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HomeMy WebLinkAboutCERT OF LIABILITY OP ID ROJA DATE(MMIDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE PETER-3 06/08/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LSB Financial HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 219 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cedar Falls IA 50613 Phone: 319-268-4242 Fax:319-268-4211 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: The Travelers Indemnity Co 25658 INSURER B: Travelers Property Casualty Co 25674 Peterson Contractors, Inc Reinbeck Motors, Inc INSURERC: The Travelers indem CO of CT 25682 PO Box A / 104 Blackhawk St INSURERD: The Travelers Indemnity Co 25658 Reinbeck A 50669 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGt IU I A X COMMERCIAL GENERAL LIABILITY VTEKCO7880B883INDO9 07/01/09 07/01/10 PREMISES(EaKtNoccurtUence) $ 300,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $ 10,0 0 0 X Blanket Contractu PERSONAL&ADV INJURY $ 1,000,000 X XCU Coverage GENERAL AGGREGATE $ 2,0 0 0,0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X ANY AUTO VTJCAP3510A26ATIL09 07/01/09 07/01/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,0 0 0,0 0 0 A X OCCUR CLAIMSMADE VTSMKCUP3510A271IND0907/01/09 07/01/10 AGGREGATE $ 5,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND ORS I Al U- O X TORY LIMITS ERR C EMPLOYERS'LIABILITY VTC2EUB9123B85509 07/01/09 07/01/10 E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER D Cargo QT660140D783TIA08 07/01/09 07/01/10 800,000 D Leased / Rent Equi QT660140D786TIA08 07/01/09 07/01/10 750,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS For the project described as Westfield Ave. Connection, The City of Waterloo, Westin Solutions and Deere & Co. are listed as additional insureds under the General Liability per written contract requirements. PCI#J2146. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of Waterloo IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 715 Mulberry St. REPRESENTATIVES. Waterloo IA 50703 AUTH I DREPRESENT VE ACORD 25(2001/08) ©ACORD CORPORATION 1988 CITY OF WATERLOO DEPARTMENT OF ENGINEERING TRANSMITTAL 715 Mulberry Street Waterloo, IA 50703 DATE:5/28/09 Contract No.N/A TO: Joe Becker, AECOM PROJECT:NHSX-63-6(69)--3H-07 Transmitted herewith are: QUANTITY DESCRIPTION Agreement Change Order Contracts and Bonds Engineering Contract Maintenance Bond Plans and Specifications .,..4. I �..+ F UI II.I I LIJI TV Reports one original Contingency Request Letter I For your Action I I Per Your Request For your Approval I I Per our Conversation For your Information For your review For your signature ® For your Files Other COMMENTS: Cc: Nancy Eckert, City Clerk w/original, Michelle Weidner, Finanance Dept. w/copy, Pauline Closson, Eng. Dept. wi/copy, File w/copy. City Engineering Department By: A ) Jeff Btel /Associate Engineer