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HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (18)ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town & Country Blvd, Suite 500 CONTACT NAME: PHONE 713-877-8975 FAX 713 877-8974 A/C No Ext : AIC No E-MAIL ADDRESS: Houston, TX 770244549 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC INSURER B :Underwriters at Lloyd's London 1775 EAST 69TH AVENUE INSURER C :American Zurich Insurance Company 40142 INSURER D :Zurich American Insurance Company of Illinois 27855 DENVER, CO 80229 INSURER E :American Guarantee and Liability Insurance Company 26247 INSURER F : COVERAGES CERTIFICATE NUMBER:W3DAL2LC 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 UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE FRIOCCUR 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 a JE LOC PRODUCTS -COMP/OP AGG $ 10,000,000 $ OTHER: I I 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 $ $ E X UMBRELLALIAB X OCCUR 000194471-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ $ C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE /M OFFICEREMBER EXCLUDED? N (Mandatory in NH) N / A WC 0194360-02 (AOS) WC 0194361-02 (WI & MA) 08/01/2017 08/O1/2018 X PER OTH- 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 It yes, describe under 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) 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. rFRTIFIrATF Hint nFR 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, COLORADO AUTHORIZED REPRESENTATIVE 1 4316 LAPORTE AVE. FORT COLLINS, CO 80522 (,! Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD