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HomeMy WebLinkAbout166269 GARNEY CO - INSURANCE CERTIFICATE (18)A017 DATE (MMIDDlYYYY) `C"R" CERTIFICATE OF LIABILITY INSURANCE g/2a/ (MM/ 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 NAME. Carolyn Short Arthur J. Gallagher Risk Management Services, Inc. PHONE o �_ 816-395 8558 Nol_ 816-467-5558 2345 Grand Blvd., Suite 400 Kansas City MO 64108 E-MAIL . carolyn_short@ajg.com Travelers Prooertv Casualtv Co of America 125674 INSURED GARNCOM-01 Garney Holding Company (See attached fist of Additional Named Insureds) 1333 NW Vivion Road Kansas City MO 64118 CM/FRar:FC CFATIFICATF NI IMRFR- 1166914047 RF\/ICIr ri IulIMRFR• 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 WVD POLICY NUMBER POLICY EFF MM/DDIYY POLICY EXP DfYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ll OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence S MED EXP (Any one son) $ PERSONAL & ADV INJURY E GEN'LAGGREGATE LIMIT APPLIES PER: POLICY I PRO- JECT I LOC OTHER: GENERALAGGREGATE $ 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) S BODILY INJURY (Per accident) E Per accident $ S A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE Y Y ZUP-14S78452-17-NF 10/1/2017 10/1/2018 EACH OCCURRENCE $15,000,000 AGGREGATE $15,000,000 DED X RETENTION s None $ 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 f A STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE E E.L. DISEASE - POLICY LIMIT --- S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See Attached... CERTIFICATE HOLDER CANCELLATION City of Fort Collins P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y / © 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 #: ACOR" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED Arthur J. Gallagher Risk Management Services, Inc. Garney Holding Company (See attached list of Additional Named Insureds) 1333 NW Vivion Road POLICY NUMBER Kansas City MO 64118 CARRIER NAIC CODE EFFECTIVE DATE: 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: Garney Holding Company Garney Companies, Inc. Grimm Construction Company, Inc. Garney 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. 10-1-2017/10-1-2018 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. 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