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HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (15)r, AIR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYY 0 7 /18/2 0/18YY) 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 Alliant Insurance Services, Inc. CONTACT Kimberly Leikam PHONE FAX lA/C.No.ExtI: 415-403-1491 A/C No: 415-874-4818 100 Pine Street, llth Floor E-MAIL kleikamOalliant.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: VALLEY FORGE INS CO 20508 San Francisco, CA 94111 INSURED INSURERB: CONTINENTAL CAS CO 20443 Layne Inliner, LLC INSURER C: TRANSPORTATION INS CO 20494 INSURERD: 585 West Beach Street INSURER E : INSURER F: Watsonville, CA 95076 COVFRAGFS CFRTIFICATF NtIMRFR• 53421008 RFVISIr)N 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 ADDL SUBR POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X GL2074978689 08/01/18 10/01/18 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADEOCCUR DAMAGEPREMISESSE.Ea (o.ccurr"ence)$ 2,000,000 MED EXP (Any one person) $ Nil PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY � PRO JECT X❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X BUA2074978692 08/01/18 10/01/18 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB X OCCUR L2068209453 08/01/18 10/01/18 EACH OCCURRENCE $ 81000,000 AGGREGATE $ 81000,000 X EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE a OFFICER/MEMBEREXCLUDED? (Mandatory in NH) IN WC274978630 (CA) WC274978644 (AOS/StopGap WC274978661 (MT,WI,HI) 08/01/18 08/O1/18 08/01/18 10/01/18 10/01/18 10/O1/18 X PER STATUTE EORH E.L. EACH ACCIDENT - $ 2,000,000 $ 2,000,000 E.L. DISEASE -EA EMPLOYEE C DESCRIPTION OF OPERATIONS below If yes, describe under D WC274978658 (NY) 08/01/18 10/01/18 E, L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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. ta ;LeiRol=1 h_1►[�Ja\�_l1CU► SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF FORT COLLINS, COLORADO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4316 LAPORTE AVE. 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 ttaganap 53421008