HomeMy WebLinkAbout166269 GARNEY HOLDING CO - INSURANCE CERTIFICATE (12)CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DONYYY)
912MO19
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 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 endorsements).
PRODUCER MMIA
NAME:
Arthur J. Gallagher & Co. Insurance Brokers of CA. PHONE FAX
1255 Battery Street #450 415-391-1500 A,C No): 415-391-1882
E-MAIL
San Francisco CA 94111
INSURER AFFORDING COVERAGE NAIL
INSURER A: Liberty Mutual Fire Insurance Company 23035
INSURED GARNCOM-02 INSURER S : Travelers Property Casualty Co of America 25874
Garvey Holding Company/Gamey Construction
/Garvey Pacific, Inc./Garney Federal, Inc. INSURERC:
1333 NW Vivion Road INSURERD:
Kansas City MO 64118 INSURER E:
COVERAGES CERTIFICATE NUMBER: 1739916316 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' - - _. pO1JCcY EFF POUppV E%P i_-_
LTR TYPE OF INSURANCE POLICYNUMSER MWDQ'YYY Mat1)D/YYYV UWTS
A
X COMMERCIAL GENERAL LIASUM
CLAIMS MADE OCCUR
_
Y
Y
TB2641426942729
10/1/2019
10/1/2020
EACHOCCURRENCE
$2.000,000
pPREEMMISEBEaa oowrranca
$300,000
MED E%P (Any one person)
t610,000
PERSONAL 8 ADV INJURY
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY FTIjEco� F7LOC
OTHER:
GENERAL AGGREGATE
$4,000,000
PRODUCTS - COMP/OP AGO
$4,000,000
S
A
AUTOMONLEUI"ILm'
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED -OWNED
X AUTOS ONLY X AUTOS ONLY
Y
Y
AS2641426942719
10/12019
10/1/2020
COMSINE DSIN GLELIMIT
Ea accident)
$2.000.000
BODILY INJURY (Per person)
$
BODILY INJURY fear acridentl
$
DAMAGE
(Par
y
S
S
X UMBRELLA LIAS X OCCUR
I EXCESS L AS CLAIMS -MADE
ZUP14S7845219NF
10/12019
10/12020
EACH OCCURRENCE
115,000,000
AGGREGATE
$15,000,000
DIED I RETENTION
A WORKERS COMPENSATION
A AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETOR PARTNER.EXECUTIVE
OFFICER'MEMBEREXCLUDED?
(Mandatory In NN)
It yes. describe under
DESCRIPTION OF OPERATIONS oelow
NIA
Y
WA264D426942739
WC2641437723909
10112019
10/12019
10/12020
10/12020
X TASTE ER
E.L, EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS' VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached It more /pace Is required)
Gamey Job # Work Order Job Name 1416 Castlerock Sewer Service Repair City of Fort Collins is additional insured with regards to general liability and
automobile liability, as their interest may appear, where required by written contract.
GtR I II-IGA I t MULL)t:K GAIVL.tLLA I IUN
City of Fort Collins
PO Box 580, 700 Wood Street
Fort Collins CO 80522-0580
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
D REPRESENTATIVE
01988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016iO3) The ACORD name and logo are registered marks of ACORD
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