONTRACTUAL X X.CIICOVERAGF PERSONAL aADVINJURY s2000000 GEN'L AGGREGATE LIMIT APPLIES PER: j{ POLICY JECT - ElLOC GENERAL AGGREGATE $ 51000,000 PRODUCTS - COMPIOPAGG $ 5,000,000 $ OTHER A AUTOMOBILE LIABILITY N N BAP5817437-01 8/1/2014 8/1/2015 COMBINED SINGLE LIMIT Ea accident s 5,000,000 X BODILY INJURY (Per Career) $ XXXXXXX ANY AUTO AUAUTOSULED BODILY INJURY (Per accident $ XXXXXXX HIREDAUTOS RAOT SWNED Pare¢iCen DAMAGE $ XXXXXXX $XXXXXXX C J( UMBRELLALIAB X OCCUR N N AUC3807886-10 8/1/2014 8/1/2015 EACH OCCURRENCE $ 1000000 AGGREGATE $ 1000 000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ 1$ XJ{X'J{xxx 1 B A A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N OFFICER/MEMBEREXCLUDEDi N❑ (M)andatory in NH) If lie under 0 SLRIn. P ION OF OPERATIONS bebx NIA N WC 5817439-02 AOS) WG 5$17440-82 Wl) STOPGAP(ND,O , )A,WY) 8/1/2014 8/1/2014 8/1/2014 8/l/2015 8/1/2015 8/1/2015 PER OTH- L, STATUTE E.L. EACH ACCIDENT $ 5000000 E.L. DISEASE - EA EMPLOYEE 5000000 E.L DISEASE-PoLILY pMIT I t5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF FORT COLLINS, COLORADO IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. L MK I IrIUAIt KVLUCK CANGELLATIVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10726004 AUTHORIZED REPRESENTATIVE CITY OF FORT COLLINS, COLORADO 4316 LAPORTE AVE. FORT COLLINS CO 80522 ACORD 25 (2014101) ©9 8-2014 AC ORPORATION. All rights reserved the ACORD name and logo are registered marks of ACORD