HomeMy WebLinkAboutLayne Inliner LLC Certificate of Liability Insurance for 2013 Sewer Rehabilitation ProjectAC"R01' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY)
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3/3/2014
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., thStreet,Suite 900
Kansas City MO 64112-1906
(816) 960-9000
ME:
A/ NeEXt; (AIC, No):
E-MAIL
ADDRESS,
INSURER(S) AFFOR12ING COVERAGE NAIC If
EACH OCCURRENCE 2,000,000
INSURER A: Zurich American Insurance Company 16535
MED EXP (Any one ersan 10,000
INSURED LAYNE INLINER, LLC
26 7915 CHERRYWOOD LOOP
KIOWA, CO 60117
INSURER B:
INSURER c
NIM13E6 D:
PRODUCTS - COMP/OP AGG $ 5,000,00-0—
OOOOOOOTHER
NS RER
A
INSURER F
LIABILITY
ANYAUTO
AUTUS NED j{ gUTOSULED
HIRED AUTOS -OWNED AUTOSWNED
Cr1VPRAQPC I VTNnI CPRTIPICATP MIIMRPR- 194000:5
CMN'
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,
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OF INSURANCE
ADDL
SUER
W
POLICY NUMBER
POLICY EFF
IMMIDDLyYYY
5/1/2013
LACY EXP
POLICY
8/1/2014
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X' CONTRACTUAL
N
N
GLO 5817438-00
EACH OCCURRENCE 2,000,000
DANMAI T Ea ELATED 500,000
REM
MED EXP (Any one ersan 10,000
_2L X CI I COVERAGE
PERSONAL &ADV INJURY s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
}( POLICY[_]�E8f F]LOC
OTHER
GENERAL AGGREGATE s 5,000,000
PRODUCTS - COMP/OP AGG $ 5,000,00-0—
OOOOOOOTHER
A
AUTOMOBILE
X
X
X
LIABILITY
ANYAUTO
AUTUS NED j{ gUTOSULED
HIRED AUTOS -OWNED AUTOSWNED
N
N
BAP 5817437-00
5/1/2013
8/1/2014
SINGLE LIMIT $ S 000 000
BODILY INJURY (Per person) $ xxxx xx
BODILY INJURY (Per accident s XXX)C{XX
ar
(PROPE�dert) GE s XXXXXXX
$XxxxxxX
UMBRELLA LMB
EXCESS LIAB
OCCUR
CLAIMS -MADE
NOT APPLICABLE
EACH OCCURRENCE s XXXXXXX
AGGREGATE s XXXXXxx
DED I I RETENTION $
$
A
AANY
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICERIMEM ER�EXCLUD EXCLUDED? N
If M.dtoryta NH)
DESCRIPTION OF OPERATIONS bebw
NIA
N
WC 5817439-00 AOS)
WC 5817440-00(WI) )
STOPGAP(ND,O A,WY
5/1/2013
5/1/2013
8/1/2014
8/1YL014
X STATUTE o IR
EL. EACH ACCIDENT $ -5,000,000
E. L. DISEASE - EA EMPLOYEE 5,000,000
E . DISEASE -POLICY LIMIT 5,000 ,000
DESCRIPTION OF OPERATIONS r 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.
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VnrvV CLLXtIVry JCC AIIaCnruent
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12409035 AUTHORIZED REPRESENTATIVE
CITY OF BOZEMAN, MONTANA
CITY HALL, CITY CLERK'S OFFICE
121 NORTH ROUSE AVENUE
BOZEMAN, MT 59715
ACORD 25 (2014/01) @T968-2014 AC ORPORATION. All rights reserved
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