Loading...
2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (17) CERTIFICATE OF LIABILITY INSURANCE 08/O1/2018YY) 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 FAX A/C No Ext: 415-403-1491 /C, -874-4818 415-874-4818 E-MAIL kleikam@alliant.com 100 Pine Street, 11th Floor ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# San Francisco, CA 94111 INSURERA: VALLEY FORGE INS CO 20508 INSURED INSURER B: CONTINENTAL CAS CO 20443 Layne Inliner, LLC INSURER C: TRANSPORTATION INS CO 20494 585 West Beach Street INSURER D: AGCS MARINE INS CO 22837 INSURER E Watsonville, CA 95076 INSURERF: COVERAGES CERTIFICATE NUMBER: 53580577 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY X X GL2074978689 08/01/18 10/01/18 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR 2,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ Nil PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY PRO X❑ PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X BUA2074978692 08/01/18 10/01/18 COMBINED S INGLE LIMIT $ 2,000,000 Ea acadent X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDX NON-OWNED PROP ERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB X OCCUR X X L2068209453 08/01/18 10/01/18 EACH OCCURRENCE $ 8,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $ 8,000,000 DED RETENTION$ $ PER J A WORKERS COMPENSATION X WC274978630 (CA) 08/01/18 10/01/18 X STATUTE I EERH AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE - N/A X WC274978644 (AOS/StopGap 08/01/18 10/01/18 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? 10/01/18 2,000,000 C (Mandatory in NH) X WC274978661 (MT,WI,HI) 08/01/18 E.L.DISEASE-EA EMPLOYEE $ C If yes describe under DESCRIPTION OF OPERATIONS below X WC274978658 (NY) 08/01/18 10/01/18 E.L.DISEASE-POLICY LIMIT $ 2,000,000 D Owned, Leased/Rented Eqpt MXI93059745 07/01/18 07/01/20 Limit 2,000,000 Per Occurrence DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: 2013-14 Sanitary Sewer and Manhole Rehabilitation Project Contract No. 14-0025-UT City of Clearwater, its respective officers and employees are included as an additional insured as respects General Liability on a primary and non-contributory basis, and Automobile Liability, per the attached endorsements. General Liability, Automobile Liability and Workers' Compensation waiver of subrogation applies in favor of the above reference additional insureds, per the attached endorsements. 30 Days Written Notice of Cancellation for Non-Renewal and 10 Days Notice of Cancellation for Non-Payment of Premiums GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 100 SOUTH MYRTLE AVENUE AUTHORIZED REPRESENTATIVE CLEARWATER, FL 33756 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ttaganap 53580577 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 08/01/2018 NAME OF INSURED: Layne Inliner, LLC SUPP(10/00) CNA (Ed 0 (Ed. 01/13)1/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by"written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory"of this Coverage Part.) A. Section II -Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage,"or"personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products-completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract"specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part by are replaced by the words 'arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the "written contract"; c. That described in B.1. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or G-140331-D (Ed. 01/13) POLICY#: GL2074978689 Page 1 of 2 EFFECTIVE: 08/01/2018 Copyright, CNA All Rights Reserved. CNA (Ed 0 (Ed. 01/13)1/13) any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or"suit"that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or"suit"; and (4) Tender the defense and indemnity of any claim or"suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or"suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V— DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily injury"or"property damage"; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. Material used with permission of ISO Properties, Inc. G-140331-D (Ed. 01/13) POLICY#: GL2074978689 Page 2 of 2 EFFECTIVE: 08/01/2018 Copyright, CNA All Rights Reserved. POLICY No.: GL2074978689 COMMERCIAL GENERAL LIABILITY Effective Date: 08/01/2018 CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Waiver of Transfer of Rights of Recovery Against Others to Us This endorsement modifies insurance provided under the following; Commercial General Liability Coverage Form Under SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work"included in the"products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. POLICY NO. ISSUED TO: EFFECTIVE DATE OF THIS GL 2074978689 Layne Christensen Company ENDORSEMENT 08/01/2018 CNA71527XX CNA (Ed. 10/12) ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Persons Or Organizations Any person or organization whom the named insured is required by written contract to add as an additional insured on this policy. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II — LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident"for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Policy No: BUA2074978692 Page 1 of 1 Endorsement No: Effective Date: 08/01/2018 Insured Name: Layne Christensen Company Copyright CNA All Rights Reserved. POLICY NUMBER: BUA2074978692 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Layne Christensen Company Endorsement Effective Date: 8/01/2018 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1 G-1 9160-B CNA (Ed. 11/97) WORKERS'COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS-CALIFORNIA This endorsement changes the policy to which it is attached. It is agreed that Part One—Workers'Compensation Insurance G.Recovery From Others and Part Two—Employers'Liability Insurance H.Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us_) PREMIUM CHARGE—n/a The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is n/a %. UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties.Schedule : Any person or organization for whom the named insured has agreed by written contract to furnish this waiver. WC43 03 05(Ed 7-00) -----------------------------------------------------------------------------------------------------------------------------------------------------I---------------------- WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT All Other States where allowed(except CA,TX, UT) We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization for whom the named insured has agreed by written contract to furnish this waiver WC00 03 13 (Ed 4-84) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 08/01/2018 WC274978644 Valley Forge Insurance Company WC274978658 Transportation Insurance Company WC274978661 Transportation Insurance Company WC 274978630 Valley Forge Insurance Company G-1 9160-B Page 1 of 1 (Ed. 11/97)