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Home My WebLink About166269 GARNEY COMPANIES INC - INSURANCE CERTIFICATEA " oe CERTIFICATE OF LIABILITY INSURANCE ATE (MMON"Y) °09/14/2012 09/la/2012 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: ti the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. N 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 endoraemenl s . PRODUCER 1-816-521-7788 Arthur J. Gallagher Risk Nanapement Services, Inc. T Susan MCCaffray -NAME' PRONE FA% gVG No t. 816-395-869a IAIp R0; 016-467-5696 ADDRESS: eusan_mcceffreyBajg.com 7345 Grand Blvd., Suite 400 _\�I/�^ Kansas City, NO 65106 , II`," INSURERS AFFORDING COVERAGE NAlc a INSURERA: ST PAUL FIRS 6 NARINE INS CO 24767 Tamer Burne V" \ INSURED Carney Holding Company / Gamey Companies, Inc. / Gamey INSURER B: Construction Company, Inc. / Grimm Construction Company, INSURER C: INSURER D: Inc. / Weaver Construction Management, Inc. 1333 M Vlvion Road Kansas City, NO 64118 INSURER E: INSURER F: COVERAGES CFRTIFICATF NLIMRFR• 29065615 RFVIRInM MIIMRFR. 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. IN9N LTR TYPE OF NBURAMCE UBR POLICY NUMBER POUCYEFF Y MUCYE%P M DYrtB GENERALLMBAITY EACH OCCURRENCE_ f COMMERCIAL GENERAL LIABILITY DAMAGET R PREMI E Ens om,n n f MEDEXP ae Pena? f 71 CUIMS-MADE ❑OCCUR PERSORALSADVINJURY i GENERAL AGGREGATE f GEN G,GREGATE UMITAPPLIES PER. PRODUCTS - COMPIOP AGO f POLICY PRO- LOC f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea ed 1) BODILY INJURY(P. PSlson) f ANY AUTO ALL OS ALTOS SCHEDULED AUTOS AUTOS BODILYIWURY(P.*o Wwl 1 f NUTOS O HIRED AUTOS AUTOS PROPERTY DAMAGE P r tled f f A Y UMBRELLA UAS Y OCCUR Y Y ZUP-ldS78652-12-NF 10/03/1 10/01/13 EACH OCCURRENCE f 15,000,000 AGGREGATE f 15,000,000 EXCESS LUIB CLAIMS MADE DED Y RETENTION NONE f WORKERS COMPENSATION WC STATU- OTW AND EMKOYERV UJUIILRY YIN ANY PROPMETOWPARTNERIEXECUTIVF OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT f EL DISEASE -EA EMPLOYE f (YUlestmy In NM) Ilyyeecs Msr be uMer DESCRIPTION OF OPERATIONS below EL. DISEASE -POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(At hACORD 101, AddHbIW Rene?. ftloWule, H mom aPm N rpuMj Following Form Primary/Underlying Policies with Liberty Mutual Fire Insurance Company, General Liability including Completed Operations Policy BTB2-641-426942-722 HEY. 10-1-2012/10-1-2013 Auto Liability Policy aAS2-661-426942-712 Bff. 10-1-2012/10-1-2013 Employers Liability/workers' Compensation Policy 81D12-6aD-6269a2-732 aft. SO-1-2012/10-1-2013 Following Form Including Blanket Additional Insured, Primary and Non -Contributory and Blanket Waiver of Subrogation an required by written contract. Includes All Work and Operations Performed by insured covered by Primary/Underlying Policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort'Collim THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5316 LaPorte Avenue AUTHORUED REPRESENTATIVE Port Collins, CO 80522 USA / SI 1ORS-Inin ACnRn CTIRRTI11ATHIM All Hn H1...... A ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD micbor 29065615 I'Rr•Ip]dp] A� i" CERTIFICATE OF LIABILITY INSURANCE °09/14/2012 09/16/7017 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: N the certHicate holder Is an ADDITIONAL INSURED, the pollcy(laa) must be endorsed. H 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 endorsements . PRODUCER 1-816-621-7788 Arthur J. Gallagher RSBk Management Services, Inc. CONTACTNAME:Susen MCCaYfray PHONE FAX Mm . 816-395-8696 ,gC NP: 816-667-5696 EJMIL ADpRE BYBaa_MCCBEEIOyBajq.C® 7365 Grand Blvd., Suite 600 INSURERS MFOROING COVERAGE NAIC0 Kansas City, NO 66108 INSURERA: ST PAUL PINE A MARINE INS CO 76767 Tanner Burns INSURED cerney Holding Company / Garnet' Companies. Inc. / Oerney INSURER B: Construction Company, Inc. / Grim Construction Company, INSURER C: INSURER D: Inc. / Weaver Construction Management, Inc. 1333 NW VSvlon Road Kansas City, MO 66118 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER- 29065513 RFVISInm NUMRFR. 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. INSB Im TYPEOFINSURANOE ADpL INSR U Me POLICY NUMBER POLICYEFF IMMIDDATM P0HCYEXP (MUN10DjYYMUNITS GENERAL LIARUJTV EACH OCCURRENCE f COMMERCIAL GENERAL LIABILITY OAIMGE Si RENTED PREMISES 'RENTS ncl If MED EXP ana pi S CLAIMS E ❑ OCCUR PERSONAL S ADV INJURY $ GENERALAGGREGATE f GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPA)P AGG i POLICY PHI LOC f AUTOMOBILE UJUNIXTY COMBINED SINGLE LIMIT Ee ant BODILY IWURY(Per Perron) $ ANY AUTO _ ALL DINNED SCHEDULED AUTOS AUTOS BODILY IWURY(Per accgad I f NON-0WNED HIRED AUTOS AUTOS PYDAWGE Perer accdml 6 S A X UMBRELLA LmB X OCCUR X X SUP-14878452-17-RIP 30/01/1 10/01/13 EACH OCCURRENCE S 15, 000, 000 AGGREGATE $15,000,000 EXCEII LU1B CLAIMS MADE DED I X I RETENTION MORE f I WORKERSCOMPENSATKIN SSTATU� OTM- ER ANDEMPLOYERS'WBILnY YIN ANY PROPMETOWARTNERAE ECUTIVE❑ OFFICERPXEMBER EXCLUDED? NIA E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE $ (Mmd n, In NMI If—Eyee IkPTmN un OheW DE mcnlM OF E.L. DISEASE -POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKech ACORD 101, Ad Iftlai M Rwne/a SCIwtlYN, N mom epee IF mquhed) Following Form Prinary/Uvderlylnq Policies with Liberty Mutual Fire Insurance Coapanyl General Liability including Completed operations Policy BTB7-661-676967-772 Sff. 10-1-2012/10-1-7013 Auto Liability Policy BAB7-661-6269/7-712 aff. 10-1-2012/10-1-7013 Employers Liability/Workere• Compensation Policy 11110,7-66D-676962-737 aft. 10-1-2012/10-1-7013 Following Form Including Blanket Additional Insured, Primary and Non-Coatributory and Blanket Waiver of Subrogation as required by written contract. Includes All Work and Operations Performed by insured covered by Primary/Underlying policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Port Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LaPorte Avenue AUTHORRED REPRESENTATIVE p Collins, CO 00522 UBA / 01988.2010 ACORD CORPORATION. All rights reserve) ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD micbor 29065513 YSSWxI}px13 A OM CERTIFICATE OF LIABILITY INSURANCE D 09/14 2012M BNM1D VI 012 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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must 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 time not confer rights to the certificate holder In lieu of such endoraemen s . PRODUCER 1-816-421-7788 Arthur J. Gallagher Risk Management Services, Inc. CONTACTSusan McCaffrey NAYS: EKU: 816-395-869e WC, 11 4Vc No), 816-s67-569a816-a67-569A EMAIL ADORE !: auBan_mCCLLLrerBajq.COm 2365 Grand Blvd., Suite 400 INSURERS AFFOROWG COVERAGE NMC1 Kansas City, NO 64100 INSURERA: ST PAUL FIRB 6 N HE INS CO 24767 Teener Burns INSURED Garner Holding CompmY / Garner Companies, Inc. / Oerney NSURER e Construction Company, Inc. / Grim Construction crnpany, INSURER C: INSURER tit Inc. / Weaver Construction Management, Inc. 1333 BIN Vivion Road Kansas City, NO 64118 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29065509 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 WBURANCE AWISU POLICY EFF POLICY EXP LTR POLICY NUMBER Y M UNITS GENERAL LABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES EOaruR n $ MED EXPMED M�Pne 0e S0e S CLAIMS -MADE OCCUR PERSONAL a ADV INJURY S GENERALAGGREGATE S GENT AGGREGATE UNIT APPLIES PER: PRODUCTS - COMPlDP AGG S POIJCY PRO- Lot i AUTONOBILE LIABILITY COMBINED SINGLE LIMIT Ee ec nl BODILY INJURY (Pw Penn) f ._ - ANY AUTO __ __ _ - _ ALL OWNED SCHEDULED AUTOS AUTOS( BODILY PWecrJEenl INJURY ) t NON-0GMED HIRED AUTOS AUTOS PROPERTY DAMAGE PeramJEeM $ S A I UMBRELLA LAB N SUN E I SDP-16878452-12-01F 10/01/1 10/01/13 EACH OCCURRENCE S 15,000, coo AGGREGATE 315,000,000 EXCESS LIAR CLAIMS MADE DED I E I RETENTION S NONE S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LABIIITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERJMEMBER EXCLUDED? ❑ NIA E.L. EACH ACCIDENT i EL DISEASE - EA EMPLOYE 1 IMarde"InNH) D S =1=uMw DESCRIPTION OFOPERATIONSW1mv E.LDISEASE-POLICYLIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IALMPn ACOIIO 1 W, Aeallbnd RenarYF M6FSVIF, H maF FpNw b nNu6N) Following Form Primary/underlying Policies with Liberty Nutual Fire Insurance Cony: General Liability including Completed Operations Policy #m2-6e1-626942-722 Eff. 10-1-2012/10-1-2013 Auto Liability Policy eAB2-641-426942-712 Eff. 10-1-2012/10-1-2013 EsIployers Liability/Workers' C'oapensation Policy #DIPS-6aD-e269e2-732 Bff. 10-1-2012/10-1-2013 Following Form Including Blanket Additional Insured, Primary and Non -Contributory and Blanket Waiver of Subrogation as required by written contract. Includes All Work and Operations Performed by insured covered by Primary/Underlying policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Port Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LaPorte Avenue AUTHOF=D REPRESENTATIVE Q C011lna, CO 80525 -- I1 , USA / 01988-2010 ACORD CORPORATION. All dahts reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD mlcbor 29065509 ri W Psautant d Q CERTIFICATE OF LIABILITY INSURANCE °o9/14u/201/colA9/Y" a 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 CONSMUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H the Certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to the tames and conditions of the policy, certain policies may require an endorsement. A statement on this certificate time not confer rights to the certificate holder In lieu of such endorsement a . PRODUCER 1-816-421-7788 Arthur J. Gallagher Risk YBnagement Services, Lac. A Snsm I[cCaYfray PHONE FAX yy tla . 816-395-869{I CNp; 816-467-5694 2345 Grand Blvd., Suite 400 AZIIL euean-occaffray4aj4.com INSURER(S) AFFORDING COVERAGE NAICS Kansas City, YO 64100 INSURERA: ST PAUL PINS 6 MARINE INS CO 24767 Tanner Burns INSURED Garney Holding Company / Gamey Companies, Inc. / Gamey INSURER B: Construction Company, Inc. / Grimm Construction Company, INSURER C: INSURER O: Inc. / Heaver Construction me-agement, Inc. 1333 NW Vivion Road Kansas City, ISO 64118 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29065666 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 rypE OF A66LSUIM POLICY Err POLICY EXP LTR POLICY NUMBER (INSUDDIYYYY1 IMWDD1YYMLIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIALGENERALUASUTY DAMAGET aENTEO PREMI E E 0 curtenm $ MEOEXP An .,Pe eOn $ CLAIMS -MADE DOCOUR PERSONAL 4 ADV INJURY S GENERAL AGGREGATE S GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S PDUCY PRO Lot JFCT f BILE LIABILITYEa COMBINED SINGLE LIMIT BODILY INJURY(P. Penns) S YAUTO F�INNo LL OWNED SCHEDULED UTOSAUTOS( BODILY INJURY Pe ectl4eml 1NON-0WNED S IRED UTOS AUTOS PROA PPERLY DANAGE S $ A Z UMBRELLA LAB 2 OCCUR ZUP-14S78452-12-MP 10/01/1 10/01/13 EACH OCCURRENCE S 15, 000, 000 AGGREGATE $15,000,000 EXCESS UAB CLAIMS MADE DED I X RETENTION I NONE f YIORXERSCOMPENSATION WCSTATIF OTH- AND EMPLOYERS' LIABIIITY YIN ANY PROPMETORNARTNEILEXECUPW OFFICERNEMBER EXCLUDED? ❑ MIA T, E.L. EACH ACCIDENT f E.L.DISEASE-EAEMPLOYE $ (Mm4mlory IA NHI 11 yea. 4esmme UMw DESCRIPTION OF OPERATIONS mebw E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES OMNON ACORD 101, A44NIaW Rwnaft ScM4uN, N nwn FPAOe N n9u6m4) Following Form Primary/underlying Policies with Liberty Mutual Fire Insurance Companys General Liability including Completed Operations Policy 4TB2-641-426942-722 Eff. 10-1-2012/10-1-2013 Auto Liability Policy eAS2-641-426942-712 Eff. 10-1-2012/10-1-2013 Employers Liability/Workers- Compensation Policy aWA2-64D-426942-732 Eff. 10-1-2012/10-1-2013 Following Form xncluding Blanket Additional Insured, Primary and Nov -Contributory and Blanket Waiver of Subrogation as required by written contract. Includes All Work and Operations Performed by insured covered by Primary/Underlying Policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Port Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LaPorte Avenue Port Collins, CO 00525 USA I T✓ 11"'�'- / 01988.2010 ACORD CORPORATION. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD mlcbor 29065666 rsz�+wzNuz S A� oe °A9/"W2012 CERTIFICATE OF LIABILITY INSURANCE 09/1s/2012 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 pollcy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cartificate time not confer rights to the certificate holder In Ilou of such andorsemen s . PRODUCER 1-016-621-7788 Arthur J. Gallagher Risk Management Services, Inc. CONTACT BOben McCaffrey NAME. PHONE . 816-395-8694 IFZ,Na, 816-667-5696 Ea1AIL ADORE euem-mccaffreyanlg.cam 2345 Grand Blvd., Suite 400 INSURERIe AFFORDING COVERAGE NAICa Kansas City, NO 65108 INSURERA: ST PAM FIRS s MAKINE INS CO 26767 Tamar Burns INSURED Carney Bolding Company / Carney Companies, Inc. / Carney INSURER B: Construction Company, Inc. / Grimm Construction Company, INSURER C: INSURER O: Inc. / Weaver Construction Yanagameat, Inc. 1333 NY Vivion Road Kansas City, NO 66110 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29065589 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. DIM LTRINSROW�Pol1CY TYPE OF INSURANCE NUMBER POLICY EFF IM=WnYn POLICY EAP IMMJDDNYYY)LH015 GENERALLUBM.T' EACH OCCURRENCE 6 COMMERCUL.GENERALLIABILITY DAMAGE TO RENTED PREMISES EaU curt m S MED EXP ma poem $ CLAIMS -MADE OCCUR PERSONAL S ADV INJURY $ GENERALAGGREGATE f GENI AGGREGATE OMIT APPLIES PER PRODUCTS -COMPX)P AGG f POLICY PRO-LOC L AUTOMOBILE UABftflY COMBINED SINGLE LIMIT Ea acddanl BODILY INJURY(Pwpslsan) ANY ALTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(P. a dmt) i NON -OWNED HIRED AUTOS AUTOS(PE PROPERTY DAMAGE InEdat) f $ A E UMBRELLA UAB E BUR E E ZUP-ldS78452-12-NF 10/01/1 10/01/13 EACHOCCURRENCE f 15,000, 000 AGGREGATE 515,000,000 "a"W19 CWMS-MADE DED I E RETENTION I MOM $ WORKERS COMPENSATION - WC STATU- OTH- ANDEMPLOYERS'WBILITY YIN TORaWIa' EL EACH ACCIDENT S ANY PROPRIETONPARTHERIEXECUTIVE OFFICERRAEMBEREXCLUDEW ❑ NIA E.L. DISEASE - EA EMPLOYE f (WndYmy In NH) Ilym deemba UMW DESCRIPTION OF OPERATIONS Meb,v EL DISEASE - POLICY LIMN S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtU0 ACORD 101, AMNmnM Rsms,Ys fth uM, M m m spsa h a9uaadl Following Form Primary/Underlying Policies with Liberty Mutual Fire Insurance Companyc General Liability including Completed Operations Policy #M2-641-626962-722 Eff. 10-1-2012/10-1-2013 Auto Liability Policy •AS2-661-426942-712 Eff. 10-1-2012/10-1-2013 Employers Liability/Yorkers• Compensation Policy IRM2-64D-4269492-732 Eff. 10-1-2012/10-1-2013 Following Form Including Blanket Additional Insured, Primary and Non -Contributory and Blanket Waiver of Subrogation as r,u Uired by Written contract. Includes All York and Operations Performed by insured covered by Primary/Underlying policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 6316 LaPorte Avenue AUTHORNED REPRESENTATIVE p Port Colllne, CO 00522 --I-1)'�' , USA / 01888.2010 ACORD CORPORATION. All rlahtft meame, ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD miabor 29065589 n W