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HomeMy WebLinkAboutInsurance Certificate: Insituform Technologies, LLC i ® DATE(MMfDDNYYY) ACC)R fD CERTIFICATE OF LIABILITY INSURANCE 7/l/2026 4/28/2026 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement($). PRODUCER Lockton Companies,LLC CONTACT NAME: DBA Lockton Insurance Brokers,LLC in CA PHONE FAX AIC No: CA license itOFt5767 E.MgIL Three City Place Dr.,Ste.900 ADDRESS: St.Louis h40 63141-7081 INSURER S AFFORDING COVERAGE NAfC E (314)432-0500 midwesiccrtificalcs@lockton.cony INSURER A:XL Insurance America Inc 24554 INSURED Insituform Technologies,LLC INSURER B:ACE American Insurance Com art 22667 1347989 580 Goddard Avenue INSURER C:ACE Fire Underwriters Insurance Com an 20702 Chesterfield MO 63005 INSURER D: INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER: 23428518 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. tNSR _ TYPE 9F INSURANCE XMDL SUBR -� POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MMIDD Ml MDD A X COMMERCIAL GENERAL LIABILITY Y N CGD300084910 7/1/2025 71I/2026 EACH OCCURRENCE s 2 000 000 CLAIMS-MADE �OCCUR DAMAGES4 RENTED A BROAD FORM PI?ICONTRAGT AL PREMISES Ea ocaurence $ 1000 000 X Indeuendt Contractor MED EXP(Any one person) $ 10,0)0 X XCI_I PERSONAL&AOV INJURY s 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PH0 � LOC PRODUCTS-COMPIOPAGG s 4,000,000 OTHER: s B AUTOMOBILE LIABILITY Y N ISAHI1428551 7/1/2025 7/U2026 Eaa d:D SINGLE LIMIT t $ 5Q00,000 X ANY AUTO BODILY)NJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX AUTOS ONLY AUTOS - --._-...-- --. HIRED NON-OWNED pe° ae IOAG� s XXXXXXX AUTOS ONLY AUTOS ONLY sXXXXXXX UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS L1AB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION Nr X B AND EMPLOYERS'LIABILITY 1VLRC7309740A(AOS) 7/l/2025 7/1/2026 STATUTE ERH C ANY PROPRIETORIPARTNEPJFXECUTIVE Y/N SCFC73097447(\ I) 7/I/2025 7/1/2026 E.L.EACH ACCIDENT $ 1,000,000.. C OFFICERUEMBER EXCLUDED? FN] N 1 A (EXCLUDING MONOPOLISTIC E.L.DISEASE-EA EMPLOYE $ 1 000 000 IMandatoryinNH) _ If yes,descrbeunder DESCRIPTIIPTIONN OF OPERATIONS he,ow E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Insituforni lob No.202465: 'Wasteumter Collections and Storm Drainage-CIPP;Project No,2024-25 City of Ashland,its agents,officers,and employees are additional insureds under General Liability and Automobile Liability on a priniary and non-contributory basis where required by written contract executed prior to lass,but only with respect to liability arising out of the Named Insured's operations. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE 2342851$ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street Ashland OR 97250 AUTHORIZED REPRE5ENTAT ©i98e-2 CORD CORPORATI N. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code: D592023 Master ID: 1347989,Certificate ID: 23428518 LOCKPW City of Ashland 20 E Main Street Ashland OR 97250 IMPORTANT NOTICE To whom it may concern: In our continued effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance going forward. To ensure future renewals of this certificate,we need your email address. Please contact us via one of the methods below, referencing Certificate ID 23428518 -Email: stl-edelivery@lockton.com *Phone: (866) 728-5657(toll-free) If we do not receive your email address via one of the above methods prior to the client's next renewal,we will assume you no longer need the certificate. If you received this certificate through an internet link where the current certificate is viewable,we have your email and no further action is needed. The above inbox is for collecting email addresses for renewal electronic certificate delivery ONLY You will not receive a response from this inbox, Thank you for your cooperation. Lockton Companies Lockton Companies I I�ic� C'i Dr, suite 900 Si, l.,�u�is, ,\Its 6 S l 41-70Sfi 314-432-0500I tockton.com Attachment Code:D544786 Certificate ID: 23428518 POLICY NUMBER: CGD300084910 COMMERCIAL GENERAL. LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL_ LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN VARIOUS AS REQUIRED PER WRITTEN CONTRACT WRITTEN CONTRACT OR WRITTEN AGREEMENT TO INCLUDE S AN ADDITIONAL INSURED PROVIDED THE"BODILY INJURY" R"PROPERTY DAMAGE"OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT,INCLUDING INDEMNIFICATION AGREEMENTS. Information required to complete this Schedule if not shown above will be shown in the A. Section If—Who Is An Insured is amended to B.With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following additional organization(s)shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This Insurance does not apply to"bodily injury"or damage"or"personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1.All work, including materials, parts or equipment furnished in connection with such 2.The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs)to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s)at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2.That portion of"your work"out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted by intended use by any person or organization law; and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 Attachment Code: D544786 Certificate ID:23428518 C.With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III—Limits Of Insurance; whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we will pay on behalf of the additional insured is the applicable limits of insurance, amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 O Insurance Services Office, Inc., 2018 CG 20 10 12 19 Attachment Code: D544786 Certificate ID: 23428518 POLICY NUMBER: CGD300084910 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED IN A KITTEN CONTRACT OR WRITTEN AGREEMENT TO INCLUDE AS VARIOUS AS REQUIRED PER THE WRITTEN CONTRACT. N ADDITIONAL INSURED PROVIDED THE"BODILY INJURY"OR 'PROPERTY DAMAGE"OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT,INCLUDING INDEMNIFICATION AGREEMENTS. Information required to complete this Schedule if not shown above will be shown in the A. Section II--Who Is An Insured is amended to B.With respect to the insurance afforded to these Include as an additional insured the person(s)or additional insureds, the following is added to organization(s)shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury"or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we your work"at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2.Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured applicable limits of insurance. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 Attachment Code:D544786 Certificate ID: 23428518 Attachment Code:D544796 Certificate ID:23428518 ENDORSEMENT# This endorsement, effective 12:01 a.m., 7I112025, forms a part of Policy No. CGD300084910 issued to AZURIA WATER SOLUTIONS, INC. By XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 c0,2005, XL America, Inc. Attachment Code:D544797 Certificate ID:23429518 AUTOMATIC ADDITIONAL INSURED ENDORSEMENT Named insured Azurla Water Solutions, Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA ISAH 11428551 7/1/2025 TO 7/1/2026 7/1/2025 Issued By(Name of Insurance Company) ACE American Insurance Company Insert the pd cy number.The remainder of the IrfarmatJon is to be completed only wfien this endorsement Is Issued subsequent to the preparation of Fhe po4icy. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SECTION 11 - LIABILITY COVERAGE, WHO IS AN INSURED is amended to include as an "insured' any person or organization you are required in a written contract or agreement to name as an Additional Insured on your policy but only for "bodily injury"or"property damage"to which this insurance applies if the"accident" is caused by: 1. You,while using a covered"auto"or 2. Any other person,while using a covered"auto"with your permission. The insurance provided by this endorsement shall be subject to the following additional condition: 1. The Limit of Insurance provided for the Additional insured shall not be greater than those required by contract and, In no event,shall the policy Limits of Insurance be increased by the contract. 2,All insuring agreements, exclusions, terms and conditions of the policy shall apply to the coverage (s) provided to the Additional Insured,and such coverage shall not be enlarged or expanded by reason of the contract. 3. Coverage provided by this endorsement shall be excess over any other valid and collectible insurance available to the Additional Insured (s)whether primary, excess, contingent or on any other basis unless the contract specifically requires that this insurance be primary or you request that it apply on a primary basis prior to loss. Attachment Code: D544797 Certificate ID:23428518 1 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named Insured Azuria Water Solutions, Inc. Endorsement Number Policy Symbol Policy Number Policy Period Effective bate of Endorsement ISA 1SAH114285 7/1/2025 TO 7/1/2026 7/1/2025 51 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 endorsoment Is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM Schedule Organization Additional insured Endorsement Any additional insured with whom you have agreed to provide such non- contributory insurance,pursuant to and as required under a written contract executed prior to the date of loss. (if no information is filled in, the schedule shall read: "Alt persons or entities added as additional insureds through an endorsement with the term'Additional Insured"in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy,the following is added to the Other Insurance Condition under General Conditions: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured")for a loss we cover under this policy,this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. DA-21886b(06/14) Page 1 of 1 Attachment Code: D544456 Certificate ID: 23428518 ENDORSEMENT# This endorsement, effective 12:01 a.m., 7/112025, forms a part of Policy No. CGD300084910 issued to AZURIA WATER SOLUTIONS, INC. 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 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. Ali Rights Reserved. Attachment Code:D543763 Certificate ID: 23428518 NOTICE TO OTHERS ENDORSEMENT - SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named insured Azuria Water Solutions, Inc. Endorsement Number 38 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA ISAH11428551 711I2025 To 7/1/2026 Issued gy(Name of Insurance Company) ACE American Insurance Company Insert the poNcy 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 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. Authorized Representative Attachment Code:D544740 Certificate 1D:23428518 Workers'Compensation and Employers'LlabilRy Policy Named Insured Endorsement Number AZURIA WATER SOLUTIONS, INC. 580 GODDARD AVENUE Policy Number CHESTERFIELD MO 63005 Symbol;WLR Number:WLRC7309740A Policy Period Effective Date of Endorsement 7/112025TO 7I1I2026 7/1/2025 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 to which it is attached and its effective on the date issued unless otherwise stated. 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. dnFhnri�arl Ranraeant�#iva