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HomeMy WebLinkAbout16- Certificate of Liability Insurance - Layne Inliner, LLCACOR" CERTIFICATE OF LIABILITY INSURANCE �/" DATE (MM/DD/YYYY) 10/24/2016 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(les) must 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: PHONExt : 713-877-8975 ac No): 7I3-877-8974 Houston, TX 77024-4549 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Company 16535 05/01/2016 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: INSURER E: AGE TO RENTED - 1,000,000 PREMISES Ea occurrence $ INSURER F: _ COVERAGES CERTIFICATE NUMBER:GNXG4J5V 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. I TR TYPE OF INSURANCE ASD SPOLICY WVD POLICY NUMBER MMD D POLICY EXP MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362-00 05/01/2016 08/01/2017 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE F Ovl AGE TO RENTED - 1,000,000 PREMISES Ea occurrence $ 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- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 10,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP 0194359-00 05/01/2016 08/01/2017 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR iOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICEWMEMBER EXCLUDED? FN (Mandatory in NH) N / A C 0194360-00 SAOS) WC 0194361-00 (WI & MA) 05/01/2016 05/01/2017 I X PER oTH- STATUTE ER 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 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: 2013 Sewer Rehabilitation 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. lrCRi irm,iAi C nuLumm 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 Bozeman, Montana City Hall, City Clerk's Office AUTHORIZED REPRESENTATIVE 121 North Rouse Avenue Bozeman, MT 59715 Page 1 of 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Re: LAYNE CHRISTENSEN COMPANY LAYNE HEAVY CIVIL, INC. LAYNE INLINER, LLC The enclosed certificate of insurance replaces the current certificate of insurance you have in your files. This replacement will only affect the Property, Contractor's Equipment and Builders Risk policies. If you are currently holding a General Liability, Auto Liability, Umbrella Liability, Workers' Compensation, Contractor's Pollution and/or Professional Liability certificate of insurance, these will not be affected. If you have any questions, please feel free to contact us. McGriff, Seibels & Williams of Texas, Inc. Aurora Capuano — Account Manager — acapuanoCcD-mcgriff.com or 713-273-2627 Lindsay Garza — Assistant Account Service Rep. — laarzana.mcgriff.com or 713-402-1497