HomeMy WebLinkAbout15- Layne Inliner LLC (Lockton Companies) Certificate of LiabilityACORN® CERTIFICATE OF LIABILITY INSURANCE 8/1/2016
IDATE(MM/DD/YYYY)
7/28/2015
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 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 Lockton Companies
444 W. 47th Street, Suite 900-MOREA
Kansas City MO 64112-1906
(816) 960-9000
NT CT
NAME:
FAX
Ext): No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
N
INSURER A: Zurich American Insurance Company 16535
GLO 5817438-02
INSURED LAYNE INLINER, LLC
1331501 7915 CHERRYWOOD LOOP
KIOWA, CO 80117
INSURER B: American Zurich Insurance Company 40142
INSURER C : Lexington Insurance Company 19437
CLAIMS-MADEOCCUR
INSURER D:
INSURER E:
INSURER F:
COVERAGES LAYTN7915 CERTIFICATE NUMBER: 12409035 REVISION NUMBER: XXXXXXX
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
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
N
N
GLO 5817438-02
8/1/2015
8/1/2016
EACH OCCURRENCE s 2,000,000
CLAIMS-MADEOCCUR
DAMAGE TO RENTED SOO 000
PREMISES Ea occurrence
MED EXP (Any oneperson) 10,000
X CONTRACTUAL
X X.C.0 COVERAGE
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY❑ PEC LOC
GENERAL AGGREGATE $ 5,000,000
PRODUCTS - COMP/OP AGG $ 5,000,000
$
OTHER
•
AUTOMOBILE
LIABILITY
N
N
BAP 5817437-02
8/1/2015
8/1/2016
EaaacltleDtSINGLE LIMIT $ 5,000,000
BODILY INJURY (Per person) $ XXXXXXX
X
ANY AUTO
AUTOWNED SCHEDULED
BODILY INJURY (Per accident $ ��XXXXX
HIRED AUTOS AO OSWNED
Per accidenDAMAGE $ XXXXXXX
$ xxxxxXX
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $ XXXXXXX
EXCESS LIAB
CLAIMS -MADE
NOT APPLICABLE
AGGREGATE $ XXXXXXX
DED I I RETENTION $
$
B
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYN
Y/N
ANY(Mandatory in NH)
OFFICER/MEMBER EXCLUDED? PROPRIETOR/PTNERIEXECUTIVE N❑
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / %�
WC 5817439-03 AOS)
WC 5817440-03 (WI)
STOPGAP(ND,O , WA,WY�
8/1/2015
8/1/2015
8/1/2016
8/1/2016
PER I OTH-
X STATUTE FIR
E.L. EACH ACCIDENT $ 5,000,000
E.L. DISEASE - EA EMPLOYEE 5,000,000
E.L. DISEASE- POLICY LIMIT 5,000,000
C
EQUIPMENT FLOATER
N
N
026159794
8/1/2015
8/1/2016
ALL LEASED, OWNED OR RENTED
EQUIPMENT. $5,000,000 LIMIT PER
OCCURRENCE.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 2013 SEWER REHABILITATION — CITY OF BOZEMAN. 45 DAYS NOTICE OF CANCELLATION APPLIES.
12409035
CITY OF BOZEMAN, MONTANA
CITY HALL, CITY CLERK'S OFFICE
121 NORTH ROUSE AVENUE
BOZEMAN, MT 59715
ACORD 25 (2014/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
n1- RR -2014 ACORD CORPORATION- All rinhtc racnrvarl
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