HomeMy WebLinkAbout166269 GARNEY CO - INSURANCE CERTIFICATE (10)Certificate of Insurance
'IBIS CLRI'[FICA ITi ISSUED AS A MAITBR Oil INFORMA'NON, ONLY AND CONFERS NO RIGHT UPON YOU THE CERTIFICATE HOLDER. "1H0 CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR AL"1'ER TILE COV ERAGE AFFORDED BY THE POLICIES LISTED BBLO W,
This is to Certify that
Garney Companies Inc
pa
1333 NW Vi Road
NAME AND
ADDRNAME As
OP INSURED
1�� Liberty
Kansas City
MO 64118
Mutual®
IS,.1 the issol (FIFO OI tlas eettificta., insured by Ill,
CoratitlonR fund i8 not altersd by any re,lo rellluat,
Company ailderthe p011ey(Ie8) listed bel.,,. The iasaoual affor(ed by the listed polley(le9) Is albfect to all their leiiiis, eselotiolls load
Ron or eondltloll ofaily collbact or other (I0e11111cal Wall I'Cspecl to which this o0111I1cate Koy be issued,
TYPE OF POLICY
EXP DATE
❑ CONTINUOUS ❑ EXTENDED
POLICY NUMBER
LIMITOP LIABILITY
® POLICY TERM
WORKERS
COMPENSATION
10/1/2009
WA2-14D-426942-738
COVERAGE AFFORDED UNDER WC
LAW OF THE FOLLOWING Sl'AI'ES:
AL,AR,AZ,CO,FL,GA,KS,KY,MO,
NE,SD,TN,TX
EMPLOYERS LIABILITY
Bodilybiuryby
Accidcm
1 000 OOO rsd, Aeoadeal
Bodily In}ay By Disease
1 000 000 .
Bodily Injury By Disease
1 000 000
GENERAL LIABILITY
10/1/2009
TB2-141-426942-728
Grnleral Aggregate —Other than Poldums/ Conlplcted Operations
2 000 000
❑ OCCURRENCE
Products / Completed Operations Aggregate
❑ CLAIMS MADE
2 000 000
bodily Injury and Properly Damage Liability
$1,000,000 Per occur,cllee
Personal hljwy
1000000 Far Pelson rorgani>atlon
RGfRO DATE
Gt119100,000 Fire Legal OilV0,000 Medical
5
AUTOMOBILE
LIABILITY
10/1/2009
AS2-141-426942-718
Eaeb Aceident--single l.,illlit
$1,000,000 BA, And P.D. combined
Each Person
1�I
LJ OWNED
Each Accident or Occun'enec
NON -OWNED
r❑
IJ I HEED
Eaeb Accident or Oecuncnec
OTHER
ADDITIONAL COMMENTS
Re: Alpine St. Human Bean Alley Sanitary Sewer Replacement.
The City of Fort Collins, Colorado is an additional insured as their interest may appear where required by written contract
on Auto Liability and General Liability.
^ Ifthe certificate expiration dale is continuous or eslondod boor, you,,ill be notified ifcoverage is terminated or reduced before the certificate expiration date
SPECIAL NO' I'ICP:OIIIO: ANY PI'-ItSON WHO, R91'II INTENT IA DIYRAUD OR KNOWING THAT HE IS FACILU Al'ING A FRAUD AGAINST' AN INSURCR, SUBMITS
AN APPLICATION OR RLES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OP INSURANCE FRAUD.
IMPOR EAN'r NOTICE TO FLOR IDA POLICYHOLDERS AND CIMTIFICA'FE HOLDERS: IN I Iili IiVENI YOU HAVE; ANY QU17STIONS OR NEED INFORMATION ABOUT
'flits CERTIFICATE FOR ANY REASON, PLEASE CON'FAC'r YOUR LOCAL. SALES PRODUCER WHOSE, NAME AND TELEPHONE NUMBER APPEARS IN 'TIIE LOWER
RRUIT HAND CORNER DELIUS CERTIFICATE Ins APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO RE 013'I'AINED I3Y CALLING URSNUMBER, Liberty Mutual
NOTICE OF CANCELLATION: (NO] ' APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) IIISRI'allCO Group
BEFORE '1HE S"I'ATED EXPIRATION DATE TILE COMPANY WILL NOT CANCEL OR REDUCE THE
INSURANbl AFFORDED UNDER'I'IIEABOVEPOLICIESUN'I'ILA'1'LEAS'r 60 DAYS NOTICE
017 SUCH CANCELLATION HAS BEEN MAILED T O
Alpine St. Human Bean Alley Sanitary Sewer Repl. �1
rCity of Fort Collins
Laura Rudolph
St. Louis 10442 AUTHORIZED REPRESENTATIVE
as
12250 Weber Hill Road
300 Laporte Ave. St. Louis MO 63127 800-392-9223 9/11/2009
Fort Collins CO 80522 I OFFICE: PHONE DAIIF. ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects Such insurance as is afforded by those Companies NM 772