HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (7)P5260021 )2
DATE(MMIDDIYYYY)
ACOR'LY CERTIFICATE OF LIABILITY INSURANCE 09/18/2018
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 Y Leikam
Alliant Insurance Services, Inc. PHONE FAX
� 415-403-1491 ;415-674-4818
E-MAIL kleikam?alliant.com
100 Pine Street, llth Floor ADDRESS: _ _ _
INSURERS) AFFORDING COVERAGE NAIC f
San Francisco, CA 94111 INSURERA:VALLEY FORGI INS CO 20508
INSURED INSURERS: CONTINENTAL CAS CO 20443
Layne Inliner, LLC TRANSPORTATION INS CO 20494
Granite Inliner, LLC INSURERC:
585 West Beach Street INSURER D:
INSURER E :
Watsonville, CA 95076 INSURERF:
rnvcnnrcc r`FQTICIrATF IJI71UIR1:R• 53990336 RFVISIAN NI111tRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I IAVE 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 ADDL SUER POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE26a POLICY NUMBER MMX)D/YYYY MMIDD
A
%
COMMERCIAL GENERAL LIABILITY
%
Y
GL2074978689
10/01/18
10/01/21
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE r% OCCUR
TO
PREMISES EaENTED occurrence)
$ 2.000.000
MED EXP (Any one person)
i Nil
PERSONAL & ADV INJURY
f 2,000,000
GENERAL AGGREGATE
$ 10, 000, 000
GENT.
AGGREGATE LIMIT APPLIES PER
PRODUCTS -COMPIOPAGG
i 2,000,000
POLICY C] PO-
JECT [�] LOC
f
OTHER.
A
AUTOMOBILE LIABILITY
%
%
BUA2074978692
10/01/18
10/01/21
SINGLELIMIT$
2,000,000
BODILY INJURY (Per person)
f
ANY AUTO
OWNED - SCHEDULED
AUTOS ONLY AUTOS
I%
% HIRED % NON -OWNED
AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
_
PROPERTY DAMAGE
(Per acodwO
_
B
%
UMBRELLALIAB
Y
OCCUR
CUE2068209453
10/01/18
10/01/19
EACH OCCURRENCE
$ 8,000,000
AGGREGATE
i 8,000,000
%
EXCESS LIAR
CLAIMS -MADE
DIED RETENTIONS
$
A
C
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORIPARTNERlEXECUTIVE
OFFICEPJMEMBEREXCLUDED9
(Mandatory In NH)
NIA
%
%
Y
WC274978644 (AOS/StopGap)10/01/18
WC274978658 (NY)
WC274978630 (CA)
10/01/18
10/01/18
10/01/19
10/01/19
10/01/19,000,000
Y ST_ATUTE ER
-
El. EACH ACCIDENT
S 2,000,000
E.L.EDISEASE-EAEMPLO
f
E.L. DISEASE -POLICY LIMIT
$ 2,000,000
C
If yes describe under DESCRIPTION OF OPERATIONS below
Y
WC274978661 (IIT,WI,HI)
10/01/18
10/01/19
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACCORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Re: 8123 Cured -In -Place Pipe for Sanitary Sewers/Stormwater Koine Rehabilitation Certificate holder, its officers,
agents and employees are included as an Additional Insured on the General Liability and Automobile Liability policies
as required by written contract and granted Waiver of Subrogation on the General Liability, Automobile Liability and
Workers Compensation policies as required by written contract subject to policy terms, conditions and exclusions. In
the event of cancellation by the insurance company(ies) the General Liability, Automobile Liability and Workers'
Compensation and Employer's Liability policies have been endorsed to provide (30) days Notice of Cancellation (except
for non-payment) to the certificate holder shown below.
, CnT¢r ATC unr nCD rANrFI I ATHIN
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.
PO Box 580
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
/�
(�;l_ / U
USA
(/
U 19Si1-ZUI O AL;UKU t.UKF'UKA I IUN. All rlgnis reserveo.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
dltamayo
53990336