HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (6)P521NN12 N/N12
O
DATE(MMIDD/YYYY)
AC 40RO CERTIFICATE OF LIABILITY INSURANCE 09/19/2018
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 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 LIC #OC36861 1-415-403-1491 CONTACT Kimberly Leikam
NAME: _
Alliant Insurance Services, Inc. PHONE 415-403-1491 FAX 415-874-4818
O.
E-MAIL klaikaz9alliant.com
100 Pine Street, llth Floor ADD RE88:
INSURE S AFFORDING COVERAGE NAIL 9
San Francisco, CA 94111 INSURER A: Vey FORGE INS CO 20508
INSURED INSURERB:CONTINEMTAL CAS CO 20443
Layne Inliner, LLC TRANSPORTATION INS CO 20494
Granite Inliner, LLC INSURERC:
585 West Beach Street INSURER O:
INSURERE:
Watsonville, CA 95076 INSURERF:
rnvCDAGCC rr-DTIFIrATF NIIYRFR- 54005620 RFVISION NIiMRFR-
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.
MAT-ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIOD
A
X
COMMERCIAL GENERAL LIABILITY
E
GL2074978689
10/01/18
10/01/21
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE ( X , OCCUR
DAMA ET RENTED
PREMISES We occurrencef
2,000,000
MED EXP (Any one person)
f Nil
PERSONAL SADVINJURY
f 2,000,000
G_EWL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 10, 000, 000
_ ]POLICY JEST [�] LOC
PRODUCTS - COMPIOP AGG
f 2,000,000
$
OTHER.
A
AUTOYOBILELUIBILITY
Y
BUJL2074978692
10/01/18
10/Ol/21
COMBINED SINGLE LIMIT
L ecadeM)
f 2,000,000
BODILY INJURY (Per person)
S
Y ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED % NOWOWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
IPer ace 0
$
f
B
E
UMBRELLA LIM
z
OCCUR
CUE2068209453
10/01/18
10/01/19
EACH OCCURRENCE
$ 8,000,000
AGGREGATE
$ 81000,000
X
EXCESS LIAR
CWMS MADE
DED I I RETENTION $_
A
C
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
NIA
WC274978644 (AOS/StopGap)10/O1/l8
WC274978658 (NY)
WC274978630 (CA)
10/01/18
10/01/18
10/01/19
10/01/19
10/01/19
z STATUTESTER
E.L. EACH ACCIDENT
$ 2,000,000
E.L.DISEASE -EAEMPLOYEE
i 2,000.000
E.L. DISEASE -POLICY LIMIT
f 2,000,000
C
If D describe
DESCRIPTION OOFF OPERA balmWC274978661
(NT,WI,HI)
10/01/18
10/01/19
DESCRIPTION OF OPERATION31 LOCATIONS / VEHICLES (ACORD 101, Addldonal Remarks Schedule, may be attached It more space is requlrW)
Re: work in the right-of-way Certificate holder is included as an Additional Insured on the General Liability and
Automobile Liability policies as required by written contract subject to policy terms, conditions and exclusions.
Primary 4 Nan -Contributory wording is included on the General Liability and Automobile Liability policies as required
by written contract, subject to policy terms, conditions and exclusions.
n0oT1r1^AV= unr neo rANr`FI I ATInm
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
281 N. COLLEGE AVENUE
AUTHORIZED REPRESENTATIVE/yp
FORT COLLINS, CO 80524
USA
[Ci
U TBao-Zuio AL.VKU 1.VKruKAI IVP1. Au ngnis reserveO.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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54005620
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