HomeMy WebLinkAbout20020549.tiff ACORD CERTIFICATE OF LIABILITY INSURANClLID R
ATCSI DATE(MWDD/YY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Linden/Bartels & Noe Agency GR HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
3459 W 20th Street Suite 224 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley CO 80634
Phone: 970-356-1133 Fax:970-356-4088 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Ohio Casualty Group
INSURER B:
Flat Coat Asphalt Specialists INSURER C:
601A Innovation Drive INSURER D:
Windsor CO 80550 -- -- -
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 _POL Y FF IVE P I IRA I N
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DDIYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY 52730892 03/03/02 03/03/03 FIRE DAMAGE(Any one fire) $ 100,000
CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY X PROT I I LOC
JEC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000
A X ANY AUTO 52730892 03/03/02 03/03/03 (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 EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE
RETENTION $ $
WORKERS COMPENSATION AND WCYI OIR-
TO
EMPLOYERS LIABILITY TORY LIMITMITS ER
E.L.EACH ACCIDENT $
E.L.DISEASE-EA EMPLOYEE $
EL.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: 2002 CRACK SEAL PROJECT; CERTIFICATE HOLDER IS NAMED AS
ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY.
CERTIFICATE HOLDER Y ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION
WELD-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
WELD COUNTY IMPGSE-N OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
ATTN: ENGINEERING DEPT
P.O. BOX 758 ''REPR E ATIVES.I
GREELEY CO 80632 �,.1�?�. („��-�.e�,t`.J
Dean . Meyer, ChFC
ACORD 25-S(7/97 2002-0549
PERFORMANCE BOND
Bond No. P58281
KNOW ALL MEN BY THESE PRESENTS: That
FLAT COAT ASPHALT SPECIALISTS, LLC
Name of Contractor
601 A INNOVATION CIRCLE, WINDSOR, CO 80550
Address of Contractor
a Limited Liability Corporation , hereinaftercalledPrincipal, and
Corporation, Partnership, or Individual
PIONEER GENERAL INSURANCE COMPANY
Name of Surety
6780 E. HAMPDEN AVENUE, DENVER, CO 80224
Address of Surety
hereinafter called Surety are held and firmly bound unto THE BOARD OF WELD COUNTY
COMMISSIONERS, 915 10th Street, Greeley, Colorado 80632, hereinafter called County, in the penal sum of
FORTY FOUR THOUSAND ONE HUNDRED FIFTY TWO AND 20/100 Dollars ($ 44,152.20) in lawful
money of the United States, 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.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain Contract
with the County, dated the 22 day of February , 2002, a copy of which is attached and made apart
hereof for the construction of:
2002 RUBBERIZED CRACK FILLING PROJECT
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the undertaking,
covenants, terms, conditions, and agreements of said Contract during the original term thereof, and any
extensions thereof which may be granted by the County, with or without notice to the Surety and during the one
year guarantee period, and if he shall satisfy all claims and demands incurred under such Contract, and shall fully
indemnify and save harmless the County from all costs and damages which it may suffer by reason of failure to do
so, and shall reimburse and repay the County all outlay and expense which the County may incur in making good
any default, then this obligation shall be void; otherwise to remain if 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 work to be performed thereunder or 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 of the work or to
the specifications.
PROVIDED, FURTHER, that no final settlement between the County and the Contractor shall abridge the right of
any beneficiary hereunder, whose claim may be unsatisfied.
IN WITNESS WHEREOF, this instrument is executed on 22 day of February 2002
AT COAT ASPH T SPECIALISTS LLC
Princip.
ATTEST:
— — By ILJA
Principal Secretary orman W. Davis, Managing Member
(SEAL)
( 01-/L)c� 601 A INNOVATION CIRCLE, WINDSOR, CO 80550
Witness as to Principal Chanda Davis Address
601 A INNOVATION CIRCLE
Address
WINDSOR, CO 80550
A EST:
�2 iivun
Surety Secretary STELLA FERRIS
PIONEER GENERAL INSURANCE COMPANY
(SEAL)
X6 fit.. r1 F VL10 BY ✓ a A 11,j �i 'LLA4 Witness as to Surety STELLA FERRIS thdyn Y. Dryg, rney-in-Fact
()rLXi'l�r,t NJ Utz U/lY 1 6780 E. HAMPDEN AVENUE
Address
//�� Address
eoMe )s, (.l) c,(-)f:5:11:3 DENVER, CO 80224
NOTE: Date of bond must not be prior to date of Contract. If Contractor is a 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.
PAYMENT BOND
Bond No. P58281
KNOW ALL MEN BY THESE PRESENTS: That
FLAT COAT ASPHALT SPECIALISTS, LLC
Name of Contractor
601 A INNOVATION CIRCLE, WINDSOR, CO 80550
Address of Contractor
a Limited Liability Corporation , hereinafter called Principal, and
Corporation, Partnership, or Individual
PIONEER GENERAL INSURANCE COMPANY
Name of Surety
6780 E. HAMPDEN AVENUE, DENVER, CO 80224
Address of Surety
hereinafter called Surety are held and firmly bound unto THE BOARD OF WELD COUNTY COMMISSIONERS,
915 10th Street, Greeley, Colorado 80632, hereinafter called County, in the penal sum of
FORTY FOUR THOUSAND ONE HUNDRED FIFTY TWO AND 20/100 Dollars ($ 44,152.20)
in lawful money of the United States, 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.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain Contract
with the County, dated the 2 2 day of February, 2002, a copy of which is attached and made apart
hereof for the construction of:
2002 RUBBERIZED CRACK FILLING PROJECT
NOW, THEREFORE, if the Principal shall, during the entire length of said Contract and any extension thereof,
promptly make payment to all persons, firms, subcontractors, and corporation 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, coal and coke, repairs on
machinery, equipment and tools, consumed or used in connection with the construction of such work, and all
insurance premium on said work, and for all labor, performed in such work whether subcontractor or otherwise,
then this obligation shall be void; otherwise to remain 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 work to be performed thereunder or the
specifications accompanying the same shall in any way affect its obligation on time, alteration or addition to the
terms of the Contract or to the work or to the specifications.
PROVIDED, FURTHER, that a final settlement between the County and the Contractor shall abridge the right of
any beneficiary hereunder, whose claim may be unsatisfied.
IN WITNESS WHEREOF, this instrument is executed in (number) counterparts, each one of
which shall be deemed an original, this the 22 day of February , 2002
FLAT COAT ASPHA SPECIALISTS LLC
Principa
ATTEST:
By 41114141^ /
Principal. Secretary Orman W Davis, Managing Member
(SEAL)
411-2 CiTh 601 A INNOVATION CIRCLE,WINDSOR, CO 80550
Witness as to Principal Chanda Davis Address
601 A INNOVATION CIRCLE
Address
WINDSOR, CO 80550
PIONEER GENERAL INSURANCE COMPANY
Surety
ATTEST:
V/+-1-V[.(.i. By 'tat L •
Witness as to Surety STELLA FERRIS Kathrynl. Dryg, Att e}�-in-Fact
/loNttnkL g? AitM IWill 6780 E. HAMPDEN AVENUE
Address>f C:(J Y���,�.!'� Address
n& (2C)u y j DENVER, CO 80224
NOTE: Date of bond must not be prior to date of Contract. If Contractor is a partnership, all partners should
execute bond.
IMPORTANT: Surety Companies executing bonds must appear on the Treasury Departments most current list
(Circular 570 as amended) and be authorized to transact business in the state where the project is
located.
PIONEER GENERAL INSURANCE COMPANY
Denver, Colorado P 58282
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That the PIONEER GENERAL INSURANCE COMPANY,a corporation of the State of Colorado has its prindpal office in the City of Denver,Colorado pursuant to the
following By-law,which was adopted by the Board of Directors of the said Company in 1990,to wit:
'Artlde VI-Section 2-RESIDENT OFFICERS AND ATTORNEYS-IN-FACT The President or any Vice-President,acting with any Secretary or Assistant Secretary,shall
have the authority to appoint Resident Vice-Presidents and Attorneys-In-Fact,with the power and authority to sign,execute,acknowledge and deliver on its behalf,as Surety:
Any end all undertakings of suretyship and to affix thereto the corporate seal of the corporation.The President or any Vice-President,acting with any Secretary or Assistant
Secretary,shall also have the authority to remove and revoke the authority of any such appointee at any time,does hereby make,constitute and appoint
*** MICHAEL D. PIERCE, RAE L. CAMPBELL, JOAN DELAUDER ***
*** KATHRYN Y. DRYG, LAWRENCE E. LUTGEN, RENE STEIN ***
OF
FORT COLLINS, COLORADO
its true and lawful Attorney(s)-In-Fact,to make,execute,seal and deliver for and on its behalf,as Surety:
And any and all undertakings of suretyship
And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Company,as fully and amply,to all intents and purposes,
as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its offices in Denver,Colorado,in their own persons.
The following Resolution was adopted at the Regular Meeting of the Board of Directors of the Pioneer General Insurance Company,held on June 1,1990.
'RESOLVED,That the signatures of officers of the Company and the seal of the Company may be affixed by facsimile to any Power of Attorney executed in accordance
with Article VI-'Section 2 of the Company By-laws;and that any such Power of Attorney bearing such facsimile signatures,including the facsimile signature of a certifying
Assistant Secretary and facsimile seal shall be valid and binding upon the Company with respect to any bond,undertaking or contract of suretyship to which it is attached."
All authority hereby conferred shall remain in full force and effect until terminated by the Company.
IN WITNESS WHEREOF,PIONEER GENERAL INSURANCE COMPANY has caused these presents to be signed by its President and its corporate seal to be hereunto
affixed this 1st day of May 2001
PIONEER GENERAL INSURANCE COMPANY 1 iNsok
.....
...
Secretary ��_ o\ S 1': A 1.
State of Colorado )
) ss. ByA PRESIDENT
County of Arapahoe ) �OI�.R ADS.
on this 1st day of May 2001 before me personally came Bruce H. Lowdermilk
to me known,who being by me duly sworn,did depose and say that(s)he resides in the County of Adams,State of Colorado;that(s)he is the President of the PIONEER
GENERAL INSURANCE COMPANY,the corporation described in which executed the above instrument;that(s)he knows the seal of the said corporation;that the seal affixed
to the said instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said corporation;that(s)he signed(his)(her)name by like order;and
that By-law,Article VI-Section 2,adopted by the Board of Directors of said County,referred to in the preceding instrument,is now in force.
7174171,
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ICY �]
My Commission Expires 1/18/2003 ",'3\A0 B...%Opap' Notary Public m �
M.J. Frick Secretary of PIONEER GENERAL INSURANCE COMPANY, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney executed by said PIONEER GENERAL INSURANCE COMPANY,which is still in full force and effect.
Signed and sealed at the City of Denver,Colorado this day of ,
P133 Secretary 9 � �
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