HomeMy WebLinkAbout20131220.tiffRESOLUTION
RE: APPROVE CONTRACT EXTENSION/RENEWAL FOR 2013 SLURRY SEAL/ SAND
SEAL (BID #B1200057) AND AUTHORIZE CHAIR TO SIGN - A-1 CHIPSEAL
COMPANY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Contract Extension/Renewal For 2013
Slurry Seal/ Sand Seal (Bid #B1200057) between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department of
Public Works, and A-1 Chipseal Company (Bid #B1200057), commencing May 9, 2013, and
ending May 8, 2014, with further terms and conditions being as stated in said 2013 Contract
Extension/Renewal, and
WHEREAS, after review, the Board deems it advisable to approve said 2013 Contract
Extension/Renewal, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Contract Extension/Renewal For 2013 Slurry Seal/ Sand Seal (Bid
#B1200057) between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Public Works, and A-1 Chipseal
Company be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said 2013 Contract Extension/Renewal.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 20th day of May, A.D., 2013, nunc pro tunc May 9, 2013.
BOARD OF COUNTY COMMISSIONERS
WELD CO Y, COLORADO
ATTEST:cru.cas_ . A
Weld County Clerk to th
BY:
AP
ney
Date of signature:
SAY
mA
William F. Garcia, Chair
T co( adc g tr
Dougl ema er, Pro-Tem
EXCUSED
Sean P. Conway
Mike Freeman
EXCUSED
Barbara Kirkmeyer
W , P uv 1ffr
2013-1220
EG0068
MEMORANDUM
TO: Clerk to the Board DATE: May 20, 2013
FROM: Josh Holbrook, Inspection Supervisor
SUBJECT: BOCC Agenda
Bid No. B1200057
Doc # 2012-0911
Attached is one original 2013 Contract Extension/Renewal for the 2012 Slurry Seal/Sand Seal
Contract with A-1 Chipseal Company in the amount of $1,437,841.00.
M:\Francie\AGENDA memo,\AgendaJosh . docx
2013-1220
BOARD OF COUNTY COMMISSIONERS
REVIEW/ WORK SESSION REQUEST
RE: Weld 2013 Slurry Seal/Sand Seal contract
DEPARTMENT: WELD COUNTY PUBLIC WORKS DATE: 5.7.2013
PERSON REQUESTING: Joshua Holbrook, Weld County Public Works
Brief description of the problem/issue:
The current contract for Slurry Seal/Sand Seal between Weld County and A-1 Chipseal is nearing expiration.
The contract allows for yearly extensions and possible rate adjustments. Per the contract, the allowable rate
adjustments are based upon the yearly percent change (+/-) to the Denver/Boulder/Greeley Consumer Price
Index (CPI). The percent change to the CP Index between 2011 and 2012 is a +1.9%. A-1 Chipseal has not
asked for a cost increase for 2013. This extension would be for the second year of a possible three year limit.
The 2013 budget for these services has $1,438,860.00 available. The total amount utilized in 2013 for these
services would be $1,437,841.00.
What options exist for the Board? (Include consequences, impacts, costs, etc. of options)
The Board may either approve or deny the contract renewal/extension.
Recommendation to the Board:
PW is very satisfied with the contractor's performance and rates for selected services from past years. Based
upon past experiences I am recommending approval for the attached 2013 contract renewal for A-1 Chipseal.
Approve Schedule
Recommendation Work Session Comments
William F. Garcia, Chair
Douglas Rademacher, Pro -Tern
Sean P. Conway
Mike Freeman
Barbara Kirkmeyer
Attachments: 2013 Contract Extension/Renewal
2013 Rate Schedule
M:\Maintenance Contracts\Slurry Seal -Sand Seal-Rejuvenator\20 13\RenewahWorkSession(Work Session Request).docx
CONTRACT EXTENSION / RENEWAL
Weld County Slurry Seal/Sand Seal
Date: 5.7.2013
Project: Slurry seal fifty-eight (58) miles of road and sand seal three (3) subdivisions.
Owner: Weld County Public Works Department. PO Box 758. Greeley, Colorado 80632
Consultant: A-1 Chipseal Co.. 2001 W. 641b Lane, Denver CO 80221
The following change is hereby made to the Contract Documents:
Contract Time Extension: The original Agreement for A-1 Chipseal is extended from May 9, 2013 to May 8, 2014 as
permitted by the contract. This extension will be the second year of a possible three year
contract.
Change to Original Rate Schedule: The 2012 Bid Schedule of the original contract shall be replaced by the attached
2013 Bid Schedule.
CHANGE TO CONTRACT PRICE:
The total contract amount of $1,437,841.00.
CHANGE TO CONTRACT TIME:
The Contract time will be increased by 365 calendar days.
RECOMMENDED:
Owner Representative:
Director:
APPROVALS:
Contr orjA-1 Chipseal
By:/O
Title: V P
Date: HAY 2 0 2013
Date: I3. / 3
Date: !a
Date: — 13
02013-a070
BID SCHEDULE 2013
Item
Number
Description
Estimated
Quantity
Unit
Unit Price
Contract Bid
411
Slurry Seal
906,000
Square Yard
1.44
1,304,640.00
409
Sand Seal
75,900
Square Yard
.99
75,141.00
614
Traffic & Signing
Sand Seal
3
Per Location
4,250.00
12,750.00
614
Traffic & Signing
Slurry Seal
58
Per Mile
695.00
40,310.00
2013 & 2014 BID ITEMS
627
Pavement Marking
with Paint.
0 - 2013
LS
N/A
N/A
411
Place
Rubberized Crack
Filler and
supply Traffic
Control
0 - 2013
Ton
N/A
N/A
FORCE ACCOUNT ITEMS
700
F/A Minor Contract
Revisions
FA
1
$5,000
$5,000
NOTE: For the Crack Fill Portion of this contract includes all equipment and blotter material will be bid
and paid for by Unit Price per ton of filler; complete in place and ready for use.
1,437,841.00
TOTAL BID:$
Bidder agrees to perform all Work described in the Contract Documents for the unit prices as shown in the Bid
Schedule. Payment will be based on the Lump Sum price or the actual quantities furnished, installed or constructed.
SIGNATURES:
Dated this 29th day of April , 20 13
FIRM NAME: A-1 Chipseal Co.
By: Daniel J. Gryzmala
TITLE: Vice President BIDDER'S LEGAL SIGNATURE:011
STATE OF INCORPORATION: Colorado
9
ADDRESS: 2001 W. 64th Lane, Denver, CO 80221
TELEPHONE NO: (303) 464-9267
FAX NO: (303) 464-9261
5
COLORADO
eisKstro
MEMORANDUM
TO: Donna Bechler, Clerk to the Board DATE: May 29, 2013
FROM: Francie Collins, Public Works
SUBJECT: Item for Recording with Doc # 2013-1220
Contract Extension/Renewal
2013 Slurry SeaUSand Seal Contract
Attached is the Notice of Award, W-9 form, Performance Bond, and Certificate of Liability
Insurance for your records.
M Trancie\AGENDA memos \ItemForRecording.dock
C Rda
(�- 3-2013
eie, or
NOTICE OF AWARD
2013 Slurry Seal/Sand Seal Contract
To: A-1 Chipseal
2011 W. 64th Lane
Denver, Colorado 80221
Project Description:
2013 Slurry Seal/Sand Seal Contract
The project, 2013 Slurry Seal/Sand Seal Contract, in general consists of:
❑ Slurry Seal on approximately 58 miles at various locations in Weld County (906,000
S.Y).
❑ Sand Seal at three subdivisions (75,900)
The Owner has considered the Bid submitted by you for the above described Work in response to its Invitation for
Bids and Instructions to Bidders.
You are hereby notified that your Bid has been accepted in the amount of $1,437,841.00 or as shown in the Bid
Schedule.
You are required by the Instructions to Bidders to furnish the required Performance Bond, Payment Bond and
Certificates of Insurance within ten (10) calendar days from the date of this Notice to you.
If you fail to execute said Agreement and to furnish said Bonds within ten (10) days from the date of this Notice,
said Owner will be entitled to consider all your rights arising out of the Owner's acceptance of your bid as
abandoned. The Owner will be entitled to such other rights as may be granted by law.
You are required to return an acknowledged copy of this Notice of Award to the Owner.
Dated this 20th day of May 2013
Weld County, Colorado, Owner
Aglully signed by loth Holbrook
Josh Holbrook <`_,>s.uta -brit
U &C.o��l�lk
Byto -Aber, talk
y ro„�s, 99,1,6 m07
Construction Inspection Supervisor
ACCEPTANCE OF NOTICE
Receipt of the above Notice of Award is hereby acknowledged by
(Contractor)
Dated this
By:
Znd
day of
ky,ag
6-'ry2 Ma- (cam
Title:
20
13
\III k�5r& it
Pan. W-9
Ines. Novenae 2005'..Identification
repetition u w Miry
tramps Fsa)u Saete
Request for Taxpayer
Number and Certification
Give form to the
requester. Do not
send to the IRS.
Pint or type
See Specific Instructions cm pugs 2.
in :as grown on you' Income tau rats
A-1 Chipseal Co.
Bahian tame X Moroni from ateys
ii Inlsld al: ® Corporalbl � Pamesip I] Bear e.
Clock appoirLYe Ws Bap Froprrata .............. ....
Exempt Iran bactup
wbtddhg
Mews ss Irasnbw. atln& and apt cr cute no;,
2001 W. 64th Lane
Red celr•s earn aria mess mesons"
Cty, dale and ZP cols
Denver, CO 80221
Let accost nwane al Ilea (cptbnsr,
Taxpayer Identification Number (TIN)
Enter yotr TN In the appropriate tarsi The TIN provided must math the name Own m Line t to avoid
backup tathreldhy. Far IndMduals, bas Is your soda security number (SSNI. I -Keever, for a resident
Alen, sole proprlitcc, or cesregarded entity, see to Part I Instuctlons on page 3. For other thirties, It Is
your employer laentftcabon ranter (EN). It you do rot have a number, see How b gar a Talon page 3.
Nate. If the account Is In more than one nails, see the chart on page 4 for guldelnee m whose
number to enter.
Part 1
Certification
Soda) security nuntsr
+ 1
Or
empoaw Idelhemcaeon number
814 +1 12 11 16 1 811 1.7
Under penalties of perjury. I certlly that:
1. The rulrtler shown en this form is rind correct tanpayer Identification hunter (or I am waiting ter a number to ne Issued to mad. and
2. lain not subject to backup'Mthholdmg because: re(, I am etempt from backup wl tndding, cc (bj I have not bean nailed by the Internal
Revenue Service ;IRS) that I ain sutleCt to backupwitholdig as a result 01 a failure to report all interest or dividends, Cr .Or the IRS ha;
notified ins that I am no longer wispier to bacqupiettnhoIdrg, aid
a. I inn a U.S. person redoing a U.S. resident alert).
ter -uneaten Instructions. You must cross cut kern 2 Sae it you have been maned by to IRS that you are currently sttject to ba:klp
withholding because you have fated to report all IrRrest and dNtdends an you tar rRum FCC real estate trinsaottns. Item 2 does riot ajopy.
For mortgage Interest pat acquisition or atendorment of secured property, cancelatm of debt, contributions to an Individual retired
arrangement (IRA,, and generally, payments over tren merest aro amoebas, you are not required to sign ma certification. tut you must
provide your correct TIN. fSeeMie yntuc'Ibnsi on page 4.)
Sign
Hero
elenatJTs or
U.S. person ►
Daniel J. Gryzmala 4/29/13
teen lo
Purpose of Form /
A person who ie required to file en information ream with the
IRS, must obtain yar correct tnxpeyer identification number
If IN) to report, for example, income paid to you, reel estate
transactions, mortgage interest you paid, acgredion or
abandonment of served property. cancellation of debt or
contributions you made to en IRA.
U.S. person. Use Form W-0 only if you are a U.S. person
Qrcludng a resident alias. to provide your correct TIN to the
person requesting it (the requester) ard, when applicable, to:
1. Certify that the TIN you are going is correct for you are
wade for a rarnb:r to be issued',
2 Certify that you are not subject to backup withholding. or
3. Claim etsempton from backup withholding if you are a
U.S. exempt payee.
In 3 above. if applcable you are also certifying that as a
U.S. person, your allocable share of any pertnere ip incomes
from a U.S. trade or business is riot subject to the
withholding tax on foreign patnere' share of effectively
connected income.
Note. If a requester gives you a fonn other than Form W-9 to
request your TIN, you must use the requester's form if it ie
substantially similar to this Form W-9.
For federal taw purposes. you are considered a person if you
are:
• An irdhviduel who is a ekffin or resident of the United
States.
e A partnership, corporation, company, or association
created or ergerrized in the United States or under the laws
of the United States or
s My estate (other than a foreign estatei or bust Sae
Regulati• ns sections 301.7701-6(a) and 7(a) for additional
infcmnetl,n.
special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required
to pay a withholding tan on any foreign partners there of
income from such business. Further. in certain cases where e
Form W-0 has not teen received, a pertentip is regired to
preerne that a partner ie a foreign person. and pay the
wiWxlding tan Therefore, if you ere a U.S perern that ie a
partner in a paltarehp conducting a trade or business in the
United States. provide Font W-9 to the partnership to
establish your U.S. statue ard aa:id withholding on your
share of partnership income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S status and avoiding
withholding on its allocable share of net income from the
partnership conducting a trade or business in the United
States is In the fcll+w.ing cases:
• The U.S. owner of a disregarded entity and rot he entity,
.� No. 1Cc31%
rum, W-9 Imn. 1120)51
BOND NO. 929572302
PERFORMANCE BOND
2013 Slurry Seal/Sand Contract
KNOW ALL MEN BY THE PRESENTS; that
A-1 Chipseal Company
2001 West 64th Lane
Denver, CO 80221
(Name of Contractor)
(Address of Contractor)
A Corporation
Contractor, and a (Corporation, Partnership, or Individual)
Western Surety Company
10375 Park Meadows Drive
Littleton, CO 80124
(Name of Surely)
hereinafter called
(Address of Surety)
hereinafter called surety, are held and firmly bound unto
Weld County. Colorado
(Name of Owner)
1111 H Street. P. O. Box 25R, Greeley, Colorado 8063_'
(Address of Owner)
hereinafter called Owner, in the penal sum of One Million Four Hundred*Dollars, ($1,437, 841.09
in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind
ourselves, successors and assigns, jointly and severally firmly by these presents.
*Thirty Seven Thousand Eight Hundred Forty One and No/100---
THE CONDITION OF THIS OBLIGATION is such that whereas, the Contractor entered into a
certain Contract with the Owner, dated the 17th day of May
attached and made a part hereof for the construction of:
, 20 13 a copy of which is hereto
2012 Slurry Seal/Sand Seal Contract described in the Invitation for Bids, Bid No. B1200057
NOW THEREFORE, if the Contractor shall well, truly and faithfully perform its duties, all of the undertakings,
covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions
thereof which may be granted by the Owner, with or without notice to the Surety and during the one year guaranty
period, and if he shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and
save harmless the Owner from all costs and damages which it may suffer by reason of failure to do so, and shall
reimburse and repay the Owner all outlay and expense which the Owner may incur in making good any default, then
this obligation shall be void; otherwise to remain in force and effect.
PROVIDED, FURTHER, that the said Surety for value received hereby stipulates and agrees that no change,
extension of time, alteration or addition to the terms of the contract or to the Work to be performed thereunder of the
Specifications accompanying the same shall in any way affect its obligation on this Bond, and it does hereby waive
notice of any such change, extension of time, alteration or addition to the terms of the contract or to the Work or to
the Specifications.
PROVIDED, FURTHER, that no final settlement between the Owner and the Contractor shall abridge the right of
any beneficiary hereunder, whose claim may be unsatisfied.
-7-
PERFORMANCE BOND
2013 Slurry Seal/Sand Seal Contract
IN WITNESS WHEREOF, this instrument is executed in five (5) counterparts, each one of which shall be deemed
an original, this 21st day of May ....2013.
Contractor) Secretary
Stephanie Wallis
(SEAL)
2001 West 64th Lane
(Witness as to Contractor)
Denver, CO 80221
(Address)
ATTEST:
N/A
(Surety) Secretary
(SEAL)
Witness as to Surety
8055 East Tufts Avenue, #1000
(Address)
Denver, CO 80237
By
Daniel// Gryzmala, Vice President
2001 West 64th Lane
(Address)
Denver, CO 80221
Wes ern Sure
Karen A. reggeys'tn c
10375 Park Meadows Drive
(Address)
Littleton, CO 80124
NOTE: Date of Bond must not be prior to date of Contract. If Contractor is Partnership, all partners should
execute Bond.
IMPORTANT: Surety companies executing Bonds must appear on the Treasury Department's most current list
(Circular 570 as amended) and be authorized to transact business in the State where the Project is located.
MEMBER T MOODY INSURANCE AGENCY, INC.
NASBP
WrIOWIASSCOATIPON OF
9JIIETV BOW MOVERS
8055 East Tufts Avenue, Suite 1000
DENVER, COLORADO 80237
PHONE: (303) 824.6600
1
-8-
BOND NO. 929572302
LABOR & MATERIALS PAYMENT BOND
2013 Slurry Seal/Sand Seal Contract
KNOW ALL MEN BY THE PRESENTS; that
A-1 Chipeal Company
2001 West 64th Lane
Denver, CO 80221
(Name of Contractor)
(Address of Contractor)
A Corporation
Contractor, and a (Corporation, Partnership, or Individual)
Western Surety Company
hereinafter called
10375 Park Meadows Drive
Littleton, CO 80124
(Name of Surety)
(Address of Surety)
hereinafter called surety, are held and firmly bound unto
Weld County. Colorado
(Name of Owner)
1111 H Street. P.O. Box 758. Greeley Colorado 80632
(Address of Owner)
hereinafter called Owner, in the penal sum of One Million Four Hundred Thirty Seven Thousand*
Dollars, iS 1,437, 841.00 ). in lawful money of the United States of America, for the payment of
which sum well and truly to be made, we bind ourselves, successors and assigns, jointly and severally firmly by
these presents.
*Eight Hundred Forty One and No/100---
THE CONDITION OF THIS OBLIGATION is such that whereas, the Contractor entered into a certain Contract
with the Owner, dated the 17thlay of May , 2013 , a copy of which is hereto attached
and made a part hereof for the construction of:
2012 Slurry Seal/Sand Seal Contract described in the Invitation for Bids, Bid No. B1200057
NOW, THEREFORE, if the Contractor shall promptly make payment to all persons, firms, Subcontractors, and
corporations furnishing materials for or performing labor in the prosecution of the Work provided for in such
contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants,
oil, gasoline, repairs on machinery, equipment and tools, consumed or used in connection with the construction of
such Work, and all insurance premiums on said Work, and for all labor, performed in such Work whether by
Subcontractor or otherwise, then this obligation shall be void,; otherwise to remain in full force and effect.
PROVIDED, FURTHER, that the said Surety for value received hereby stipulates and agrees that no change,
extension of time, alteration or addition to the terms of the contract or to the Work to be performed thereunder of the
Specifications accompanying the same shall in any way affect its obligation on this Bond, and it does hereby waive
notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the Work or to
the Specifications.
PROVIDED FURTHER, that no final settlement between the Owner and the Contractor shall abridge the right of
any beneficiary hereunder, whose claim may be unsatisfied.
-9-
LABOR & MATERIALS PAYMENT BOND
2013 Slurry Seal/Sand Seal Contract
IN WITNESS WHEREOF, this instrument is executed in five (5) counterparts, each one of which shall be deemed
an original, this 21st day of May 20 13
-CilZ.
(Contractor) Secretary
Stephanie Wallis
(SEAL)
(Witness as to Contractor)
2001 West 64th Lane
(Address)
Denver, CO 80221
ATTEST:
N/A
(Surety) Secretary
(SEAL)
Witness as to Surety
8055 East Tufts Avenue, #1000
(Address)
Denver, CO 80237
A-1 Chipseal Company
ctor
By _1
Daniel
yzmala, Vice President
2001 West 64th Lane
(Address)
Denver, CO 80221
Western Surety Comp
Attorney -in -Fact
Karen A. Feggestad
10375 Park Meadows Drive
(Address)
Littleton, CO 80124
NOTE: Date of Bond must not be prior to date of Contract. If Contractor is Partnership, all partners should
execute Bond.
IMPORTANT: Surety companies executing Bonds must appear on the Treasury Department's most current list
(Circular 570 as amended) and be authorized to transact business in the State where the Project is located.
MEMBER T MOODY INSURANCE AGENCY, INC.
NASBP
MICNAJESCCMICHOf
ao �DxE� RA ,
8055 East Tufts Avenue, Suite 1000
DENVER, COLORADO 80237
PHONE: (303) 824-6600
1
-10-
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota. and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Evan E Moody, Vera T Kalba, Karen A Feggestad, Brandi J Tetley, Bradley J Moody,
Individually
of Denver. CO, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign. seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 22nd day of April, 2013.
State of South Dakota
County of Minnehaha
}
WESTERN SURETY COMPANY
aul T. Bruflat, Vice President
On this 22nd day of April. 2013, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument; that he knows the seal of said corporation: that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges
same to he the act and deed of said corporation.
My commission expires
June 23.2015
CERTIFICATE
4-717)6,4„,
J. Mohr, Notary Public
I, L. Nelson. Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 21st day of May 2013
WESTERN SURETY COMPANY
c t t.g4_,nn'
L. Nelson, Assistant Secretary
Form F42st1-7-2012
'`� �® CERTIFICATE OF LIABILITY INSURANCE
5/21/2013'
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(les) must 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 endorsement(s).
PRODUCER
Moody Insurance Agency, Inc.
8055 East Tufts Avenue
Suite 1000
Denver CO 80237
CONTACT Erin Threlkeld, CRIS
NAME:
A N Fan. (303) 824-6600 I fA/O No): (303)370-0118
ADDRESS. ethrelkeld@moodyins.com
INSURER(S) AFFORDING COVERAGE
NAICa
INSURER A :Travelers Indemnity Company
25658
INSURED
A-1 Chipseal Company
DBA: Rocky Mountain Pavement, LLC
2001 West 64th Ln
Denver CO 80221
INSURERB:Travelers Prop Cas Co of Amrca
25674
INSURERC:Pinnacol Assurance
41190
INSURER D:
INSURERE:
INSURER F:
COVERAGES
CERTIFICATE NUMBER:12-13 All Lines w/Forms
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.
INSR LTR
TYPE OF INSURANCE
IN SR
YND
POLICY NUMBER
IR MM/DDYIYYYPYI
(MM/DD/YEYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
X
DTC00190P673PHX12
Additional Insured Endt
when required by contract
CGD246 08/05 attached
10/1./2012
10/1/2013
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any ore person)
$ 10,000
I CLAIMS -MADE
X
OCCUR
PERSONAL BADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
GENT AGGREGATE
—I POLICY
X
LIMIT APPLIES
PFo
PER:
LOC
$
B
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALLOWNED
HIRED AUTOS
X
S
SCHEDULED
AUTOS
NON -OWNED
DT8100190P673TIL12
10/1/2012
10/1/2013
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Peraccident)AUTOS
$
PROPERTY DAMAGE(Per
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
DTSMCUP0190P673TIL12
10/1/2012
10/1/2013
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10,000,000
$
DED I X I RETENT ON$ 10,000
O
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE rYIN
(Mandatory In ER EXCLUDED? IN
In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
4055760
10/1/2012
10/1/2013
X I WTOC STATU-TH
LIMITS I 10FR
EL. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
RE 2013 Slurry Seal/Sand Seal Contract
Weld County, Colorado is Additional Insured in regards to General Liability as required by written
contract.
CERTIFICATE HOLDER
CANCELLATION
Weld County, Colorado
1111 H Street
PO Box 758
Greeley, CO 80632
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
E Threlkeld, CRIS/CHR
ACORD 25 (2010/05)
INSO25 romnnsr m
ID 1988-2010 ACORD CORPORATION. All rights reserved.
The erasion name and Inn^ are ranietarad marire nf arnon
Insured A-1 Chinese) Company
[I CI kLittlikINII IkkliItiiiitit
Policy Number; DT000190r673PHX12
e AMERCIAL GENERAL LIABILITY •
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
. (CONTRACTORS)
This endorsement modifies insurance provided under the fallowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED — (Section II) Is amended c)
to Include arty person or organization that you
agree In a "written contract requiring Insurance`
to include as an additional Insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
,'property damage" or "personal injury"; and
b) if, and only to the extent that, the injury or
damage Is caused by acts or omissions of
you or your subcontractor in the performance
of 'your work" to which the "written contract
reckoning insurance" applies. The person or
organization does not qualify as an additional
Insured with respect to the independent acts
or omissions of such person or organization,
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event, that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required -by the
"written central requiring insurance, the In-
surance provided to the additional insured
shall be limited to the limits of liability -re-
quired by that "written contract requiring in-
surance". This endoisamerd shall not in-
crease the limits of Insurance described In
Section I® — Limas Of Insurance.
to) The insurance provided to the additional In-
sured does riot apply to "bodily Injury",'prop-
erty damage' or *personal Injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, Inducting;
I. The preparing, approving, or tailing to
prepare or approve, maps, shop draw-
ings, opinions, -reports, surveys, field or-
dors or change orders, or the preparing,
approving, or falling to prepare or ap-
prove, drawings and specifications; and
iL Supervisory, inspection, architectural or
engineering activities.
—PG-D2 46•08-116 •
OMNI
The insurance provided to the additional In-
sured does not apply to °bodily 'Injury" or
'property damage" caused by "your work"
and Included In the "products -completed op -
orations hazard" undies the 'written contract
requiring Insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily Injury,"'or"property damage" that oc-
curs before the End of the pealed of time for
which the "written contract requiring nsta-
once" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The Insurance provided to the additional insured
by this endorsement Fe excess over any valid and
collootibte "ether insurance", whether primary,
(xcess, contingent or on any other basis, that is
available to the additional Insured fir a loss we -
cover under this endorsement However, -if the
"written contract requiring Insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non-eerdnbutory basis,
this insurance is primary to "other Insurance'
available to the additional insured which covers
that person or organization as a named Insured
• for such loss, and we will not shore win that
'other insurance', But the insurance provided to
the additional insured by this endorsement still Is
excess over any valid end coltectlble "other In-
surance", whether primary, excess, contingent ar
on any other beais, that is available to the addi-
tional insured when that person or organization Is
an additional Insured under such "other insur-
ance'.
4. As a condition 4o1 coverage provided to the
additional insured by this endorsement
a) The additional Insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result In a
claim To the extent possibie, such natioe
should Include:
33 2005 The SL'PaulTiaveiers Compariles- h d.
..---Fragefof7 -.
Insured: A-1 Chipseal Company
Policy Number DTCO0190P673
COMMERCIAL GENERAL L IA6,.If Y
How, when and whom the °occurrence"
or offense took place;
B. The names and addresses of any injured
persons and witnesses, end
iii. The nature and location of any injury or
damage arising out of "ocourrence" ar
offense.
by El a claim Is made or "suit" is brought against
the additional insured, the additional Insured
must:
I. Immediately record the specifics of the
claim or "suit" and the date recelved; and
II. ',Notify us as soon as predicable.
The additional Insured must see to It that we
receive written notice of the claim or "suit" es
soon as practicable.
c) The additional Insured must immediately
send us copies of all legal papeja received in
connection with the claim or "sun" cooperate
with us in the investigation or sediment of
the claim or defense against the °su(t", and
otherwise comply with all policy condition-
al) The additional insured must tender the de-
fense and Indemnity of any claim or'sult" to
any provider of "other insurance" which would
- cover the additional insured for a loss we
cover under this endorsement However, this
condition does not affect whether the Insum
once provided to the additional Insured by
this endorsement is primary to "other. Insur-
ance" available to the additional insured
which covers that person or organization es a
named insured as described In paragraph 3.
above.
S. The following definition is added to SECTION V.
DEFINITIONS:
'Written contract requiring Insurance" means
that part of any written contract or agreement
undet which you am required to Include a
person or organization as an additional In-
sured on this Coverage Part, provided that
the "bodily Injury" and "property damage" oc-
curs and the "personal injury" is roused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b, While that part of the contract or
agreement is In effect; and
c. Before the end of the policy period;
' ' 2U05 The a Paul traveler"s'Coiiipai-dS, Tnii -
Cb P2 46 U8 f1s-
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