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HomeMy WebLinkAbout166269 GARNEY CO - INSURANCE CERTIFICATE (5)[his certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) GARNEY CONSTRUCTION 10822 W TOLLER DRIVE, SUITE 100 LITTLETON, CO 80127 is not altered by any requirement, term or Expiration Tvpe Continuous* Extended Policy Tenn JX Workers Compensation . General Liability HClaims Made X Occurrence :1 Retro Date Automobile Liability tX Owned X Non -Owned X Hired their terms, exclusions and conditions and to which 10/01/2006 / 10/01/2007 WA2-I4D426942-736 Coverage afforded under WC low of the following states: Employers Liability Bodily Injury By Accident $1,000,000 Each Accident AR, AZ, CO, FL, GA, KS, KY, MO, NE, OK, SC, SD, TN, TX, UT, WY Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person 10/01 /2006 / 10/01/2007 I TB2-141-426942-726 I General Aggregate -Other than Prod/Completed Operations Products/Completed Operations Aggregate Bodily Injury and Property Damage Liability I Per Personal and Advertising Injury I Per Person / Other Liability Other Liability $300,000 Fire Legal $10,000 Medical 10/01/2006 / 10/01/2007 AS2-141-426942-716 Each Accident - Single Limit - B. I. and P. D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence C I *WA Policy includes deductible endorsement with $250,0t)0 deductible per occurrence/claims (disease) with the provision that Liberty Mutual will (may) advance payment of O the deductible amount. -- Project: Spring Creek Pre -Disaster Mitigation C&S RR Detention Pond. The City of Fort Collins, and Rothberg, Tamburini and Winsor are additional M insured with respect to general liability where required by written contract. E N T S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower left corner of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 60 days notice of such cancellation has been mailed to: Office: OVERLAND PARK, KS Phone: 913-681-1700 Certificate Holder: City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80522 CHRISTINA GRAVELY Date Issued: 09/11/2006 Prepared By: CH Chis certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those compames. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) GARNEY CONSTRUCTION 10822 W TOLLER DRIVE, SUITE 100 LITTLETON, CO 80127 is, at the issue date of this certificate, insured by the Company under the policy(im) listed below. The insurance afforded by the listed policy(im) is subject to is not altered by anv reauirement. term or condition of anv contract or other document with rm act n, which thin certificate may he issued. Exviration Type Continuous* Extended Policy Term JX Workers Compensation General Liability dClaims Made X Occurrence Retro Date Automobile Liability X Owned X Non -Owned X Hired +'i all thew terms, exclusions and conditions and EffJExp. Date(s) Policy Numbers) Limits of Liability 10/01/2006 / 10/01/2007 WA2-14D-426942-736 Coverage afforded under WC law of Employers Liability the following states: Bodily Injury By Accident AR, AL, CO, FL, GA, KS, KY, MO, NE, $1,000,000 Each Accident OK, SC, SD, TN, TX, UT, WY Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person 10/01/2006 / 10/01/2007 I TB2-141-426942-726 I General Aggregate -Other than Prod/Completed Operations Products/Completed Operations Aggregate Bodily Injury and Property Damage Liability I Per Personal and Advertising Injury I Per Person / Other Liability I Other Liability $300,000 Fire Legal $10,000 Medical 10/01/2006 / 10/01/2007 AS2-141-426942-716 Each Accident - Single Limit - B. I. and P. D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence C *WA Policy includes deductible endorsement with $250,000 deductible per occurrence/claims (disease) with the provision that Liberty Mutual will (may) advance payment of O the deductible amount. — Project: Dry Creek Drainage Improvements - East Vine Diversion Channel, Spillway & Turnout Structure. City of Fort Collins, Larimer and Weld M Irrigation Company and URS Corporation, Iuc. are additional insured with respect to general liability where required by written contract M E N T S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower left corner of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies un[d at least 60 days notice of such cancellation has been mailed to: Office: OVERLAND PARK, KS Phone: 913-681-1700 Certificate Holder. City of Fort Collins, Colorado 300 Laporte Avenue Fort Collins, CO 80522 CHRISTINA GRAVELY Date Issued: 09/11/2006 Prepared By: CH Phis certificate is executed by Liberty Mutual Insurance Croup as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or aher the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) GARNEY CONSTRUCTION 10822 W TYILLER DRIVE, SUITE 100 LITI'LETON, CO 80127 is, at the issue date of this certificate, insured by the Company under the policy(im) listed below. The insurance afforded by the listed policy(ies) is subject to is not altered by anv re mirement. term or condition of anv contract nr other drvnrrteri with remtent to which thin re. ifirntr. mao M iamwd ExPiration TvDe Continuous* Extended Policy Tenn X Workers Compensation General Liability HClaims Made X Occurrence Retro Date Automobile Liability X Owned X Non -Owned X Hired all their terms, exclusions and conditions and EfrJE Date(s) Policy Numbers) Limits of Liability 10/01/2006 / 10/01/2007 WA2-14D426942-736 Coverage afforded under WC law of Employers Liability the following states: Bodily Injury By Accident AR, AZ, CO, FL, GA, KS, KY, MO, NE, $1,000,000 Each Accident OK, SC, SD, TN, TX, UT, WY Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person 10/01/2006 / 10/01/2007 I TB2-141426942-726 I General Aggregate -Other than Prod/Completed Operations Products/Completed Operations Aggregate Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Personal and Advertising Injury Per Person / $1,000,000 Or anizatioi Other Liability Other Liability $300,000 Fire Legal $10,000 Medical 10!01/2006 / 10/01/2007 I AS2-141-426942-716 I Each Accident - Single Limit - B. I. and P. D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence C I *WA Policy includes deductible endorsement with $250,000 deductible per occurrence/claims (disease) with the provision that Liberty Mutual will (may) advance payment of O the deductible amount. -- Project: Dry Creek Drainage Improvements -Irrigation Conveyance Improvements. City of Fort Collins, Colorado, Stantec, Inc. and URS Corporation, M Inc., are additional insureds as respects general liability. E N T S *If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower left corner of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 60 days notice of such cancellation has been mailed to: Office: OVERLAND PARK, KS Phone:913-681-1700 Certificate Holder. City of Fort Collins, Colorado 300 Laporte Avenue Fort Collins, CO 80S22 CHRISTINA GRAVELY Date Issued: 09/11/2006 Prepared By: CH fh_is_ _certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policies listed below. This is to certify that (Name and address of Insured) GARNEY CONSTRUCTION 10822 W TOLLER DRIVE, SUITE 100 LITTLETON, CO 80127 is not altered by anv requirement, term Expiration Type Continuous* Extended Policy Term JX Workers Compensation General Liability HClaims Made X Occurrence Retro Date Automobile Liability X Owned X Non -Owned X Hired atr� I by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject in all their terms, exclusions and conditions and idition of my contract or other document with respect to which this certificate my he issued. Efl . Date(s) Policy Number(s) Limits of Liability 10/01/2006 / 10/01/2007 WA2-14D-426942-736 Coverage afforded under WC law of Employers Liability the following states: Bodily Injury By Accident AR, AZ, CO, FL, GA, KS, KY, MO, NE, $1,000,000 Each Accident OK, SC, SD, TN, TX, UT, WY Bodily Injury By Disease $1,000,000 Policy Limit Bodily Injury By Disease $1,000,000 Each Person 10/01/2006 / 10/01/2007 I TB2-141-426942-726 I General Aggregate -Other than Prod/Completed Operations Products/Completed Operations Aggregate Bodily Injury and Property Damage Liability I Per Personal and Advertising Injury I Per Person / Other Liability Other Liability $300,000 Fire Legal $10,0()0 Medical 10/01/2006 / 10/01/2007 AS2-141426942-716 Each Accident - Single Limit - B. I. and P. D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence C *WA Policy includes deductible endorsement with $250,000 deductible per occurrence/claims (disease) with the provision that Liberty Mutual will (may) advance payment of O the deductible amount. -- Project: Dry Creek Drainage Improvements - Dry Creek SCADA System. City of Fort Collins, Larimer and Weld Irrigation Company and URS M Corporation, Inc. are additional insured with respect to general liability where required by written contract. M E N T -n the cemncate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. However, you will not be notified annually of the continuation of coverage. Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Important information to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales producer, whose name and telephone number appears in the lower left comer of this certificate. The appropriate local sales office mailing address may also be obtained by calling this number. Noticeof cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 66 days notice of such cancellation has been mailed to: Office: OVERLAND PARK, KS Phone: 913-681-1700 Certificate Holder. City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80522 CHRISTINA GRAVELY Date Issued: 09/11 /2006 Prepared By: CH POLICY NUMBER: HDOG23719290 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Persons Or Or anization s : If required by contract, CITY OF FT COLLINS Location(s) Of Covered Operations 64090010 All as required by contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Endorsement #A2 ADDITIONAL INSURED — OWNERS LESSEES OR CONTRACTORS --�1 NAMED- INSURED'S ACTS OR OMISSIONS ONLY A Section II — Who is An Insured is amended to include as B. With respect to the insurance afforded to these additional an additional insured the person(s) or organization(s) insureds, the following additional exclusions apply: shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and This insurance does not apply to "bodily injury" or advertising injury" caused solely by: property damage" occurring after: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same Endorsement #A2A section II — Who Is An Insured is amended to include as an additional insured n(s) or organization(s) shown in the the person(s)or Schedule, but only with respect to liability for "bodily injury" or "property damage" caused solely by "your work" at the location desi Hated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard."