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HomeMy WebLinkAbout486984 GRANITE INLINER LLC - INSURANCE CERTIFICATE%26Ile1tlal] 3 _ Q AC'� ® DATE(MWDDrfM) A CERTIFICATE OF LIABILITY INSURANCE 09/13/2019 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: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. H 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 endorsements . PRODUCER LIC #OC36861 1-415-403-1491 CONTACT NAME: Kimberly Lei.kam Alliant Insurance Services, Inc. PHONE IAIC415-403-1491 FAX 415-874-4818 . No. ,,U. /AA:. Nsl: E-MAIL klaikem0alliant.com 100 Pine Street, llth Floor ADDRESS: INSURER(S) AFFORDING COVERAGE am# San Francisco, CA 94111 INSURER A: VALLEY FORM INB CO 20509 INSURED _ _.. _... INSURERS: CONTINlQTTAL CAB CO 20A43 Granite Inliner, LLC INSURERC: TRANSPORTATION INS CD 20494 585 West Beach Street INSURER D: IWatsoaville, CA 95076 (INSURER F: rnVFQARFS rFGTTFIr ATF MIISAll 97218034 DFVlernu uuunco. 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. — - R TYPE OF INSURANCE MOL SWVn UER POLICY NUMBER MWDOY/YYYY DD E%P LIMITS LT A z COMMERCIAL GENERAL LIABILITY Z r GL2074978689 10/Ol/18 10/01/21 EACH OCCURRENCE S 2,000,000 CLAIMS -MADE _❑ OCCUR AMAI ESE awaulanm GE TO RENTED 2 2,000,000 z MED EXP (Any one person) S Nil ZCO z Contractual Liability PERSONAL 4 ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 10,000,000 POLICY � O [z] LOC PRODUCTS -COMP/OP AGG s 2,000,000 $ OTHER: I A AUTOMON.EUANUTY Z Z BDA2074978692 10/01/18 10/01/21 COMBINED SINGLE WITT(Es ami0art) $ 2,000,000 Z ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOSBODILY ONLY AUTOS INJURY (Par acddaa0 S = HIRED HI N AUTOS ONLY AUTOS AUTOS ONLY PROPERTY DAMAGE S _ S a z I UNWELLALIM z OCCUR CUR2068209453 10/01/19 10/01/20 EACH OCCURRENCE s 8,000,000 AGGREGATE X SS LUIB CLAIMS -MADE S 8,00o,o ZI I RETENTIONS $ A C C WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y I N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERMIEMBEREXCLUDED7 (Mandatory In NH) NIA j Z X pC274978644 (ADS/StopOap NC274978661 (MT,WI,RI) MC274978658 (NY) 10/01/19 10/01/19 10/ol/19 10/01/20 10/01/20 10/O1/20 = PTATUTE OR E.L. EACH ACCIDENT $ 2,000,000 s 2.000,000 E.LDISEASE• FAEMpLOYEE A oescnoe under ;yesCRIPTION OPERATIONS bebw DES z WC274978630 (CA) 10/01/19 10/01/20 $ 2,000,000 El DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlNunal Remarks Schedule, may M aaaehad lam space Is required) Re: 8123 Cured -In -Place Pipe for Sanitary Savers/Stormarater Maine Rehabilitation Certificate holder, its officers, agents and employees are included as as 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(iss) the General Liability, Automobile Liability and Workers - Compensation and Ruiployerrs Liability policies have been endorsed to provide (30) days Notice of Cancellation (except for non-payment) to the certificate holder shown below. 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 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ttnganap 57218034