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HomeMy WebLinkAbout166269 GARNEY CO - INSURANCE CERTIFICATE (26)ACOR" CERTIFICATE OF LIABILITY INSURANCE �./ DATE(MMIDDIYYYY) F9/28/2017 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 Arthur J. Gallagher Risk Management Services, Inc. 2345 Grand Blvd., Suite 400 Kansas City MO 64108 CONTACT NAME:__ -__ Carolyn Short -PHONE 816-395-8558 FAX $16-467-5558 (AIC,No, Ext): _ __ ADDWE_ss. carolyn_short@ajg.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Travelers Property Casual Co of America 25674 INSURED GARNCOM-01 INSURER B : INSURERC: Garney Holding Company Additional Named Insureds) INSURERD: (See attached list of 1333 NW Vivion Road INSURER E : Kansas City MO 64118 INSURER F : COVERAGES CERTIFICATE NUMBER: 51175040 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. INTSRR TYPE OF INSURANCE I POLICY NUMBER POLIDNYYY PMIOWLDDYnYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE E _ GEN'L _ -DAMAGE TORENTED— PREMISES Ea occurrence E MED EXP (Anyone person) E PERSONAL & ADV INJURY E AGGREGATE LIMIT APPLIES PER: POLICY F7 JECT LOC OTHER: GENERAL AGGREGATE E PRODUCTS - COMPIOP AGG E E AUTOMOBILE LIABILITY ANY AUTO AUTOWNED OS ONLY AUTOSULED HIRED NON -OWNED AUTOSTOS ONLY AUTOS ONLY Ea accident E BODILY INJURY (Per person) E BODILY INJURY (Per accident) E R-OPERTYDWGIE— E E A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y Y ZUP-14S78452-17-NF 10/1/2017 10/1/2018 EACH OCCURRENCE E15,000,000 AGGREGATE $15,000,000 DED X RETENTION E None E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yyes, describe under DESCRIPTION OF OPERATIONS below NIA PER ,STAT UTE I I ER E.L. EACH ACCIDENT E E.L. DISEASE - EA EMPLOYE - E E.L. DISEASE - POLICY LIMIT - E DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See Attached... UtHIIVIUAIL HULUEH GANGELLAIION City of Fort Collins 4316 LaPorte Avenue 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. RRIZED REPRESENTATIVE i� © 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 #: ,_­W014 ACCIII ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. Garney Holding Company (See attached list of Additional Named Insureds) POLICY NUMBER 1333 NW Vivion Road Kansas City MO 64118 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS 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. Garvey Wyoming, Inc. Garvey 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. Project or Job #: Garney Job #6248-2B Project: Boxelder Creek Outfall Phase 2B Overflow Channel and Urban Design Features ACORD 101 (2008101) �9 ZUUU HL.UKU LUKYUKM 1 IUN. H11 r1yn15 reSerVeU. The ACORD name and logo are registered marks of ACORD