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Home My WebLink About486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (17)A� ® CERTIFICATE OF LIABILITY INSURANCE DAT4/11/2018 Y) 04/11 /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 CONTACT NAME: MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. PHONE 713-877-8975 FAx 713-877-8974 818 Town & Country Blvd, Suite 500 A/C No Ext : A C No Houston, TX 77024-4549 E MAILrn INSURED Layne Inliner, LLC 7915 Cherrywood Loop Kiowa, CO 80117 INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURER B :Underwriters at Lloyd's London INSURER C :American Zurich Insurance Company 40142 INSURER D :Zurich American Insurance Company of Illinois 27855 INSURER E : INSURER F : r0VFRAr:FS rFRTIFICATF NIIMRFR•PASY5FGP 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. INSR LTR TYPE OF INSURANCE AD IN D SURR WVD POLICY NUMBER POLICY EFF MM1DD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE � OCCUR DA AGE 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 I PRO - POLICY � LOC 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 1AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED ONLY AUTOS ONLY $ $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A WC 0194360-02 (AOS) WC 0194361-02 WI & MA) 08/01/2017 08/01/2018 X PER OTH- I STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 If yes, describe . ,.Je, DESCRIPTION OF OPERATIONS below B Contractors Equipment EG0376516 11/01/2016 07/01/2018 All Leased & Owned Equipment Per Occurrence: $ 5,000,000 $ $ $ 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. rFRTICIr ATF wni r1FR rANrFI I ATION 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 f PO Box 580 7/ Fort Collins, CO 80522 Page 1 of 1 U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD