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Home My WebLink About20050922.tiff RESOLUTION RE: APPROVE AGREEMENT FOR THE OWENS-ILLINOIS GLASS CONTAINER MANUFACTURING FACILITY ROADWAY IMPROVEMENTS AND AUTHORIZE CHAIR TO SIGN - DON KERN CONSTRUCTION, INC. 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 an Agreement for the Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements 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 Don Kehn Construction, Inc., with further terms and conditions being as stated in said agreement, and WHEREAS,after review,the Board deems it advisable to approve said agreement, 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 Agreement forthe Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements 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 Don Kehn Construction, Inc. be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was,on motion duly made and seconded, adopted by -.,`g vote on the 14th day of March, A.D., 2005. oj,; BOARD OF COUNTY COMMISSIONERS 1861I' :.�:'`m • B WELD COUNTY, COLORADO William H. Jerke, Chair Clerk to the Board EXCUSED M. ile, Pro-Tem BY: „71 C 4 k C L�Deputy Clerk tht C oard 11 cv. Davi L ng AP V AS M: \\?. U\k,k Robert D. Masden o n AttQP%y EXCUSED Date of signature: 2.4's Glenn Vaad 2005-0922 EG0052 ! f'Gc, 2o-. f ) i, Oy"Oef-toS— MEMORANDUM CTO: Clerk to the Board DATE : March 9, 2005 • COLORADO FROM: Frank B. Hempen, Jr., P.E. Director of Public Works/County Engineer SUBJECT: Agenda Item—Request for Chair's Signature Enclosed are three original Agreements for the Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements with Don Kehn Construction, Inc. in the amount of$567,400. Once executed,please return TWO originals to Public Works Department as soon as possible.. The appropriate documentation is enclosed Enclosures pc: Cameron Parrott, Engineering M:AFrancie\Signatureltem.DOC • 2005-0922 • AGREEMENT Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements THIS AGREEMENT,made this 11.4:11A day of_ Y CN ,2005,by and between Weld County,Colorado,hereinafter called"Owner"and Don Kelm Construction,Inc. doing business as (an individual,)or(a partnership,)or(a corporation)hereinafter called"Contractor". WITNESSETH:That for and in consideration of the payments and agreements hereinafter mentioned: 1. The Contractor will commence and complete the following: The roadway improvements of Owens-Illinois Glass Container Manufacturing Facility described in the Invitation for Bids,Bid No.B0500059. 2. The Contractor will furnish all of the material,supplies,tools,equipment,labor and other services necessary for the construction and completion of the Project described herein. 3. The Contractor will commence the work required by the Contract Documents within ten(10)calendar days after the date of the Notice to Proceed and will complete the Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements within 107 calendar days unless the period for completion is extended otherwise by the Contract Documents. 4. The Contractor agrees to perform all of the Work described in the Contract Documents and comply with the terms therein for the sum of$ 567,400.00 ,or as shown in the Bid Schedule. 5. The term"Contract Documents"means and includes the following: (A) Invitation for Bids (B) Instructions to Bidders (C) Bid Proposal (D) Bid Bond (E) Statement of Qualifications and Subcontractors (F) Required Project Forms (G) Agreement (H) Labor and Materials Payment Bond (I) Performance Bond (J) Notice of Award (K) Notice to Proceed . (L) Change Order Irma 0- a (M) Certificate of Substantial Completion (N) Lien Waiver aea (O) Notice of Acceptance (P) Drawings prepared by KBN Engineers,LLC,titled"Owens-Illinois Glass Container - cu o Manufacturing Facility Roadway Improvements". (Q) Specifications prepared or issued by the Weld County Public Works Department. E. (R) Colorado Department of Transportation"Standard Specifications for Road and Bridge 3 Construction" 11) (S) Colorado Department of Transportation Standard Plans"M&S Standards" (T) Addenda: 'V a r o No. 1 ,dated February 8 ,2005. ,n o No. 2 ,dated February 11 ,2005. ScO4 6. The Owner will pay to the Contractor in the manner and at such times as set forth by the Contract o o Documents,or otherwise agreed upon in writing. MINIM cc ANN _0.1 n N Page 22 oa ems 7. This Agreement shall be binding upon all parties hereto and their respective heirs,executors, administrators,successors,and assigns. 8. Contract Appropriations: The Owner hereby states and affirms that the amount of money appropriated for this Contract is equal to or in excess of the Contract amount.No change order to this Contract requiring additional compensable work to be performed, which work causes the aggregate amount payable under the Contract to exceed the amount appropriated for the original Contract shall be issued by the Owner unless the Owner assures the Contractor,in writing,that lawful appropriations to cover the costs of the additional work has been made or unless such work is covered under a remedy-granting provision contained in the Contract. IN WITNESS WHEREOF,the parties hereto have executed,or caused to be executed by their duly authorized officials,this Agreement in three(3)copies each of which shall be deemed an original on the date first above written. ORDERED BY: ACCEPTED BY: THE BOARD OF WELD COUNTY COMMISSIONERS CONTRACTOR : Don Kehn Construction, Inc. BY `vw BY NAME William H.Jerke NAME Dan Kehn (Please Print) TITLE Chair TITLE Vice-President DATE MAR 14 2005 ADDRESS 6550 South County Road 5 Ft. Collins, CO 80528 ell 0 selq (SEAL) .1 b ATTEST: � t C� c U'l ee `-+�-�J Weld County Clerk to the Board ,',� BY ,d_,(zGt } j BY Don Kehn (Please Type) TITLE Deputy Clerk to the Board TITLE President IRMO III 111111111111 III 1111111111111 3272721 03/30/2005 12:11P Weld County, CO 2 of 2 R 0.00 D 0.00 Steve Moreno Clerk& Recorder Page 23 are2s---`'Pao? *HRH h i l b r o g e t & hobbr b b r 720 S.Colorado Blvd.,Ste.600N P.O.Box 469025 Denver,CO 80246 303-722-7776 j 5 303-722-8862 G1 v^ww.hrh.com **********IMPORTANT********** The attached Bond and Power of Attorney have purposely not been dated. Please do not date either of these documents until you have a signed contract. At that time, HRH is authorizing you to date the Bond and Power of Attorney as of the same date as the contract or a later date. Thank you for allowing us to help with your bonding needs. If you should have any questions regarding this letter, please feel free to contact our office. Bond No. S324798 PERFORMANCE BOND Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements KNOW ALL MEN BY THE PRESENTS;that Don Kehn Construction, Inc. (Name of Contractor) 6550 S. County Road 5, Fort Collins, CO 80528 (Address of Contractor) • Cnrpnration and a(Corporation,Partnership,or Individual) hereinafter called Contractor, Employers Mutual Casualty Company (Name of Surety) 8181 E. Tufts Ave.. Suite 500, Denver, CO 80237 (Address of Surety) hereinafter called surety,are held and firmly bound unto Weld County,Colorado (Name of Owner) P.O.Box 758, 1111 H Street,Greeley,Colorado 80632 (Address of Owner) ereinafter called Owner, in the Five Hundred Sixty.Seven Thousand penal sum of Four Hundred Ir 00/100 Dollars, ($567,400.00 lawful money of the United States of America,for the payment of which sum well and truly to be made, we bind 1 urselves,successors and assigns,jointly and severally firmly by these presents. HE CONDITION OF THIS OBLIGATION is such that whereas,the Contractor entered into a certain Contract with the wner,dated the _day of ,2005,a copy of which is hereto attached and made a part hereof for the onstruction of: Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements consisting approximately 3,600 If of new roadway between W.C.R. 66 and W.C.R. 64 %and other improvements as described in the Invitation_or _- i ds,_B id-No-B05000s9. OW THEREFORE,if the Contractor shall well, truly and faithfully perform its duties,all of the undertakings,covenants, t rms,conditions,and agreements of said contract during the original term thereof,and any extensions thereof which may be g anted by the Owner,with or without notice to the Surety and during the one year guaranty period,and if he shall satisfy all c aims and demands incurred under such contract,and shall fully indemnify and save harmless the Owner from all costs and d mages which it may suffer by reason of failure to do so,and shall reimburse and repay the Owner all outlay and expense ich the Owner may incur in making good any default,then this obligation shall be void;otherwise to remain in force and e feet. P OVIDED,FURTHER,that the said Surety for value received hereby stipulates and agrees that no change,extension of ti e,alteration or addition to the terms of the contract or to the Work to be performed thereunder of the Specifications a ompanying the same shall in any way affect its obligation on this Bond,and it does hereby waive notice of any such c ngc,extension of time,alteration or addition to the terms of the contract or to the Work or to the Specifications.• OVIDED,FURTHER,that no final settlement between the Owner and the Contractor shall abridge the right of any .reficiary hereunder,whose claim may be unsatisfied. Page 24 PERFORMANCE BOND Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements IN WITNESS WHEREOF, this instrument is executed in five(5)counterparts,each one of which shall be deemed an original,this day of 2005. Don Reba Construction, Inc. Contractor By: � (Contractor)Secretary (SEAL) • 6550 S. County Road 5 (Witness as to Contractor) (Address) Acsn c ramty Road 5. Fort Collins, CO 80528 Sort a,t t"" tD 80528. (Address) X : WITNESS: SURETY: . Employers Mutual Casualty Company (Surety) v Witness Cynthis H. Burnett, Vice President SEAL) By: ` if/W/ lil (�i^ C j�� Witness as t Surety Attorney-in-Fact K. Cobb, Denver, CO Y Florietta Acosta 720 S. Colorado Blvd., PR, North Tower RIRI R 71sFtc Ave. Suite 500 (Address) (Address) Denver CO 80246 Denver, CO 80237 OTE: Date of Bond must not be prior to date of Contract.If Contractor is Partnership,all partners should execute Bond. I PORTANT:Surety companies executing Bonds must appear on the Treasury Department's most current list(Circular 570 amended)and be authorized to transact business in the State where the Project is located. `'�I H R H HRH of Colorado Page 25 P.O.Box 469025 Denver,CO 80246-9025 CD 303-722-7776 hitb rogal & hobbs- 2 303-722-8862 • Bond No. S324798 LABOR& MATERIAL PAYMENT BOND Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements • KNOW ALL MEN BY THE PRESENTS;that Don Helm Construction, Inc. (Name of Contractor) 6550 S. County Road 5, Fors Collins, CO 80528 (Address of Contractor) corporation hereinafter called Contractor, and a(Corporation,Partnership,or Individual) Moyers Mutual Casualty Company (Name of Surety) 8181 H. Tufts Ave., Suite 500, Denver CO 80237 (Address of Surety) • hereinafter called surety,are held and firmly bound unto Weld County,Colorado (Name of Owner) P.O.Box 758, 1111 H Street,Greeley,Colorado 80632 (Address of Owner) Five Hundred Stxty Seven Thousand hereinafter called Owner, in the penal sum of Four Hrmdred & 00/100 - Dollars,(S 567,400.00 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. THE CONDITION OF THIS OBLIGATION is such that whereas,the Contractor entered into a certain Contract with the Owner,dated the day of ,2005,a copy of which is hereto attached and made a part hereof for the construction of: Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements,consisting approximately 3,600 If of new roadway between W.C.R. 66 and W.C.R.64 V.and other improvements as described in the Invitation for Bids, Bid No. B0500059 • 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. Page 26 LABOR&MATERIAL PAYMENT BOND• • Owens-Illinois Glass Container Manufacturin Pacili Roadway Improvements IN WITNESS WHEREOF,this instrument is executed in five(5)counterparts,each one of which shall be deemed an original,this day oF_� , 2005.—ThanSeharanclictil /Contractor (Contractor)Secretary By: (SEAL) (Witness as to Contractor) 6550 S. Corm Boad 5 (Address) 6550 S. County Road 5, Fort Collins, CO 80528 Fort Collins, CO 80528 (Address) Man WITNESS: SURETY: . (Surety) Witness: Employers Mutual Casualty Company Cynthia M. Burnett, Vice President ( PAL) Witness as to Surety By. ^uY( /t ` E. Cobb, Denver, Co Attotncy-in-Fact Florietta Acosta 720 S. Colorado Blvd., PH, North Tower (Address) $I$1 E ftfts Ave Sir 500 (Address) er CO 80246 Denver, CO 80237 N TE:Date of Bond must not be prior to date of Contract. If Contractor is Partnership,all partners should execute Bond. IM ORTANT: Surety companies executing Bonds must appear on the Treasury Department's most current list(Circular 570 mended)and be authorized to transact business in the State where the Project is located. Page 27 THE FACE •FTHIS r•CUMENT HASAC-•U E• :ACKG ID •N WHITE A E • :ACK•FTHIS ••CUMENT HASASIMULATE•WATE MA K-H•L>•ATANANGLET•VIEW. /EMC Insurance Companies No. 607080 P.O, Box 712•Des Moines, IA 50303.0712 CERTIFICATE OF AUTHORITY INDIVIDUAL ATTORNEY-IN-FACT KNOW ALL MEN BY THESE PRESENTS, that: 1. Employers Mutual Casualty Company,an Iowa Corporation 5. Dakota Fire Insurance Company,a North Dakota Corporation 2. EMCASCO Insurance Company,an Iowa Corporation 6. EMC Property&Casualty Company,an Iowa Corporation 3. Union Insurance Company of Providence,an Iowa Corporation 7. The Hamilton Mutual Insurance Company,an Ohio Corporation 4.=Illinois EMCASCO Insurance Company,an Iowa Corporation hereinafter referred to severally.as'Company'and collectively as"Companies";each does,by these presents,make,constitute and appoint DONALD E.APPLEBY, FLORIETTA ACOSTA, KRISTEN L. MCCORMICK, DILYNN GUERN, PAMELA J.HANSEN, CYNTHIA M. BURNETT, J. R. RICHARDS, DOUGLAS J. ROTHEY, INDIVIDUALLY, DENVER, COLORADO its true and lawful attorney-in-fact,with full power and authority conferred to sign,seal,and execute its lawful bonds,undertakings,and other obligatory instruments of a similar nature as follows: ANY AND ALL BONDS and to bind each Company thereby as fully and to the same extent as if such instruments were signed by the duly author zed officers of each such Company, and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed. The authority hereby granted shall expire April 1, 2006 unless sooner revoked. AUTHORITY FOR POWER OF ATTORNEY This Power-of-Attorney is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at a regularly scheduled meeting of each company duly called and held in 1999! RESOLVED:The President and Chief Executive Officer,any Vice President,the Treasurer and the Secretary of Employers Mutual Casualty Company shall have power and authorityto (1) appoint attorneys-in-fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof,and(2)to remove any such attorney-in-fact at any time and revoke the power and authority given to him or her.Attorneys-in-fact shall have power and authority,subject to the terms and limitations of the power-of-attorney issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof,and any such instrument executed by any such attorney-in-fact shall be fully and in all respects binding upon the Company. Certification as to the validity of any power-of-attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all respects binding upon this Company. The facsimile or mechanically reproduced signature of such officer, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power-of-attorney of the Company,shall be valid and binding upon the Company with the same force and affect as though manually affixed. IN WITNESS WHEREOF,the Companies re s have caused these gents to be signed for each by their officers as shown,and the Corporate seals to be hereto affixed this 3rd day of February UUbb Seals i� "' ""„ Bruce G.Kelley,Chairman Je rey SJe rey S.B "'piN5U, ,.NE.,° •s 'ft'C,,, s�s.,,:. ,h."2:- P ,: ., oF''•.- ,`e,,.::,, �s' of Companies 2,3,4,5&6; resident Assistant Secretary E'S/C'''' ate-2' = ••••••'',‘, '0i,1%a `,;o= =?'°' °�°','-° of Company 1;Vice Chairman and SEAL a :P1=' C 1863 - 1953 CEO of Company 7 a - a-' ; ;' �" rawP '� • oHa On this'3fd day of ; February AD 2005 before me a He E!Nsue^hc su'ar°°! Notary Public in and for the State of Iowa,personally appeared Bruce G.Kelley and Jeffrey S. �o c e c'' e v they 5 e'°A, `i ' Vii. Cqq"F`"c: Birdsley,who, being by me duly sworn, did say that they are and are known to me to be the -� a Q ` -3 s =d 3'3a = Chairman, President, Vice Chairman and CEO, and/or Assistant Secretary, respectively, of =!' SEAL _= = SEAL : :A: SEAL s`= � : s_ ;w o each of The Companies above;that the seals affixed to this instrument are the seals of said owa '•;°N�„'�;x�,:' �;Moimesp�°,', by corporations; of their respectiveid Boardst was iof Directors; aned and nd that th on e said Bruce of each of the G. Kelleanies y and Jeffrey S. Birdsley, as such officers, acknowledge the execution of said instrument to be the 1fTt% voluntary act and deed of each of the Companies. My Commission Expires September 30,2006. 140 R •`c. RUTH KRUMINS 1/ o i Commission Number 176255 4 Tom•-•�- -.� �•,'1� t My Comm.Exp.Sept.30,2006 Notary Public in and for the State of Iowa CERTIFICATE I,David L.Hixenbaugh,Vice President of the Companies,do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies,and this Rower of Attorney issued ppursuagnt thereto on February 3, 2005 on behalf of and this Rovter of Attoroev issued pursuant thereto oo February 3, 2005 on behalf of DOnald E.Appleby, I-IOrietta Acosta, Kristen L.MCCormicK,Dilynn Guern, Pamela J. Hansen, Cynthia M.Burnett, are true and correct and are still in full force and effectJ. R. Richards, Douglas J.Rothey In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this day of - - - Vice President F rm7832( r,2) "F•ry rific ti•n •fthe uth nticit •fth • •wer •fAtt•rn •u ma call 515 2: r-2. : •." Client#: 21172 DONKEHNI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE D ) 03/04/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HRH of Colorado ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 S. Colorado Blvd Ste 600-N HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 469025 Denver, CO 80246-9025 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Company 25658 Don Kehn Construction, Inc. INSURER B: Pinnacol Assurance 10780 6550 SCRS INSURER C: Fort Collins, CO 80528 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD% POLICY EFFECTIVE POUCY EXPIRATION LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYI DATE IMM/DD/YYI LIMITS A GENERAL LIABILITY 161E88931ND04 11/01/04 11/01/05 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Fa occurrence) $300,000 CLAIMS MADE n OCCUR MED EXP(Any one person) $10,000 AI#CGD2461002 PERSONAL&ADV INJURY $1,000,000 X Ltd Pollution GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE� LIMIT APPLIES�� PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY' A'JEOT Ix I LOG A AUTOMOBILE LIABILITY 810161 E8893TIL04 11/01/04 11/01/05 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Ltd Pollution PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA� LIABILITY CUP161E8893TIL04 11/01/04 11/01/05 EACH OCCURRENCE $2,000,000 JU I OCCUR n CLAIMS MADE AGGREGATE $2,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ B WORKERS COMPENSATION AND 2093950 10/01/04 10/01/05 X I TATUS I IOTH- EMPLOYERS'LIABILITY T1,7LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000. OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe ands SPECIAL PROVISIONS below E.L.DISEASE.POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project Description:Owens-Illinois Glass Container Manufacturing Facility Roadway Improvements. The following are Additional Insureds as respects General Liability only (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Weld County, Colorado DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL St DAYS WRITTEN PO Box 758 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1111 H Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Greeley,CO 80632 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Chee4 ACORD 25(2001/08)1 of 3 #S243432/M239388 MAS © ACORD CORPORATION 1988 • IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon, ACORD 25-S(2001/08) 2 of 3 #S243432/M239388 DESCRIPTIONS (Continued from Page 1) if required by written contract and coverage applies only as respects work performed by the Insured for the Additional Insureds. All coverage terms, conditions and exclusions of the policy apply. Additional Insureds:Weld County, Colorado; Great Western Railroad; Owens Illinois Glass Container Manufacturing; and Colorado Department of Transportation. The Additional Insured endorsement which is referenced above under"Type of Insurance-General Liability"is attached. *The following cancellation conditions always apply: -10 days for non-payment of premium -If policy shown, 10 days for Workers'Compensation for fraud; material misrepresentation; non-payment of premium; other reasons approved by the Commissioner of Insurance AMS 25.3(2001/08) 3 of 3 #S243432/M239388 INSURED: Don Kehn Construction, Inc. • POLICY-11MM: 16lE8893Thrx3 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES TH-E POLICY. PLEASE RrAD IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY— CONTRACTORS COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended c) This insurance does not apply to "bodily in- to include any person or organization you are re- jury" or "property damage" caused by "your quired to include as an additional insured on this work" included in the "products-completed policy by a written contract or written agreement operations hazard" unless you are required to in effect during this policy period and signed and provide such coverage for the additional in- executed by you prior to the loss for which cover- • sured by a written contract or written agree- age is sought. The person or organization does ment in effect during this policy period and not qualify as an additional insured with respect to signed and executed by you prior to the loss the independent acts or omissions of such person for which coverage is sought and then only or organization. The person or organization is for the period of time required by such con- only an additional insured with respect to liability tract or agreement and in no event beyond caused by "your work" for that additional insured. the expiration date of the policy. 2. The insurance provided to the additional insured 3. Subpart (1)(a) of the Pollution exclusion under is limited as follows: Paragraph 2., Exclusions of Bodily Injury and a) In the event that the limits of liability stated in Property Damage Liability Coverage (Section I — • the policy exceed the limits of liability required Coverages) does not apply to you if the "bodily by a written contract or written agreement in injury" or "property damage" arises out of "your effect during this policy period and signed and work" performed on premises which are owned or executed by you prior to the loss for which rented by the additional insured at the time "your coverage is sought, the insurance provided work" is performed. by this endorsement shall be limited to the 4. Any coverage provided by this endorsement to an limits of liability required by such contract or additional insured shall be excess over any other agreement. This endorsement shall not in- valid and collectible insurance available to the crease the limits stated in Section III — LIMITS additional insured whether primary, excess, con- 0- OF INSURANCE. tingent or on any other basis unless a written b) The insurance provided to the additional in- contract or written agreement in effect during this sured does not apply to "bodily injury", "prop- policy period and signed and executed by you erty damage", "personal injury" or"advertising prior to the loss for which coverage is sought njury" a sing out of an architect's, engineer's specifically requires that this insurance apply on a or surveyor's rendering of or failure to render primary or non-contributory basis. When this in- „,_ any professional services including: surance is primary and there is other insurance I. The preparing, approving or failing to available to the additional insured from any prepare or approve maps, shop drawings, source, we will share with that other insurance by the method described in the policy. opinions, reports, surveys, field orders, • change orders, or drawings and specifi- 5. As a condition of coverage, each additional cations; and insured must: II. Supervisory or inspection activities per- a.) Give us prompt written notice of any "occur- - formed as pail of any related architectural rence" or offense which may result in a claim or engineering activities. and prompt written notice of "suit". Hello