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BILL NO. 91-36
` SPONSORED BY COUNCILMAN HALSEY
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ORDINANCE NO. 11602
AN ORDINANCE OF THE CITY OF JEFFERSON, MISSOURI, AUTHORIZING
THE MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT WITH HAROLD
G. BUTZER, INC., FOR HEATING, AIR CONDITIONING AND REFRIGERATION
SERVICES.
BE IT ENACTED BY THE COUNCIL OF THE CITY OF JEFFERSON, MISSOURI,
AS FOLLOWS:
Section 1. The Mayor and City Clerk are hereby authorized and directed to
execute an agreement with Harold G. Butzer, Inc., for heating, air conditioning and
refrigeration services. The amount expended for the contract shall not exceed
$35,000.00.
Section 2. The agreement shall be substantially the same in form and content
as that agreement attached hereto as Exhibit A.
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Section 3. This Ordinance shall be in full force and effect from and after the
date of its passage and approval.
Passed: July 15, 1991 Approved: July 16, 1991
9�
resi Officer Ma
,Y
�X ATTEST: . ,
City Clerk
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HEATING/COOLING/REFRIGERATION AGREEMENT
` THIS AGREEMENT made and entered this� day of Y 1992, by and
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between the City of Jefferson, Missouri, a municipal corporation, hereinafter referred to
as "City," and Harold G. Butzer, Inc., hereinafter referred to as "Contractor.
WHEREAS, the City of Jefferson, Missouri, is desirous of hiring Contractor to
' provide heating, air conditioning and refrigeration work on all City heating and
,• cooling systems; and
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WHEREAS, Contractor is willing to enter into this Agreement with respect to
} ' his employment and services upon the terms and conditions herein set forth,
NOW, THEREFORE, be it agreed as follows:
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1. Scope of Services. The scope of services for heating, air conditioning and
refrigeration work on City heating and cooling systems shall consist of the following:
Performance of authorized heating, air conditioning and refrigeration
work on all City heating, air conditioning, and refrigeration systems
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j. which include all buildings occupied by the City and designated on
- Exhibit A. The shelter at the ice arena shall be the only facility at the
ice arena included in this contract.
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^� 2. Contract Period. This contract shall be in effect from July 1, 1992 through
June 30, 1993. With the consent of both parties, the contract may be extended for
one (1) additional one (1) year period.
3. Contract Amount. The amount of the contract shall not exceed Thirty-six
'{ Thousand Seven Hundred Fifty Dollars ($36,750.00). If the City exercises its option
to extend the contract for an additional one year period, such extension shall be at
' an increase no greater than five percent (5%).
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4. Payment. Payment shall be made on a monthly basis to Contractor by City
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?'f upon submission of an itemized monthly invoice,properly signed and submitted,with
;{ report per Section 5, in duplicate, to the Finance Director, 320 E. McCarty Street,
Jefferson City, Missouri, 65101.
5. Prevailini7 Wage Law. To the extent that the work performed by contractor is
subject to prevailing wage law, principal contractor and all subcontractors shall pay
not less than the prevailing wage hourly rate for each craft or type of workman
required to execute this contract as determined by the Department of Labor and
Industrial Relations of Missouri, pursuant to Sections 290.010 to 290.340 inclusive,
RSMo., 1969.
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6. Reports. Contractor shall maintain a monthly log of all service performed that
month, if any. The monthly log shall remain on the premises of each building at a
mutually agreed upon location accessible to both the contractor and the designated
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contract person for each City building.
The City shall maintain a monthly log of any service inadequately performed.
The Contractor shall review this monthly log and correct services within twenty-four
` (24) hours that were inadequately performed. The Contractor must indicate on this
form that he has corrected the service that was inadequately performed. The log will
be located in each building accessible to both the Contractor and the City contact
person for each building.
7. Visit Notice. Contractor shall post in a conspicuous place, at site locations, a
`. check sheet and enter thereon the date of each service visit, the name of the
individual performing the service and the time of the service.
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u;. 8. Indemnity. Contractor agrees to indemnify and hold harmless the City for any
' nd all damages inn'''uries actions, costs, at
fees and other expenses
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c whatsoever arising out of the performance of said work whether the property or
persons damaged are the servants and employees of the Contractor or third parties
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in no manner connected with said work.
9. Insurance. Contractor agrees to obtain and maintain throughout the term of y
this contract
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A. Workmen's Compensation Insurance for all of its employees to be v
C" engaged in work under this contract.
` B. Contractor's Public Liability Insurance in an amount not less than
fir $1,000,000 for all claims arising out of a single occurrence and $100,000
for any one person in a single accident or occurrence, except for those
`A'` claims governed by the provisions of the Missouri Workmen's
'1K Compensation Law, Chapter 287, RSMo., and Contractor's Property
fa, Damage Insurance in an amount not less than $1,000,000 for all claims
arising out of a single accident or occurrence and $100,000 for any one
person in a single accident or occurrence.
C. Automobile Liability Insurance in an amount not less than $1,000,000
' for all claims arising out of a single accident or occurrence and $100,000
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for any one person in a single accident or occurrence. #
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D. Subcontracts - In case any or all of this work- is sublet, the Contractor
shall require the Subcontractor to procure and maintain all insurance
required in Subparagraphs (a), (b), and (c) hereof and in like amounts.
E. The Certificates of Insurance furnished to the City showing proof of
compliance with these insurance requirements shall contain a provision
that coverage under such policies shall not be canceled or materially
changed until at least fifteen days prior written notice has been given
to the City.
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10. Failure to Perform. Should Contractor fail to provide services as set forth
ant to this contract, or fail to meet any of the contract provisions, this contract
pursuant
may be canceled at the sole option of the City upon giving five (5) days written notice
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to Contractor.
11. Cancellation. This contract shall be subject to cancellation by the City at any
time following fifteen (15) days notice.
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as 12. Notices. All notices, consents, authorizations, requests and statements
hereunder shall be deemed to have been properly given if delivered by and or mailed
by first class United States mail, postage prepaid, if to the City at 320 E. McCarty,
Jefferson City, Missouri 65101, and if to the Contractor to P.O. Box 358, 721 Wicker
Lane Jefferson City, MO 65101.
IN WITNESS WHEREOF the parties hereto have set their hands and seals on the
day and year first above written.
HAROLD G. BUTZER, INC. CITY OF JEFFERSON, MISSOURI
Title:
Ya§or-
ATTEST: ATTEST:
Title: City Clerk
10
APP E TO FO M:
City ounselor
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CERTIFICATE OF INSURANCE
The Insurance Company indicated below certifies that the insurance afforded by the policy
a
numbered and described below is in force as the effective date of this certificate. This ,,,,; •
amend, extend, or otherwise alter the Terms and Conditions of
Cr-*.ificate of. Insurance does not :
Dance coverage contained in any policy or policies numbered and described below.
Cert ificate Holder's Name and Address Insured's Name and Address:
CITY OF JEFFERSON Harold G. Butzer, Inc.
.0. Box 358 <r =�. .
320 E. MCCARTY P
JEFFERSON CITY, M0. 65101
730 Wicker Lane6'`;
Jefferson City, MO 65102
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POLICY I POLICY I �)
I POLICY MMBEEt RM EFFECTIVE I EXPIRATION) LIMITS OF LIABILITY
TYPE OF INSURANCE I ISSUING OCdTANYL DATE 1 DATE L (*
Limite at Inception)
GENERAL LIABILITY
1[X] Premises - Operations 178PR-005-339-30011 9/1/92 1 9/1/93 (General Aggregate* 2,000,000 1 !;i >1r '.
{s` 1[X] Products - completed Operationsl
Pr. Carp. Op, Agg* 2,000,000
I I Nation-Tide Property & I (Each occurrence 1,000,000
I[X] Personal & Advertising Injury I Casualty Insurance Co. I (Any One Person/Org 1,000,000
i[X] Medical Expense ( ( 1 (Any One Person 5,000 t_
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I Damage Legal I I I (Any One Fire 50,000
[X] Fire Da
I[ ] other Liability
([ ]
CAME LIABILITY-PREMISES I I I (Each Accident
AITaMBILE LIABILITY i 1
F I 1 I I 78BA-005-339-30021 9/1/92 1 9/1 93 Bodil y Injury
[X] BUSINESS AJO
I[ ] GARAGE ( I I ( (Each Person)
[X1 Owned I Nationwide Property & I I (Each Accident)
1 I Casualty Insurance Co. 1 1 Property Dmrege
II _owned I ( I I (Each Accident)
l� 1,000,000 1y�r�r1,5;
I I Canbined Single
1 i Limit
Fill•-in Either Combined I � ��.
I-Sinp�]e Limits or Split Limits I J I I I
: I EXCESs LIABILITY
78CU-005-339-30041 9/1/92 1 9/1/93 I Ii
Each occurrence 5,000,000 1 ?�• ,
Nationwide Mutual I I I
I(Xl umbrella Form J Insurance Co I IAWregate# 5,000_,000
I[X] Workers Compensation I I I I Statutory Limits
I 178WC-005-339-30031 9/1/92 1 9/1/93 JBodily Injury Ea. Accident 1
1 by Accident 100,000 I ` •;r
Nationwide Property &
and ( Casualty Insurance Co. I lBodily Injury Ea. Employee 1
1 1by Disease 100,000
I Y
n X 1 i s Liability I I i J Bodil y Injury 500,000 Policy Limit i
Insurance in force only for hazards indicated by X.
Description of NOTE: AGGREGATE LIMCT OF LIABILITY APPLIES PER PROJECT
? ' Operations/Locations/ PROJECT DESC IP'PION: HEATING & AIR CONDITIONING CONTRACT FOR CITY OF JE FFERSON
Vehicles/Restrictims/
'i Item
Sperm .� �'�� �
E tine Date of Certificate: 9-1-92 Authorized Representative: Gera D. Ra
}" r' ,,;. 24-0253 '.
'' Counters at: Boonville, M) "w
Certificate Issued: 9-1-92 igned
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HAfHQLD G.Bu1Z[f1ltlC. 1' i
HEATING/C00LINGIREFRIGERATION AGREEMENT
THIS AGREEMENT made and entered this f 7 day of , 1991, by and s
` between the City of Jefferson, Missouri, a municipal corpora on, ereinafter referred
to as "City," and Harold G. Butzer, Inc., hereinafter referred to as "Contractor." >'
;.,
'< WHEREAS the City f Jefferson Missouri is desirous of hiring Contractor to
Y g t�.
provide heating, air conditioning and refrigeration work on all City heating and ;"<<
.''.; cooling systems, and ;Y
WHEREAS, Contractor is willing to enter into this Agreement with respect to
<: his employment and services upon the terms and conditions herein set forth, ;°�a;
NOW, THEREFORE, be it agreed as follows:
1. Scope of Services. The scope of services for heating, air conditioning and rtk4C!
refrigeration work on City heating and cooling systems shall consist of the following:
Performance of authorized heating, air conditioning and refrigeration`
work on all City heating, air conditioning, and refrigeration systems
which include all buildings occupied by the City and desi gnated on
Exhibit A. The shelter at the ice arena shall be the only facility at the
" 0 ice arena included in this contract.
" 2. Contract Period. This contract shall be in effect from July 1, 1991 through
June 30, 1992. With the consent of both parties, the contract may be extended for
two (2) additional one (1) year periods.
3. Contract Amount. The amount of the contract shall not exceed Thirty-five
Thousand Dollars ($35,000.00). If the City exercises its option to extend the contract
for additional periods, the first year extension shall be at an increase no greater than
s'. five percent (5%). The second one year extension shall be at an additional increase
no greater than five percent (5%),
'rl 4. Payment. Pa
yment shall be made on a monthly basis to Contractor by City •�.
upon submission of an itemized monthly invoice,properly signed and submitted, with
report per Section 5, in duplicate, to the Finance Director, 320 E. McCarty Street, ,
Jefferson City, Missouri, 65101. ,
5. Prevailing Wage Law. To the extent that the work performed by contractor is «
subject to prevailing wage law, principal contractor and all subcontractors shall pay ,
not less than the prevailing wage hourly rate for each craft or type of workmany
P g g Y
tr required to execute this contract as determined by the Department of Labor and
Industrial Relations of Missouri
, pursuant to Sections 290.010 to 290.340 inclusive,
RSMo., 1969.
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6. Reports. Contractor shall maintain a monthly log of all service performed that
.r,
month, if any. The monthly log shall remain on the premises of each buildin g at a
mutually agreed upon location accessible to both the contractor and the designated
contract person for each City building. grated
The City shall maintain a monthly log of any service inadequately performed. E
The Contractor shall review this monthly log and correct services within twent -four ,~ x
r: (24) hours that were inadequately performed. The Contractor must indicate on this
at form that he has corrected the service that was inadequately q y performed. The log will
be located in each building accessible to both the Contractor and the City contact
person for each building. @.A
}: 7. Visit Notice. Contractor shall post in a conspicuous place, at site locations, a .p
check sheet and enter thereon the date of each service visit the name of the U ryu
tk}�{}�, j(,,' r
�.� individual performing the service and the time of the service.
AN
8. Indemnity. Contractor agrees to indemnify and hold harmless the City for an �i
!; and all damages, injuries, actions, costs, attorney's fees and other expenses r
:I whatsoever arising out of the performance of said work whether the property or
persons damaged are the servants and employees of the Contractor or third parties
in no manner connected with said work,
` 9. Insurance. Contractor agrees to obtain and maintain throughout the term of '°
this contract3 ;
A. Workmen's Compensation Insurance for all of its employees to be r_
engaged in work under this contract.
B. Contractor's Public Liability Insurance in an amount not less than 't*
$1,000,000 for all claims arising out of a single occurrence and $100,000 :z "
for any one person in a single accident or occurrence, except for those '
n
claims governed by the provisions of the Missouri Workmen's '
Compensation Law, Chapter 287, RSMo., and Contractor's Property '
Damage Insurance in an amount not less than $1,000,000 for all claims
arising out of a single accident or occurrence and $100,000 for any one
person in a single accident or occurrence.
C. Automobile Liability Insurance in an amount not less than $1,000,000
for all claims arising out of a single accident or occurrence and $100,000 K
for any one person in a single accident or occurrence.
D. Subcontracts - In case any or all of this work is sublet, the Contractor
shall require the Subcontractor to procure and maintain all insurance
required in Subparagraphs (a), (b), and (c) hereof and in like amounts.
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:E r E. The Certificates of Insurance furnished to the City showing proof of
2)615 compliance with these insurance requirements shall contain a provision
that coverage under such policies shall not be canceled or materially
changed until at least fifteen days prior written notice has been given
to the City.
10. Failure to Perform. Should Contractor fail to provide services as set forth
pursuant to this contract, or fail to meet any of the contract provisions, this contract
may be canceled at the sole option of the City upon giving five (5) days written notice
to Contractor.
11. Cancellation. This contract shall be subject to cancellation by the City at any
time following fifteen (15) days notice.
12. Notices. All notices, consents, authorizations, requests and statements to
hereunder shall be deemed to have been properly given if delivered by and or mailed
by first class United States mail, postage prepaid, if to the City at 320 E. McCarty, err
Jefferson City, Missouri 65101, and if to the Contractor to P.O. Box 358, 721 Wicker
Lane Jefferson Cit y MO 65101.
IN WITNESS WHEREOF the parties hereto have set their hands and seals on the
day and year first above written.
CITY OF JEFFERSON, MISSOURI
M
ATTEST:
'City Clerk
r.
CONTRACTOR
Title:
ATTEST:
04
Tit
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�.:t• ,�y�t�*�A���ti°ni�F �a�5�7+t�i�.d 'rl� +a'��f�s4'�'y�+ FX� •Irk' 4 F � "
Ti
t Y V! ISSUE DATE(MM/DD/YY) g
AINDOc1®A CERTIFICATE 0`F INSURANCE Q9/01/91 07/22/91
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
1 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
-
i The Lockton Insurance Agency POLICIES BELOW. --
1 Cit".yplace, 1 Cityplace Dr. , 11160 COMPANIES AFFORDING COVERAGE
I Gaint Lnuis h10 63141
COMPANY
1
LETTER CNA e< ti,,
' COMPANY
LETTER B
1 INSURED 347 u 8 "•
HAROLD G. BUTZER, INC. COMPANY h°`�f>�,•
LETTER .r ` A .
730 Wicker Lane, P.O. box 11358
Jefferson City NO 65101 COMPANY
LETTER D
COMPANY
LETTER (MAIL DIRECT TO INSURED)
COVERAbES
OITI
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.
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
t
CO TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MMIDDIYY)
LTR
GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000
l'
A X COMMERCIAL GENERAL LIABILITY 60451 1911 09/01!90 09/01/91 PRODUCTS-COMP/OP AGG. $ 1,000,900
CLAIMS MADE )(;OCCUR., PERSONAL&ADV.INJURY $ 1,000 p 000
I OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 1.000�000 t( ;
FIRE DAMAGE(Any one flro) $ 90,000
MED.EXPENSE(Any one person), $ 5,000
ff
AUTOMOBILE LIABILITY COMBINED SINGLE $ :,;;• ;.
X ANY AUTO
001:,76929 09/01/90 09/01/91 LIMIT 1,000,000
X ALL OWNED AUTOS BODILY INJURY `
1
(Per person)
X SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY $
(Per accident)
X NON-OWNED AUTOS
GARAGE LIABILITY PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $ 5 p000,000
A X UMBRELLA FORM 104 513717
09/01/90 09/01/91 AGGREGATE $ S,OOO,000
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION 1,000,000
EACH ACCIDENT $
�;k:;:'1!::,
A, AND WC - 1001376928 09/01/90 09/01/91 DISEASE—POLICY LIMIT 1'000,000 SF fit
EMPLOYERS'LIABILITY
`. DISEASE—EACH EMPLOYEE $ 1 OOO p OOO
} 1 OTHER
,'is"a�`�•r
DESCRIPTION OF OPERA'rIONS/LOCATIONS/VEHICI.ES/SPECIAL ITEMS
Re: Heating/Cooling/Refrigerators Agreements for all City Offices.
Ki
'CERTIFICATE,HOLDER;
CANCELLATION
b�� tt
1;J926 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
tjt
City Of Jefferson EXPIRATI N DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO � ;,X
320 E. Nc Carty St. MAIL �� DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Tprt,
Jefferson NO 65101 City/ ttlxft
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
s �
ACiDRD 26-8 7/90) ®ACORD CORPORATION 1990
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3`;{J
Yx Certificate of insurance
The Company indicated below certifies that the insurance afforded by the policy or policies numbered and described below is in force as of the effective
date of this certificate.This Certificate of Insurance does not amend,extend,or otherwise alter the Terms and Conditions of Insurance coverage containedrC {
r,
t n any policy or policies numbered and described below. ` y`
Certificate Holder's Name and Address: Insured's Name and Address:
? City of Jefferson Harold G. Butzer, Inc.
320 E. McCarty P.O. Box 358
Jefferson City, MO 65101 730 Wicker Lane
Jefferson City, MO 65102
r
POLICY POLICY wig
POLICY NUMBER AND LIMITS OF LIABILITY x ,• ';
TYPE OF INSURANCE EFFECTIVE EXPIRATION
ISSUING COMPANY ('Limits At Inception) �Fa#r/�
` DATE DATE
"alb" A, t
(}{) GENERAL LIABILITY 78PR-005-339-0001 9/1/91 9/1/92
(X) Premises-Operations Nationwide Property & General Aggregate' 2 000 000 zl ° v'V
f N;r 4.a r.?..
I X I Products-Completed Operations Casual t Insurance Co. Pr. Comp. Op.Agg,' 2,000,000 tw.{",#;;'s"tF�?'x '?
y Each Occurrence jt•.d r>', F,
19000,000
,:.rr.4•r1x:,
r 1Y 4't. +.
IXI Personal &Advertising Injury Any One Person/Org.2 9 000 9 000
t (X) Medical Expense Any One Person �( #
d.: I K I Fire Damage Legal Any One Fire 50:000
Other Liability
GARAGE LIABILITY-PREMISES Each Accident '
Aggregate' r
AUTOMOBILE LIABILITY# +
BUSINESS AUTO 78BA-005-339-0002 9/1/91 9/1/92 Bodily Injury r,
' ( GARAGE (Each Person)
!' (X I Owned Nationwide Property & (Each Accident)
(X ) Hired Casualty Insurance Co. Property Damage t`f
i' IX ) Non-Owned (Each Accident) ;
Combined Single
#Fill-in Either Combined Limit 190009000
Single Limits or Split Limits
EXCESS LIABILITY 78CU-005-339-0004 9/1/91 9/1/92
Each Occurrence 59000,000
` (X I Umbrella Form Nationwide Mutual Aggregate' 59000,000
t
' (x ) Workers Compensation 78WC-005-339-0003 9/1/91 9/1/92 STATUTORY LIMITS
Nationwide Property & Bodily Injury 100,000 Each Accident
_ Accident
and b
Casualty Insurance Co y
Bodily Injury 100,000 Each Employee
` X Employers' Liability ¢
[ ) Y Y by Disease
Bodily Injury 500,000 Policy Limit
by Disease
.,.' Insurance In force only for hazards Indicated by X. NOTE: AGGREGATE LIMIT OF LIABILITY APPLIES PER PROJECT
•�i
Description of Operations/Locations/
Vehicles/Restrictions/Special Items
PROJECT DESCRIPTION: Heating & Air Conditioning Contract for City of Jefferson.
.t Effective Date of Certificate: 9/1/91 Authorized Representative D Ralf
,r ix
24-0253
t Date Certificate Issued: 8/27/91 Counlereigned at: Boonville, MO
Cae.3040-A(M)
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Certificate of Insurance -
The Company indicated below certifies that the insurance afforded by the policy or policies numbered and described below is in force as of the effective
date of this certificate.This Certificate of Insurance does not amend,extend,or otherwise alter the Terms and Conditions of Insurance coverage contained
7' n any policy or policies numbered and described below.
Certificate Holder's Name and Address; Insured's Name and Address:
Harold G. Butzer, Inc.
a, P.O. Box 358 City of Jefferson
320 East McCarty
730 Wicker Lane
Jefferson City, MO 65102
Jefferson City, MO 65101
4;�i:.f• r
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TYPE OF INSURANCE POLICY NUMBER AND POLICY POLICY i
ISSUING COMPANY EFFECTIVE EXPIRATION LIMITS OF LIABILITY
u''•`` DATE DATE (*Limits At inception) r .
s ( J GENERAL LIABILITY !
A,r
1,• Yl
( ] Promises-Operations
( J Products-Complotod Operations General Aggregate'
+ Pr. Comp. Op.Agg,• ! ftjt •'�e '}Lh.
Each Occurrence '
�s„ [ I Personal 8 Advertising Injury
Medical Expense Any One Person/Org.
Fire Damage Legal Any One Person
(X] Other Liability Any One Fire
'
Owners & Contractor's s
78PR-005-484-3001 1/17/92 1/17/93 OCi Limit: $1,000,000
;f Protective Liability
Nationwide Mutual
I GARAGE LIABILITY-PREMISES Each Accident �`t',
Fire Insurance Co.
Aggregate'
AUTOMOBILE LIABILITY N
f >f
[ USINESS AUTO a�
ARAGE Bodily Injury " t
Owned (Each Person) r
r ( ] Hired (Each Accident) rr
[ J Non•Owned Property Damage
t
(Each Accident) r;
#Fill•In Either Combined Combined Single
Single Limits or Split Limits Limit
c
EXCESS LIABILITY
K
( ] Umbrella Form Each Occurrence
t
Aggregate*
*.•i [ J Workers Compensation
STATUTORY LIMITS
and Bodily Injury Each Accident
�< by Accident
Elnployera' Liability Bodily Injury ry Each Employee
by Disease
Bodily Injury
Policy imit
by Disease y
? Insurance In force only for hazards Indicated by X.
S
Any and all locations of work being done for the City of Jefferson
'. Description of Operations/Locations/ by Harold G. Butzer, Inc. .
Vehicles/Restrlctlons/Special Items
Eflectiva Date of Certificate: 1/17/92 Authorized Representative ��-
G.D Rau ��•�
24-0253
n;: �r.
(` Date Certifbate issued: 12/13/91 Countersigned at: Boonville MO
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Certifocate of Insurance
The Company indicated below certifies that the insurance afforded by the policy or policies numbered and described below is in force as of the effective
date of this certificate.This Certificate of Insurance does not amend,extend,or otherwise alter the Terms and Conditions of Insurance coverage contained .' t
I in any policy or policies numbered and described below.
Certificate Holder's Name and Address: Insured's Name and Address: xt` x.
City of Jefferson Harold G. Butzer, Inc.
320 East McCarty P.O. Box 358
Jefferson City, MO 65101 730 Wicker Lane .k
�.f.. Jefferson City, MO 65102
�s
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POLICY POLICY
POLICY NUMBER AND LIMITS OF LIABILITY ili7..13,.
TYPE OF INSURANCE EFFECTIVE EXPIRATION Limits Al Inception)
�•
ISSUING COMPANY (• !riY',r,1,.
a DATE DATE
f'. I I GENERAL LIABILITY 78PR-005-339-0001 9/1/91 9/1/92
I X I Promises•Oporations Nationwide Property & General Aggregate' 2,000,000* f 51
(X 1 Products•Completed Operations �..
2 000 000
'• Pr. Comp. Op. Agg.'
Casualty Insurance' Co. Each Occurrence � �
1,000,000
I X I Personal&Advertising Injury Any One PersonlOrg,1 000 QQQ
(XI Medical Expense Any One Person ' 5 000
(X J Fire Damage Legal Any One Fire 50'000 _ •"` ,,'y
a ( I Other Liability
A Per Project Endorsem nt Exist
�..,.
On the General Aggregate Coverage Shown.
( I GARAGE LIABILITY-PREMISES Each Accident
✓lF
Aggregate' `r
qg
1t t
AUTOMOBILE LIABILITY# � ,�,,�t;
BUSINESS AUTO 78BA-005-339-0002 9/1/91 9/1/92 Bodily Injury t7rSS t
(, ARAQE (Each Person) a �_;
Owned Nationwide Property & (Each Accident)
IX I Hired Property Damage ��•� "
Casualty Insurance Co.
IX I Non•Ownod y (Each Accident) t.�
Combined Single . xf.
#Fill-in Either Combined Limit 1,0001000
Single Limits or Split Limits ,
EXCESS LIABILITY 78CU-005-339-0004 9/1/91 9/1/92
• '� Each Occurrence 5,000,000
IX I Umbrella Form Nationwide Mutual Aggregate' 590009000
-Insurance Co.
IX I Workers Compensation 78WC-005-339-0003 9/1/91 9/1/92 STATUTORY LIMITS
7.
Bodily Injury 10Q'000 Each Accident
Nationwide Property &
and by Accident
Casualty Insurance Co
Bodily Injury 100,000 '
Each Employee r .
p;•':?s' Ix I Employers' Liability by Disease x,
Bodily Injury 500,000 Policy Limit F
[ ' by Disease
Insurance In force only for hazards Indicated by X.
Description of Operations/Locations/ '
Vehicles/Restrictions/Special Items
Pro ect Number: y'
Pro•ect Description: Any all job sit locations of work being done for the certificate holder ?j
h
1,1 r
By the Named Insured.
1 Effective Date of Cerillicato: 9/1/91 Authorized Representally G.D. Rau 3
24-0253
t.
Date Certlllcete laeued: 12/4/91 Counterelgned at: Boonville, MO
Ca.300A(0-"
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