Loading...
HomeMy WebLinkAboutInsituform Technologies - Insurance Certificate (2019)CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 7/1/2019 6/20/2018 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. TYPE OF INSURANCE 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). SUBR WVD PRODUCER Lockton Companies Three City Place Drive, Suite 900 St. Louis MO 63141 -7081 (314) 432 -0500 CONTACT POLICY EXP MM /DD/YYYY a/C N o , EXt , INC, No A E -MAIL ADDRESS: COMMERCIAL GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # CGD300084903 INSURER A : XL Insurance America- Inc. 24554 EACH OCCURRENCE INSURED Insituform Technologies, LLC 1425534 17988 Edison Avenue Chesterfield MO 63005 INSURER B: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance Co of North America 43575 INSURER D: Starr Indemnity & Liability Company 38318 UAL INSURER E: Indian Harbor Insurance Company 36940 $ 1,000,000 INSURER F MED EXP (Any one person) $ 10,000 COVERAGES FNS E02 CERTIFICATE NLIMRFR- 15284999 DMIMIrIAI WHIM= vvvvvvv 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 MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N CGD300084903 7/1/2018 7/1/2019 EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE OCCUR BROAD FORM PD /CONTRAC UAL PREMISES (Ea occur ence $ 1,000,000 X MED EXP (Any one person) $ 10,000 Indenendt Contractor X XCU PERSONAL & ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY [X LOC JERT PRODUCTS - COMP /OP AGG $ 4,000,000 OTHER: B AUTOMOBILE LIABILITY Y N ISA H25158945 7/1/2018 7/1/2019 Ee CO aBINEDtSINGL -LIMIT X __L5,000,000 BODILY INJURY (Per person) $ XXXXX� ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY ( Per accident $ XXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ XXXXXXX $XXXXXXX * UMBRELLA LIAB X OCCUR N N 1000095154181 7/1/2018 7/1/2019 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000 000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N WLRC65224987 (CA/MA) 7/1/2018 7/1/2019 X PER OER C C ANY PROPRIETOR /P ARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N/A WLRC6522494A (AOS) (EXCLUDING MONOPOLISTIC) 7/l/2018 7/1/2019 E.L. EACH ACCIDENT $ 1,000,000 DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in under If yes, describe a under E.L. DISEASE - POLICY LIMIT 1 1,000,000 DESCRIPTION OF OPERATIONS below E Contractors Pollution Liab Y N CPL742035805 7/1/2018 7/1/2019 $2,000,000 ea/ $2,000,000 agg E Professional Liab CE0742002406 7/1/2018 7/1/2019 $500,000 SIR *See Below* DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) * Includes Pollution Coverage for conditions arising from waste or materials transported by or on behalf of Named Insured via automobile during the course of perfonning covered operations. Professional Liability: (Claims -Made, Retro Date 7/1/2016) $5,000,000 Per Claim, $500,000 SIR. PROJECT NO. 17 -PW -235, SEWER REHABILITATION IN FIRST STREET. CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE ADDITIONAL INSUREDS UNDER GENERAL LIABILITY AND AUTOMOBILE LIABILITY ON A PRIMARY AND NON - CONTRIBUTORY BASIS WHERE APPLICABLE BY WRITTEN CONTRACT, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE NAMED INSURED's OPERATIONS, AND ARE ADDITIONAL INSUREDS UNDER INSTALLATION FLOATER AS REQUIRED BY WRITTEN CONTRACT. UANL rLLA I JUN Jee AITacllments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15284929 AUTHORIZED REPRESENTATIVE CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 5zzeo� zw ACORD 25 (2016103) ©1988- CORD CO ORA N. All rinhts resarvorl The ACORD name and logo are registered marks of ACORD Attachment Code : D544456 Certificate ID : 15284929 ENDORSEMENT # This endorsement, effective 12:01 a.m., 7/1/2018, forms a part of Policy No. CGD300084903 issued to AEGION CORPORATION By XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(ies) according to the notification All other terms and conditions of the Policy remain unchanged. IXI 405 0910 © 2010 X.L. America, Inc. All Rights Reserved. Number of Days Name of Person(s) or Entity(ies) Mailing Address: Advanced Notice of Cancellation : AS PER SCHEDULE ON FILE WITH 30 THE COMPANY. All other terms and conditions of the Policy remain unchanged. IXI 405 0910 © 2010 X.L. America, Inc. All Rights Reserved. Attachment Code : D543763 Certificate ID : 15284929 NOTICE TO OTHERS ENDORSEMENT SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named Insured egion orpora ion Endorsement Number 54 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA ISA 7/1/2018To 7/1/2019 H25158945 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement Is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel this Policy prior to its expiration dale by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule ") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will In turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply In the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. Authorized Representative ALL -32686 (01/11) Page 1 of 1 Attachment Code : D544740 Certificate ID : 15284929 Workers' Compensation and Employers' Liability Policy Named Insured EndorsementN umber AEGION CORPORATION 17988 EDISON AVENUE Policy Number CHESTERFIELD MO 63005 Symbol: WLR Number: WLRC6522494A (AOS) PolicyPeriod Effective Date of Endorsement 7/1/2018 TO 7/1/2019 7/1/2018 IssuedBy (Name of InsuranceCompany) Indemnity Insurance Co of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. NOTICE TO OTHERS ENDORSEMENT — SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule ") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM, TX and WI. Authorized Representative WC 99 03 69 (01/11) Page 1 of 1 Attachment Code: D544757 Certificate ID : 15284929 Starr Indemnity & liability Company Dallas, TX 1- 866 -519 -2522 Policy Number: 1000095154181 Named Insured: Aegion Corporation SCHEDULE Number Of Days' Notice 90 Earlier Notice of Cancellation Provided by US Effective Date: 7/1/2018 at 12:01 A.M. For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in Paragraph 2. of either the Cancellation Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. Signed for the company as of the Effective Date above: r, �', V/�� I'- -, 5 � I , I /-, Charles H. Dangelo, President Nehemiah E. Ginsburg, GeneralCounsel XS 147 (10108) Page 1 of 1 Copyright (0 C. V. Starr 8 Company and Starr Indemnity 8 Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc.. used with Its permission. Attachment Code : D546224 Certificate ID : 15284929 ENDORSEMENT #018 This endorsement, effective 12:01 a.m., July 1, 2017, forms a part of Policy No. CE0742002405 issued to AEGION CORPORATION by Indian Harbor Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MANUSCRIPT ENDORSEMENT - CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT This endorsement modifies insurance provided under the following: PA /CE: Professional Activities /Complete Execution PROFESSIONAL LIABILITY FOR CONSTRUCTION CONTRACTORS AND CONSTRUCTION SUPPORT SERVICES PROVIDERS In consideration of the premium charged, the Named Insured and the Company agree to the following Policy change(s): In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(ies) according to the notification schedule shown All other terms, conditions and exclusions of this Policy remain unchanged. KPD 404 1214 © 2014 X.L. America, Inc. Page 1 of 1 All Rights Reserved. May not be copied without permission. Number of Days Name of Person s) or Entity(ies) Mailing Address: Advanced Notice of Cancellation: Per Schedule on File with the Company 60 60 All other terms, conditions and exclusions of this Policy remain unchanged. KPD 404 1214 © 2014 X.L. America, Inc. Page 1 of 1 All Rights Reserved. May not be copied without permission.