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Home My WebLink About20030716.tiff ACORD,a CERTIFICATE OF LIABILITY INSURANCE 03/03/2 0 PRODUCER (303)824-6600 FAX (303)370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3773 Cherry Creek North Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver, CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC# INSURED Quality Paving Company INSURER A: Charter Oak Fire Ins Co 25615 Quality Resurfacing Company INSURERB: Travelers Indem Co of Ill 25674 PO Box 519 INSURER C: Travelers Indem Co of Ill Henderson, CO 80640-0519 INSURER D: Pinnacol Assurance INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN( 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 ADcDu'pL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION J LIMITS TR (NCIjI' DATE IMM/nnM'1 DATE IMM/nn/YYI GENERAL LIABILITY DTC0754G6115COF02 12/01/2002 12/01/2003 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PRFMISFC/Fa nen,renrel 1 CLAIMS MADE n OCCUR MED EXP(Any one person) $ 5,000 A X Blkt Addtl Insured PERSONALSADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 nPOLICY In JE, n LOC AUTOMOBILE LIABILITY DT810754G6115TIL02 12/01/2002 12/01/2003 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Blkt Addtl Insured PROPERTY DAMAGE $ (Per accident) X Deductibles Vary _ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY DTSMCUP325D2043TIL02 12/01/2002 12/01/2003 EACH OCCURRENCE $ 5,000,000 71 OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 C $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND 2288480 12/01/2002 12/01/2003 I CRY IMRSI X MI- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER QT660142D422ATIL02 12/01/2002 12/01/2003 Limit $3,769,778 Contractors Equipment C Limit $250,000 Leased/Rented Equip Deductible $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 2003 Rubberized Crack Filling Project # 80300045 The Certificate Holder is named as Additional Insured with respects to General Liability and Automobile Liability coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Weld County, Colorado BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 915 Tenth Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Greeley, CO 80632 AUTHORIZED REPRESENTATIVE �/•l Consie Hum, CISR/CAH 71.ac p_..., y ACORD 25(2001/08) ©ACORD CORPORATION 1988 OCincan,± 6 .5iftlik_.. BOND NO: 1885385 PERFORMANCE HON D KNOW ALL MEN BY THESE PRESENTS: That QUALITY RESURFACING CO. Name of Contractor 9700 Alton Way, Henderson, CO 80640 Address of Contractor a Corporation , hereinafter called Principal, / Corporation, Partnership, or Individual INSURANCE COMPANY OF THE WEST Name of Surety 600 So. Cherry St. , Suite 226, Denver, CO 80246 Address of Surety WELD hereinafter called Surety, are held and firmly bound unto THE BOARD OF W1 COUNTY COMMISSIONERS, 915 10th Street, Greeley, Colorado BD632, hereinafi called County, in the penal sum of Fifty-five Thousand Six Hundred and nn/inn Dollars ($5,500 00 in lawful money of the United States, for the payment of which sum well and tri to be made, we bind ourselves, successors, and assigns, jointly and several] firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered it a certain Contract with the County, dated the 6th day of March 2003, a copy of which is attached and made apart hereof for the construction c 2003 RUBBERISED CRACK FILLING PROJECT NOW, THEREFORE, if the Principal shall well, truly and faithfully perform i duties, all the undertaking, covenants, terms, conditions, and agreements of sa Contract during the original term thereof, and any extensions thereof which m be granted by the County, with or without notice to the Surety and during the o year guarantee period, and if he shall satisfy all claims and demands incurr under such Contract, and shall fully indemnify and save harmless the County fr all costs and damages which it may suffer by reason of failure to do so, a shall reimburse and repay the County all outlay and expense which the County m incur in making good any default, then this obligation shall be void; otherwi to remain in full force and effect. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates a agrees that no change, extension of time, alteration or addition to the terms the Contract or to work to be performed thereunder or the specificatio: accompanying the same shall in any ways affect its obligation on this bond, m it does hereby waive notice of any such change, extension of time, alteration 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 Contract( shall abridge the right of any beneficiary hereunder, whose claim may ] unsatisfied. -17- IN WITNESS WHEREOF, this instrument is executed in 6th day of March 2003 ATTEST: QUALITY RESURFACING CO. Principal Principal Secretary By A' �� (SEAL) / /') deify L. Rhea, President 2.ss as to�to Principal J z—.�� Address ames A. Russo, Secretary 9700 Alton Way, Henderson, CO 80640 Address ATTEST: Surety Secretary INSURANCE COMPANY OF THE WEST Surety (SEAL),/ art O - 1 -- W pness as o Surety Attorney-in-Fact 3773 Cherry Cr. No. Drive #800 Vera T. Kalba Address Address Denver, CO 80209 600 So. Cherry St. , #226, Denver, CO 80246 NOTE: Date of bond must not be prior to date of Contract. If Contractor a partnership, all partners should execute bond. IMPORTANT: Surety companies executing bonds must appear on the Treasu Department's most current list (circular 570 as amended) and authorized to transact business in the state where the project located. -18- BOND NO. 1885385 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: That QUALITY RESURFACING CO. Name of Contractor 9700 Alton Way, Henderson, CO 80640 Address of Contractor a Corporation , hereinafter called Principal, Corporation, Partnership or Individual / INSURANCE COMPANY OF THE WEST Name of Surety 600 So. Cherry St. , Suite 226; Denver, CO 80246 Address of Surety hereinafter called Surety, are held and firmly bound unto THE BOARDSLD OF WI COUNTY COMMISSIONERS, 915 10th Street, Greeley, Colorado 80632, hereinafI called County, in the penal sum of Fifty-five Thousand Six Hundred and 00.100 - ollars ($ 55.600.00 in lawful money of the United States, for the payment of which sum well and to to be made, we bind ourselves, successors, and assigns, jointly and several] firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered it a certain Contract with the County, dated the 6th day of March , 2003, copy of which is attached and made apart hereof for the construction of: 2003 RUBBER= CRACK PILLIiil PROSSCT NOW, THEREFORE, if the Principal shall during the entire length of said Contra and any extension thereof promptly make payment to all persons, firm subcontractors, and corporation furnishing materials for or performing labor the prosecution of the work provided for in such Contract, and any authoriz extension or modification thereof, including all amounts due for material lubricants, oil, gasoline, coal and coke, repairs on machinery, equipment a tools, consumed or used in connection with the construction of such work, and a insurance premiums on said work, and for all labor, performed in such wo whether subcontractor or otherwise, then this obligation shall be void; otherwi to remain full force and effect. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates a agrees that no change, extension of time, alteration or addition to the terms the Contract or to the work to be performed thereunder or the specificatioj accompanying the same shall in any way affect its obligation on time, alterati, or addition to the terms of the Contract or to the work or to the specification: PROVIDED, FURTHER, that a final settlement between the County and the Contract, shall abridge the right of any beneficiary hereunder, whose claim may } unsatisfied. -19- IN WITNESS WHEREOF, this instrument is executed in 2 (number) counterpa: each one of which shall be deemed an original, this the 6th day of March 2003 . QUALITY RESURFACING CO. Principal ATTEST: BY �, Principal Secretary Rhea, President (SEAL) 9700 Alton Way, Henderson, CO 80640 ness as to Principal AAAress Ja s A. Russo, Secretary Address INSURANCE COMPANY OF THE WEST Surety ATTEST: ei /� 1 ;;; as to Surety Attorney-ib-tact Vera T. Kalba Address Address 3773 Cherry Creek No. Dr. #800 600 So. Cherry St. #226 Denver, CO 80209 Denver, CO 80246 NOTE: Date of bond must not be prior to date of Contract. If Contractor is partnership, all partners should execute band. IMPORTANT: Surety companies executing bonds must appear on the Treasury Department most current list (circular 570 as amended) and be authorized to transa business in the state where the project is located. -20- No. 0004778 ICW GROUP • Power of Attorney Insurance Company of the West The Explorer Insurance Company Independence Casualty and Surety Company KNOW ALL MEN BY THESE PRESENTS: That Insurance Company of the West,a Corporation duly organized under the laws of the State of California,The Explorer Insurance Company,a Corporation duly organized under the laws of the State of Arizona,and Independence Casualty and Surety Company,a Corporation duly organized under the laws of the State of Texas,(collectively referred to as the"Companies"),do hereby appoint EVAN E.MOODY,BRAD MOODY,JODY ANDERSON,VERA T.KALBA their true and lawful Attomey(s)-in-Fact with authority to date,execute,sign,seal,and deliver on behalf of the Companies,fidelity and surety bonds,undertakings, and other similar contracts of suretyship,and any related documents. fN WITNESS WHEREOF,the Companies have caused these presents to be executed by its duly authorized officers this 16th day of January,2001. °xa Ptt. y,MS B\ Q oy}� ap�,4�wSAL n+�`� / �\ at1 garasaaret e91441;46titi......... c--461110Lio1/4",•-4-4-Arn-•--s--- John H.Craig,Assistant Secretary John L. Hannum,Executive Vice President State of California County of San Diego } SS. On January 16,2001,before me,Norma Porter,Notary Public,personally appeared John L.Hannum and John H.Craig,personally known to me to be the persons whose names are subscribed to the within instrument,and acknowledged to me that they executed the same in their authorized capacities,and that by their signatures on the instrument,the entity upon behalf of which the persons acted,executed the instrument. Witness my hand and official seal. I •r^•'+oy NORMA PORTER k - 4.4 � COMM.#1257540 pp �,�.'�� NOTAHV PUBUFCALIFORNIA f/l a z sysigna,04TY OO L .T1 MV Commission Expires I B�/1(„A'ta�I�. � �-:o,�� ,MARCH 19,2004 Norma Porter,Notary Public RESOLUTIONS This Power of Attorney is granted and is signed,sealed and notarized with facsimile signatures and seals under authority of the following resolutions adopted by the respective Boards of Directors of each of the Companies: "RESOLVED: That the President,an Executive or Senior Vice President of the Company,together with the Secretary or any Assistant Secretary,are hereby authorized to execute Powers of Attorney appointing the person(s)named as Attomey(s)-in-Fact to date,execute,sign, seal,and deliver on behalf of the Company,fidelity and surety bonds,undertakings,and other similar contracts of suretyship,and any related documents. RESOLVED FURTHER: That the signatures of the officers making the appointment,and the signature of any officer certifying the validity and current status of the appointment,may be facsimile representations of those signatures;and the signature and seal of any notary,and the seal of the Company,may be facsimile representations of those signatures and seals,and such facsimile representations shall have the same force and effect as if manually affixed. The facsimile representations referred to herein may be affixed by stamping,printing,typing,or photocopying." CERTIFICATE I,the undersigned,Assistant Secretary of Insurance Company of the West,The Explorer Insurance Company,and Independence Casualty and Surety Company,do hereby certify that the foregoing Power of Attorney is in full force and effect,and has not been revoked,and that the above resolutions were duly adopted by the respective Boards of Directors of the Companies,and are now in full force. IN WITNESS WHEREOF,I have set my hand this day of 2003 John H. Craig,Assistant Secretary To verify the authenticity of this Power of Attomey you may call 1-800-877.1111 and ask for the Surety Division. Please refer to the Power of Attorney Number, the above named individual(s)and details of the bond to which the power is attached. For information or filing claims,please contact Surety Claims,ICW Group, 11455 El Camino Real,San Diego,CA 92130-2045 or call(858)350-2400. I.C.W. GROUP Insurance Company of The West The Explorer Insurance Company Independence Casualty and Surety Company 11455 El Camino Real, San Diego, CA 92130-2045 P.O.BOX 85563, San Diego, CA 92186-5563 (858)350-2400 FAX(858)350-2707 www.icwgroup.com Bond Number: 1885385 Terrorism Risk Rider This rider addresses the requirements of the Terrorism Risk Insurance Act of 2002. In accordance with the above Act, we are providing this disclosure notice for all bonds on which one or more of the above identified companies is a surety. Coverage for certified acts of terrorism is included in the attached bond and will be partially reimbursed by the United States under a formula established by the Act. The United States will pay 90% of covered terrorism losses in excess of a statutory established deductible to the insurance company issuing the bond. In no way will the payment for loss on this bond exceed the limit of liability under this bond. This rider does not provide coverage for any loss that would otherwise be excluded by the terms of this bond. The portion of the premium, for this bond, attributable to coverage for certified acts of terrorism under the Act is One Dollar($1.00). Important Notice: The cost of terrorism coverage is subject to change on any bond that premium is charged annually. Hello