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HomeMy WebLinkAbout166269 GARNEY HOLDING CO - INSURANCE CERTIFICATE (26)A. ® DATE (MMIDD/YYYY) `./ CERTIFICATE OF LIABILITY INSURANCE 9/28/2017 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 CONTACT NAME: Carolyn Short _ Arthur J. Gallagher Risk Management Services, Inc. PHONE g16 395-8558 FAX 816-467-5558 2345 Grand Blvd., Suite 400 No ,)- -MAIL . carol n_short@a com Kansas City MO 64108 E INSURER A: Travelers Property Casualty Co of America 25674 INSURED GARN COM-01 INSURER B : Garney Holding Company INSURERC: (See attached list of Additional Named Insureds) INSURER0: 1333 NW Vivion Road Kansas City MO 64118 INSURERE: _ INSURER F rn1/CDAr_CC f GDTIFICATF IUI IMRFD• 1O44R77S6A OF\/ICICIN NI IRARFR- 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 LTR TYPE OF INSURANCE INSD WVID POLICY NUMBER POLICY EFF DIY POLICY EXP DfYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ ED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY S GEN'L _ AGGREGATE LIMIT APPLIES PER: CI ­ POLICY JJff T LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Ea accident s BODILY INJURY (Per person) $ BODILY INJURY (Per accident) s Per accident s A X UMBRELLA LIAB 1 X ' OCCUR EXCESS LIAB CLAIMS -MADE DIED X RETENTION s None Y Y ZUP-14S78452-17-NF 10/1/2017 10/1/2018 EACH OCCURRENCE $15,000,000 AGGREGATE s15,000,000 E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN.. ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) See Attached... CFRTIFICATF Ian/ f1FR CANCFI I ATIr)N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 Laporte Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522 ;7R,IZED REPRESENTATIVE r © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GARNCOM-01 LOC #: AC" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Garney Holding Company (See attached list of Additional Named Insureds) 1333 NW Vivion Road Kansas City MO 64118 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AUUI I IUIVHL KtIVIHKKZJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE For the following additional Named Insureds: Garvey Holding Company Garney Companies, Inc. Grimm Construction Company, Inc. Garvey Wyoming, Inc. Garney New Mexico, Inc. Garney Federal, Inc. Encore Construction Group, Inc. Garney Colorado, LLC Garney Water Partnership Garney P3, LLC Following Form Primary/Underlying Policies with Liberty Mutual Fire Insurance Company: General Liability including Completed Operations Policy #TB2-641-426942-727, Eff. 10-1-2017/10-1-2018 Automobile Liability Policy #AS2-641-426942-717, Eff. 10-1-2017/10-1-2018 Employers Liability/Workers' Compensation Policy #WA2-64D-426942-737, Eff. 10-1-2017/10-1-2018 Employers Liability/Workers' Compensation Policy #WC2-641-437723-907 — WI only, Eff. 10-1-2017110-1-2018 Following Form Coverage A - Excess Liability includes 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. For the following additional Named Insureds: Garney Pacific, Inc. Garney Hawaii, Inc. Following Form Primary/Underlying Policies with Liberty Mutual Fire Insurance Company: General Liability including Completed Operations Policy #TB2-641-444498-027, Eff. 10-1-2017/10-1-2018 Automobile Liability Policy #AS2-641-44498-017, Eff. 10-1-2017/10-1-2018 Employers Liability/Workers' Compensation Policy #WA2-64D-444498-037, Eff. 10-1-2017/10-1-2018 Following Form Coverage A - Excess Liability includes 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. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD