Loading...
HomeMy WebLinkAbout486984 LAYNE INLINER LLC - INSURANCE CERTIFICATE (16)�1 ACORO CERTIFICATE OF LIABILITY INSURANCE o /18/2o18YY' 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 CONTACT Kimberly Leikam Alliant Insurance Services, Inc. PHONE A IC M.,Ext): 415-403-1491 (A/C No): 415-874-4818 E-MAIL kleikam®alliant.com 100 Pine Street, llth Floor ADDRESS: INSURERS AFFORDING COVERAGE NAIC # San Francisco, CA 94111 INSURERA:VALLEY FORGE INS CO 20508 INSURED INSURERB: CONTINENTAL CAS CO 20443 Layne Inliner, LLC INSURER C: TRANSPORTATION INS CO 20494 585 West Beach Street INSURER D: INSURER E : Watsonville, CA 95076 INSURER F: COVFRAGFS CFRTIFICATF NIIMRFR• 53432466 DFI/ICIrIAI nlllnni2CD- 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 WVO POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [XIOCCURDAMAGE X X GL2074978689 08/01/18 10/01/18 EACH OCCURRENCE $ 2,000,000 T ENTER PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ Nil PERSONAL & ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY rl PRO- JECT X] LOC GENERAL AGGREGATE $ 10,000,000 GENT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X X BUA2074978692 08/01/18 10/01/18 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS $ tid r BODILY INJURY Peaccident) ( ) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) ccident _ $ B X UMBRELLA LIAB X OCCUR L2068209453 08/01/18 10/01/18 EACH OCCURRENCE $ 8,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 81000,000 DED RETENTION $ $ A A C ANDEMPSYERS'LIAILIT AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETORIPARTNER/EXECUTIVE ❑ OFFICERlMEMBEREXCLUDED? N (Mandator yin NH) NIA X X X WC274978630 (CA) WC274978644 (AOS/StopGap)O8/O1/18 WC274978661 (MT,WI,HI) 08/01/18 08/01/18 10/01/18 10/01/18 10/01/18 X STATUTE EERH E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 C If yes, describeunder DESCRIPTION OF OPERATIONS below X WC274978658 (N—f) 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) 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 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 ttaganap 53432466