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HomeMy WebLinkAboutLAYNE INLINER LLC - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/24/2017 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town & Country Blvd, Suite 500 CONTACT NAME: AICNNo Ext : 713-877 8975 ac No): 713-877-8974 Houston, TX 77024-4549 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED Layne Inliner, LLC INSURER B :American Guarantee and Liability Insurance Company 26247 INSURER C :Underwriters at Lloyd's London 7915 Cherrywood Loop INSURER D :American Zurich Insurance Company 40142 Kiowa, CO 80117 INSURER E :Zurich American Insurance Company of Illinois 27855 INSURER F COVERAGES CERTIFICATE NUMBER:LCAUCP57 REVISION NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE Fx_1 OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,250,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 10,000,000 POLICY a PROECT- ❑ LOC J PRODUCTS - COMP/OP AGG $ 10,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ B X UMBRELLA LIAB X OCCUR UC 0194471-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) NIA WC 0194360-02 (AOS) WC 0194361-02 (WI & MA) 08/01/2017 08/01/2018 - X I PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 C Contractors Equipment EGO376516 11/01/2016 05/01/2018 All Leased & Owned Equipment Per Occurrence: $ 5,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: P-8123 Cured In Place Pipe Sanitary Sewers/Stormwater Mains Rehabilitation Certificate holder is included as an Additional Insured on the General Liability, Excess Liability and Automobile Liability 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 and Automobile Liability policies have been endorsed to provide (30) days Notice of Cancellation (except for non-payment) to the certificate holder shown below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE PO Box 580 4 Fort Collins, CO 80522.p Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/24/2017 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town &Country Blvd, Suite 500 CONTACT NAME: acNr o Ext : 713-877-8975 Nc No : 713-877 8974 Houston, TX 77024-4549 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC If INSURER A :Zurich American Insurance Company _ 16535 INSURED Layne Inliner, LLC INSURER B :Underwriters at Lloyd's London INSURER C :American Zurich Insurance Company 40142 7915 Cherrywood Loop Kiowa, CO 80117 INSURER D :Zurich American Insurance Company of Illinois 27855 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:SZFZYUDG REVISION NUMBER: 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 LTR TYPE OF IN ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE Fx—] OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,250,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY F PRO T LOC PRODUCTS -COMP/OP AGG $ 10,000,000 1 $ OTHER: A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F (Mandatory in NH) N I A WC 0194360-02 (AIDS) WC 0194361-02 WI & MA) 08/01/2017 08/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 B Contractors Equipment EG0376516 11/01/2016 05/01/2018 All Leased & Owned Equipment Per Occurrence: $ 5,000,000 Is DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 8123 Cured -In -Place Pipe for Sanitary Sewers/Stormwater Mains 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 1 PO Box 580 Fort Collins, CO 80522 Page 1 of 1 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 114 R1 CERTIFICATE OF LIABILITY INSURANCEF�,.,_,� DATE (MM/DD/YYYY) 07/24/2017 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town & Country Blvd, Suite 500 CONTACT NAME: PHONE 713-877-8975 FAX 713 877-8974 C N Ex AIC No E-MAIL ADDRESS: Houston, TX 77024-4549 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED Layne Inliner, LLC INSURER B :Underwriters at Lloyd's London INSURER C :American Zurich Insurance Company 40142 7915 Cherrywood Loop Kiowa, CO 80117 INSURER D :Zurich American Insurance Company of Illinois 27855 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER:SZFZYUDG REVISION NUMBER: 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 LTR TYPE OF INSURANCE A INSD U WVD POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE S 1,250,000 CLAIMS -MADE Fx_] OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 _ PERSONAL & ADV INJURY $ 1,250,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY PRO- JECT 1-1 LOC PRODUCTS - COMP/OP AGG $ 10,000,000 A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) S X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accid entt $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N (Mandatory in NH) N/A C 0194360-02 (AIDS) WC 0194361-02 WI & MA) 08/01/2017 08/01/2018 X I PER OTH- TA E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 II es, describe under DESCRIPTION OF OPERATIONS below I I I E.L. DISEASE - POLICY LIMIT $ 5,000,000 B Contractors Equipment _ _ EG0376516 11/01/2016 05/01/2018 All Leased & Owned Equipment Per Occurrence: $ 5,000,000 S $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Re: 8123 Cured -In -Place Pipe for Sanitary Sewers/Stormwater Mains 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE I 1 PO Box 580 J Fort Collins, CO 80522 J Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 07/24/2017 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town &Country Blvd, Suite 500 CONTACT NAME' PHo No xt 713-877-8975 'C.No : 713-877-8974 E-MAIL ADDRESS: Houston, TX 77024-4549 INSURERS AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED Layne Inliner, LLC INSURER B :American Guarantee and Liability Insurance Company 26247 INSURER C :Underwriters at Lloyd's London 7915 Cherrywood Loop Kiowa, CO 80117 INSURER O :American Zurich Insurance Company 40142 INSURER E :Zurich American Insurance Company of Illinois 27855 INSURER F : COVERAGES CERTIFICATE NUMBER:LCAUCP57 REVISION NUMBER: 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 LTR TYPE OF INSURANCE D INSD U WV POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE � OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP (A one person) $ 10.000 PERSONAL & ADV INJURY $ 1,250,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 GEN'L POLICY [ X] JECT_ LOC PRODUCTS - COMP/OP AGG $ 10,000,000 A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO 1 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAR X OCCUR UC 0194471-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN_] (Mandatory in NH) N I A WC 0194360-02 AOS) WC 0194361-02 WI & MA) 08/01/2017 08/01/2018 X PER OTH- TAT E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 C Contractors Equipment EG0376516 11/01/2016 05/01/2018 All Leased & Owned $ Equipment Per Occurrence: $ 5,000,000 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: P-8123 Cured In Place Pipe Sanitary Sewers/Stormwater Mains Rehabilitation Certificate holder is included as an Additional Insured on the General Liability, Excess Liability and Automobile Liability 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 and Automobile Liability policies have been endorsed to provide (30) days Notice of Cancellation (except for non-payment) to the certificate holder shown below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE 1 PO Box 580 Fort Collins, CO 80522 Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACOR,D� �. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/24/2017 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 _ MCGRIFF,SEI6ELS & WILLIAMS OF TEXAS, INC. 818 Town & Country Blvd, Suite 500 Houston, TX 77024-4549 CONTACT - NAME` AICNN Ext : 713-877-8975 aC No): 713-877-8974 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC INSURER B :American Guarantee and Liability Insurance Company 26247 INSURER C :Underwriters at Lloyd's London 1775 EAST 69TH AVENUE DENVER, CO 80229 INSURER D :American Zurich Insurance Company 40142 INSURER E :Zurich American Insurance Company of Illinois 1 27855 INSURER F COVERAGES CERTIFICATE NUMBER:N4SLZRXJ REVISION NUMBER: 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 R TYPE OF INSURANCE INS WVD POLICY NUMBER MMIDDY/YYYY EXP MMIDDY /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 ME EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,250,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY FX JE � LOC PRODUCTS - COMP/OP AGG $ 10,000,000- $ . ;7H. P— A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT Ea accident S 5,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR UC 0194471-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTION $ $ D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/M MBER EXCLUDED? N/A WC 0194360-02 (AOS) WC 0194361-02 (WI & MA) 08/01/2017 08/01/2018 X PER OTH- R E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE S 5,000,000 (Mandatory in NH) If yyes, describe under DESCRIPI ION OF OPEPATIONS beln I E.L. DISEASE - POLICY LIMIT , - $ 5,000.000 C Contractors Equipment EG0376516 11/01/2016 05/01/2018 All Leased & Owned $ Equipment Per Occurrence: S 5,000,000 S S $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. VCRI Irn miC nuLUCR I-Ar4t.CLLAI IUIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF FORT COLLINS, COLORADO I AUTHORIZED REPRESENTATIVE 4316 LAPORTE AVE. FORT COLLINS, CO 80522 Page 1 of 1 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD