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BILL • 90-106
SPONSORED BY COUNCILMAN -HALSEY
ORDINANCE N•
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r
AN ORDINANCE OF OF • • MISSOURI, •R
MAYOR 1 CITY CLERK TO EXECUTE AN AGREEMENT • •
GARDEN CENTER, INC. , FOR THE �990 STREET TREE REPLACEMENT PROJECT.
BE IT 1xi r
ENACTED COUNCIL OF OF JEFFERSON, MISSOURI,
FOLLOWS:
Section 1. The Mayor and City Clerk are hereby authorized and
directed to execute an agreement with Green Horizons Garden Center,
for 1 Street Tree Replacement Project. The amount of
rS - contract • _ • $9, 135. 00.
!
i Section The agreement be •
i
form and content as that agreement • hereto as Exhibit
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from and after the date of passage and approval.
Passed Approved
city Clerk
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CONpTRUCTION CONTRACT
THIS CONTRACT, made and entered into this day of
w , 1990, by and between Green Horizons garden Center,
na. hereinafter called "Contractor", and the City of Jefferson,
' Missouri, a municipal corporation, hereinafter called "City".
WITNESSETH: That Whereas, the Contractor has become the lowest
responsible bidder for furnishing the supervision, labor, tools,
4' equipment, materials and supplies and for constructing the
following City improvements: 1990 Street Tree Replacement.
1 ' NOW THEREFORE, the parties to this contract agree to the following:
1. Manner and time for Completion. The Contractor agrees
with the City to furnish all supervision, labor, tools, equipment,
materials and supplies necessary to perform, and to perform, said
work at Contractor's own expense in accordance with the contract
documents and any applicable City ordinances and state and federal
r,'IR
laws. The Contractor agrees to deliver trees to be installed by the
'± City no later than November 20, 1990 and to install all other trees
by December 15, 1990.
2. Prevailing Wages. All labor utilized in the construction
of the aforementioned improvements shall be paid a wage of no less
than the "prevailing hourly rate of wages" for work of a similar
r ik
character in this locality, as established by Department of Labor
and Industrial Relations of the State of Missouri, and as
established by the Federal Employment Standards of the Department
of Labor. Contractor acknowledges that Contractor knows the
prevailing hourly rate of wages for this project because Contractor
` has obtained the prevailing hourly rate of wages from the contents
of Special Wage Determination No. 90-026-0074 in which the rate of
t > wages is set forth. The Contractor further agrees that Contractor
,�`'• , will keep an accurate record showing the names and occupations of
all workmen employed in connection with the work to be performed
under the terms of this contract. The record shall show the actual
+ ' wages paid to the workmen in connection with the work to be
= � performed under the terms of this contract. A copy of the record
shall be delivered to the Director of Public Works each week. In
a accordance with Section 290.250 RSMo, Contractor shall forfeit to
the City Ten Dollars ($10.00) for each workman employed, for each
calendar day or portion thereof that the workman is paid 'less than
the stipulated rates for any work done under this contract, by the
Contractor or any subcontractor under the Contractor.
3. Insurance. Contractor shall procure and maintain at its
' own expense during the life of this contract:
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1v'':• �{Yet 3. }• ! t y n,{Y9" :r.}y id} Cy+, �J ."t'gr ryb.,�i.5y*.� t.
1
(a) Workmen's Compensation Insurance for all of its employees
to be engaged in work under this contracts
i l �ty rns uranc in an amount not 4
(b) (�`�ntraCtO�" s p �.�ab ..
le
less than $1,000,000 for all claj• arising a single acciden t or
occurrence and $100,000 for any one person
occurrence, except for those claims governed by the provisions of ,.
the Missouri Workmen's Compensatio in aChapter mount not less1tand
Contractor's Property Damage Insurance
$1,000,000 for claims
for any personfin assingle accident
acciden or '
occurrence and $100,000 $
occurrence.
fist
(c) obile Liails� x �'nsLrance in an amount not less than
$1,000,000 for all claims any ersonfin assingle accident or .�
occurrence and $100,000 for y p
occurrence.
(d) ner's Protective Liability Insures cLi e - The Contractor ;
1 shall also obtain at its own expense and deliver to the City an
Owner's Protective Liability Insurance Policy naming for Of
Jefferson as the insured, in an amount not less than $11000,,000 ;
all claims arising out of a single accident or occurrence and
$100,000 for any one person in a single accident or occurrence,
except for those claims governed by the provisions of the Missouri
I � Workmen's Compensation Law, Chapter 287, RSMo. No policy will
underground
which excludes
structures or by reason blasting, explosion collapse
'
(e) Subcontracts - In case any or all of this work is sublet,
the Contractor shall require the Subcontractor to pb)c and (c)
maintain all insurance required in Subparagraphs (a) ,
hereof and in like amounts. {
(f) Scope of Insurance and Specials Hazard,
shall insurance
e
required under Sub-paragraphs (b) and (c)
adequate protection for the Contractor and its subcontractors,
respectively, against damage claims which may arise from operations
under this contract, whether such operations it,band the
alsoinsured
against
by anyone directly or indirectly employed by d
l any special hazards which may be encountered in the performance of
this contract.
+ ,c
NOTE: Paragraph (f) is construed to require the procurement of
Contractor's protective insurance (or contingent public liability
general contractor
and contingent property damage policies) by a
whose subcontractor has employees working on the project, unless
the general public liability and property damage policy (or
adequate
attached thereto) of the general contras p from protection against claims arising t one
ions by an
directly or indirectly employed by the Contractor
t:
t
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t t�iP � }�.%y r�M. �'a'7 jai
t".sK '�+t rir"2#� [r� aS.. *''�J+,....'r}y, .[t..);t t. (, .+ ."ry 1,.° s 3 t , ,: r r A r. .1.2 �. •t� B.r7.#i w3c{/ ''S,y z. ,- y...
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x 4• Coutraotor's Responsibility for aubaojatragtors. It is further agreed that Contractor shall be as fully responsible to
the City for the acts and omissions of its subcontractors, and of
persons either directly or indirectly employed by them, as
Contractor is for the acts and omissions of persons it directly
employs. Contractor shall cause appropriate provisions to be
inserted in all subcontracts relating to this work, to bind all
subcontractors to Contractor by all the terms herein setforth,
insofar as applicable to the work of subcontractors and to give
Contractor the same power regarding termination of any subcontract '
as the City may exercise over Contractor under any provisions of
this contract. Nothing contained in this contract shall create any
contractual relations between any subcontractor and the City or
between any subcontractors. ,
s „?
5. Liquidatedl 10amages. The Director of Public Works may, Y
at his discretion, deduct $100.00 from any amount otherwise due
under this contract for every day Contractor fails or refuses to
prosecute the work, or any separable part thereof, with such
diligence as will insure the completion by the time above
specified, or any extension thereof, or fails to complete the work v
by such time, as long as the City does not terminate the right of
Contractor to proceed. It is further provided that Contractor
shall not be charged with liquidated damages because of delays in
the (completion of the work due to unforeseeable causes beyond
Contractor's control and without fault or negligence on
Contractor's part or the part of its agents.
6. Termination. The City reserves the right to terminate `
this contract by giving at least five (5) days prior written notice
to the Contractor, without prejudice to any other rights or
remedies of the City should the Contractor be adjudged a bankrupt,
or if Contractor should make a general assignment for the benefit
of its creditors, or if a receiver should be appointed for
Contractor or for any of its property, or if Contractor should
persistently or repeatedly refuse or fail to supply enough properly F,
skilled workmen or proper material, or if Contractor should refuse
or fail to make prompt payment to any person supplying labor or
materials for the work under the contract, or persistently
disregard instructions of the City or fail to observe or perform
any provisions of the contract.
7. City's Right to Proceed. In the event this contract is
terminated pursuant to Paragraph 6, then the City may take over
the work and prosecute the same to completion, by contract or
otherwise, and Contractor and its sureties shall be liable to the
City for any costs over the amount of this contract thereby
occasioned by the City. In any such case the City may take
possession of, and utilize in completing the work, such materials,
appliances and structures as may be on the work site and are
necessary for completion of the work. The foregoing provisions are
in addition to, and not in limitation of, the rights of the City
under any other provisions of the contract, city ordinances, and
state and federal laws.
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8. Xudemnityl. The Contractor agrees to defend, indemnify,
and save the City harmless from and against all claims, suits and
z actions of every description, brought against the City and from all
' damage and costs by reason or on account of any injuries or damages
,4'}? received or sustained by any person or persons, or their property,
by Contractor, its servants, agents or subcontractors in the 3
construction of said work, or by any negligence or carelessness in
F <' the performance of the same, or on account of any act or omission
rr.�rr,
of Contractor, its servants, agents, or subcontractors, or arising
;f out of the award of this contract to Contractor.
` µ 9. Payment for Labor and Materials. The Contractor agrees
y
rr and binds itself to pay for all labor done and for all the '
materials used in the construction of the work to be completed
pursuant to this contract. Contractor shall furnish to the City a
bond to insure the payment of all materials and labor used in the
performance of this contract.
10. Payment. The City hereby agrees to pay the Contractor
the work done pursuant to this contract according to the payment
schedule setforth in the Contract Documents upon acceptance of said
work by the Director of Public Works and in accordance with the ' >
rates and/or amounts stated in the bid of Contractor dated
September 19, 1990, which are by reference made a part hereof. No
:- partial payment to the Contractor shall operate as approval or
acceptance of work done or materials furnished hereunder. The
r total amount of this contract shall not exceed Nine Thousand One zJ�.
'V� Hundred Thirty-Five and 00/100, $9, 135. 00.
11. Contract Documents. The contract documents shall consist
2' of the following:
Y f�%
a. This Contract f. General Provisions
b. Addenda g. Special Provisions
r . c. Information for Bidders h. Technical Specifications
d. Notice to Bidders i. Drawings and/or sketches ;
e.z e. Signed Copy of Bid
This contract and the other documents enumerated in this
,i u II
i 1
., paragraph, form the Contract between the parties. These documents
are as fully a part of the contract as if attached hereto or
repeated herein.
12. Nondiscrimination_ The Contractor agrees in the
performance of this contract not to discriminate on the ground or
because of race, creed, color, national origin or ancestry, sex,
t religion, handicap, age, or political opinion or affiliation,
against any employee of Contractor or applicant for employment and
shall include a similar provision in all subcontracts let or
zy"a awarded hereunder.
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ti} �
-ACORD CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY') -§
---------------------------.-------------------------------------------------------------------------------_----- -90 ----- S±s
RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Winter-Dent & Company - ------ -- y
a.t
101 East McCarty St. COMPANIES AFFORDING COVERAGE
P.O. Box 1046
Jefferson City, MO 65102 COMPANY CONTINENTAL WESTERN INS. CO.
314-634-2122 LETTER A
x .{
------------------------------------------------------------------•---
COMPANY •'?��..��� ',.
INSURED.............................................. -LETTER-B--- -----------------------------------
v; s
COMPANY
GREEN HORIZONS GARDEN CENTER LETTER C
HIGHWAY 54 SOUTH, BOX 163 -------------------------------------------------------------------
COMPANY 7,,%,,
JEFFERSON CITY, MO LETTER D ,i't,:
65101 ----------------------------------------------- -- ;
COMPANY - ------------------------•-•
LETTER E
-------------- ---
------------------ ..... ..
...---------------•---------------------------------_..........................
COVERAGES iz;,
-------------------------------
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED rO 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 �:•°v',,;` ';:.
TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
--------------------------------------------•----------------------------I-----------------I------------ ---------------------CO POLICY EFFECTIVE POLICY EXPIRATION
LTRI ----TYPE-OF•INSURANCE I POLICY HUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) ALL LIMITS IN THOUSANDS
---+- -----------+------------------+----------------+-----------------+-------------------^---------- ---
A GENERAL LIABILITY H0131 04-05-90 04-05-91 GENERAL AGGREGATE $2,000, 1
[XI COMMERCIAL GENERAL LIABILITY PROD COMP/OPS AGGR $2,000,
[
I[ I CLAIMS MADE• [XI OCCURRENCE $1,000,'
PERSONAL & ADV INJURY
[ I OWNER'S & CONTRACTORS PROTECT EACH OCCURRENCE $1000
[ I FIRE DAMAGE(ONE FIRE) $ 50,
[ I (MEDICAL EXP(1 PERSON) $ 5
---+---------------------------------+------------------+----------------+-----------------+----------------------------------
A AUTOMOBILE LIABILITY C011952
12-21-89 12-21-90 CSL
[XI ANY AUTO
$1,000,
[XI ALL OWNED AUTOS BODILY INJURY
[XI SCHEDULED AUTOS (PER PERSON) $
[XI HIRED AUTOS
BODILY INJURY NON-OWNED AUTOS JURY
(PER ACCIDENT) $
[ I GARAGE LIABILITY PROPERTY
-+------------- ----- ---- ---- --- DAMAGE $
+------------------+----------------+-----------------+--------------- •-------------- i
iI t EXCESS LIABILITY EACH OCCURRENCE AGGREGATE r! i y�yi
$ $
i
I OTHER THAN UMBRELLA FORM
................................ -------- I J1.ga5p.•v..: >::
STATUTORY
A WORKERS' COMPENSATION H0131 04-05-90 04-05-91 $ 100, (EACH ACCIDENT) ,'?�5,° ;'4f'"•>
AND $ 500, (DISEASE POL) •' "
EMPLOYERS'
..+---- ----O------LIABILITY------ -+ -- --- --- --- - ------- --- -- ---- - $ 100, (DISEASE EACH EMP)
OTHER -+- -+- I--------------------------------- _4 .�k
�q�
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
JOB: 1990 TREE REPLACMENT, FAIRMONT BOULEVARD, JEFFERSON CITY, MISSOURI i?�v r+' 'IC
--------------------------- ------------ a .
.CERTIFICATE HOLDER CANCELLATION f` rk r
------------------- ------------------------------- ------+---------------------------------------------------------------
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1 THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR y
CITY OF JEFFERSON TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED
I 320 E. MGCARTY TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO
JEFFERSON CITY MISSOURI 65101 OBLIGA ION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS
AGE N RWRE REPRESENTATIVES.
TTN: BONNIE HUBERT .--- -- -------------- - ---------------------------
AU HO NT�TIVEJ�OA'CORD
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BOND NUMBER: 012
CASUALTY INDEMNITY
i
EXCHANGE
Jefferson City,Missouri .r <-
a: A Reciprocal ';.
bE�.
PERFORMANCE BOND
4�
c
i T
KNOWN.ALL MEN BY THESE PRESENTS: That
Green Horizons Garden Center, Inc.
4316 Rt. CC, Jefferson City, MO 65109
syf, II ere inwrt the name and addres,or legal title of the Contractor)
;.)<< as Principal, hereinafter called Contractor, and, CIE SERVICE CORPORATION as Attorney in Fact for the
rY.
subscribers at the Casualty Indemnity Exchange located in Jefferson City, Missouri, as Surety, hereinafter called `
Surety, are held and firmly bound unto '
City of Jefferson, Missouri, a municipal corporation {f
'f' Jefferson CIt MO } , '
320E McCarty St. , y,
Vii' I Hare insert the name and address or legal title of the Ownerl F,1t
}k' as Obligee, hereinafter called Owner,in the amount of Nine Thousand One Hundred Thirty-Five and 00/100
„
--------------------------------------------------------- Dollars($ 9,135.00 l�
Qr the payment whereof Contractor and Surety binds themselves, their heirs, executors, administrators, successors :y
and assigns,jointly and severally, firmly by these presents.
'
WHEREAS, Contractor has by written agreement dated 1990
entered into a contract with Owner for
1990 Street Tree Replacement
;.: in accordance with drawings and specifications prepared by Cit of Jefferson —
�:: 1�E..a���•�,;_,Je erson City, MID
(Here insert full name,title and address)
�k
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
^ NOW,THEREFORE,THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform said Contract,
then this obligation shall be null and void;otherwise it shall remain in full force and effect.
r The surety hereby waives notice of any alteration or extension of succession of defaults under the contract or contracts of completion
tY time made by the Owner. arranged under this paragraph)sufficient funds to pay the cost of com-
Whenever Contractor shall be, and declared by Owner to be in pletion less the balance of the contract price; but not exceeding,
default under the Contract, the Owner having performed Owner's including other costs and damages for which the Surety may be liable
tobligations thereunder, the Surety may promptly remedy the default, hereunder, the amount set forth in the first paragraph hereof. The i
or shall promptly term "balance of the contract price," as used in this paragraph, shall
mean the total amount payable by Owner to Contractor under the
1)Complete the Contract in accordance with its terms and condi- Contract and any amendments thereto,less the amount properly paid i
tions.,or by Owner to Contractor.
2) Obtain a bid or bids for completing the Contract in accordance Any suits under this bond must be instituted before the expiration
with its tsrnts and conditions,and upon determination by Surety of the of two(2)years from the date on which final payment under the con-
"",lowest responsbile bidder, or,if the Owner elects, upon determination tract falls due.
f•: iy the Owner and the Surety jointly of the lowest responsbile bidder, No right of action shall accrue on this bond to or for the use of any
�,. arrange for a contract between such bidder and Owner,and make avail- person or corporation other than tho Owner named herein or the heirs,
able as Work progressos(even though there should be a default or a executors,administrators or successors of Owner.
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h
BOND NUMBER: 012
S
CASUALTY INDENMTY
EXCHANGE
~•.ai,w ��3
Jefferson City,Missouri °` f
A Reciprocal "
♦A�•1i � 54jt•
LABOR AND MATERIAL PAYMENT BOND � w.
The bond is issued simultaneously with another bond in favor of the yet
owner conditioned for the full and faithful performance of the contract. °
tt
Green Horizons Garden Center, Inc.
KNOWN ALL 1►v11EN BY THESE PRESENTS: That
4316 Rt. CC, Jefferson Clty, MO 65109 �ti. z�
(Here insert the name and address or legal title of the Contractor)
as Principal, hereinafter called Principal, and, CIE; SERVICE CORPORATION as Attorney in Fact for the
subscribers at the Casualty Indemnity Exchange located in Jefferson City, Missouri, as Surety, hereinafter called
rykn "f
Surety, are held and firmly bound unto
City of Jefferson, Missouri, a municipal corporation
320 E. McCarty St. , Jefferson City, MO
.r
(Here insert the name and address or legal title of the Owner) <•>
as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinbelow defined, in the amount of
ine Thousand, One Hundred Thirty—Five and 00/100 `•
(Here insert a sum equal to at least one-half of the contract price) 9,135.00
Dollars($
for the payment whereof Principal and Surety binds themselves, their heirs, executors, administrators, successors
and assigns,jointly and severally, firmly by these presents.
WHEREAS, Principal has by written agreement dated November 6, 19 90 }
entered into a contract with Owner for
1990 Street Tree Replacement _ s,
in accordance with drawings and specifications prepared by City of Jefferson
320 E. McCarty, Jefferson City, Missouri
(Here insert full name,title and address) '
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall promptly make payment to all claimants as
hereinafter defined,for all labor and material used or reasonably required for use in the performance of the Contract,then this obligation shall be
void;otherwise it shall remain in full force and effect,subject,however,to the following conditions:
1. A claimant is defined as one having a direct contract with the the work or labor was done or performed. Such notice shall be served
Principal or with a subcontractor of the Principal for labor,material,or by mailing the same by registered mail or certified mail, postage pre-
both, used or reasonably required for use in the performance of the paid, in an envelope addressed to the Principal, Owner or Surety, at
contract, labor and material being construed to include that part of any place where an office is regularly maintained for the transaction of
water,gas, power,light, heat,oil,gasoline,telephone service or rental business, or served in any manner in which legal process may be '
of eqquipment directly applicable to the Contract. served in the state in which the aforesaid project is located, save that
2. The above named Principal and Surety hereby jointly and such service need not be made by a public officer.
severally agree with the Owner that every claimant as herein defined, b) After the expiration of one(1)year following the date on which
who has not been paid in full before the expiration of a period of ninety Principal ceased work on said Contract, it being understood,however,
(90) days after the date on which the last of such claimant's work or that if any limitation embodied in this bond is prohibited by any law
labor was done or performed, or materials were furnished by such controlling the construction hereof such limitation shall be deemed to
claimant,may sue on this bond for the use of such claimant,prosecute be amended so as to be equal to the minimum period of limitation
the suite to final judgment for such sum or sums as may be justly due permitted by such law.
claimant, and have execution thereon. The Owner shall not be liable 0 Other than in a state court of competent jurisdiction in and for
for the payment of any costs or expenses of any such suit, the county or other-political subdivision of the state in which the pro-
3. No suit or action shall be commended hereunder by any claimant: ject, or any part thereof, is situated, or in the United States District
a) Unless claimant, other than one having a direct contract with Court for the district in which the project, or any part thereof, is
the Principal,shall have given written notice to any two of the following: situated,and not elsewhere.
The Principal, the Owner, or the Surety above named, within ninety 4. The amount of this bond shall be reduced by and to the extent of
(90)days after such claimant did or performed the last of the work or any payment or payments made in good faith hereunder, inclusive of
` labor, or furnished the last of the materinls for which said ckrim in the payment by Surety of mechanics'liens which mayy be filed or-record ;f
made, stating with substantial accuracy the amount claimed and the against said improvement,whether or not claim for the amount of such
name of the party to whom the materials were I'll r•nished, or for whom lien he presented under and against this hoed.
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•>i
ACORD INSURANCE BINDER ISSUE DATE (MM/DD/YY) ?I
10-25-90
--•--••---------------------------------------------------- -- -
TIIIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE-CONDITIONS_SHOWN-ON THE-REVERSE SIDE^OF-THIS FORM. •-
PRODUCER COMPANY CONTINENTAL WESTERN INS. CO. BINDER NO.
[ ]
-------------------------------------------------------------------------------
jo. Winter-Dent & Company
EFFECTIVE EXPIRATION "
101 East McCarty St. DATE TIME I DATE TIME tit
P.O. Box 1046 -----------------------•......-----------+----------- .........
;r Jefferson City, MO 65102 12.01 CX] AM [X] 12:01 AM
x 314-634-2122 11-05-90 11-05-91
---------------•--- ----•--------__..
C ] PM C ] Noon g
CODESUB-CODE I--•---------------------------------------------------------------------------
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED - �;:;'
a
< -•-'•••---•---•--------------------------•---- COMPANY PER EXPIRING POLICY N0. °ti • �,,.
INSURED -------------------------------------------------------------------------------
DESCRIPTION OF OPERATION/VEHICLES/PROPERTY (INCLUDING LOCATION)
CITY OF JEFFERSON " •'
fix= l
320 EAST MCCARTY OCP
"i gyp`
JEFFERSON CITY, MO 65101 �;,�,„�.���, ,2�_,•
______________________________________________________________________________________________
COVERAGES ALL LIABILITY LIMITS IN THOUSANDS r'
---- --------------------------------------------------------------------------------- �" ruy#3j
.�� TYPE OF INSURANCE COVERAGES/FORMS AMOUNT DEDUCTIBLE COINSURANCE
PROPERTY CAUSES OF LOSS
[ ] BASIC C ] BROAD [ ] SPECIAL
• ,°rah::.49� •t��;1^
GENERAL LIABILITY GENERAL AGGREGATE $1 000 000.
:
[ ] COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPS AGG. $1 000:000.
.i. [ I [ ] CLAIMS MADE [ ] OCCURRENCE PERSONAL & AD. INJURY $ X100,000.
[XI OWNERS & CONTRACTORS PROTECT. EACH OCCURRENCE $ 100,000.
I ) FIRE DAMAGE(ANY ONE FIRE) $ 50,000.
[ ) RETRO DATE FOR CLAIMS MADE: MEDICAL EXP(ANY ONE PER.) $ 5,000.
TOMOBILE [ ] ALL VEHICLES [ ] SCHEDULED VEHICLES CSL $
2 LIABILITY BI PERS/ACCID $
[ I NON/OWNED PD $ {i
[ I HIRED MED. PAY $
[ I GARAGE plp $
r
[ ] UM $
AUTO PHYSICAL DAMAGE I[ ] ALL VEHICLES [ ] SCHEDULED VEHICLES I C ] ACV
C I COLLISION DED: [ ] STATED AMOUNT I$ °r
[ ] OTC DED:
[ ] OTHER
EXCESS LIABILITY EACH AGGREGATE
[ ] UMBRELLA FORM I I OCCURRENCE I ISELF-INSURED
RETENTION
[ I OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE:
7 --------------------------------+-----------------------------------------------------+------------------------------------- fi
` WORKERS' COMPENSATION ST$TUTORY (EACH ACCIDENT)
AND $ (DISEASE POLICY LIMIT)
` EMPLOYERS' LIABILITY (DISEASE EACH EMPL.)
is
SPECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES
IT IS HEREBY AGREED THAT GREEN HORIZONS GARDEN CENTER, INC. IS RESPONSIBLE FOR PREMIUM AND AUDIT
' ----------------------------------------------------------------------------------------------------------------------------
NAME & ADDRESS '
--------•--------------------------------------------
�;' C ] MORTGAGEE [ ] ADDITIONAL INSURED
-[-] LOSS PAYEE
------------------------
LOA #
e
--- -- - -------- ---- -------- -
-
' A H I ED REPRE ENTATIVE
,'ORD 75-S (11/85)
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