HomeMy WebLinkAbout20031077.tiff �w.,r,. akua e ...uu ,� m !SAFe xi a 15ASY"; '(' ' 04/14/03 ^.°
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lind i Aeeeciatee, Inc. ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.D. Box 1523 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
COMPANIES AFFORDING COVERAGE
Norfolk NE 68702c-352rn 19_: 1 9 COMPANY
(402) 379-9000 II -FAR (402)379-9080 A COLUMBIA INS. CO.
INSURED COMPANY
Monarch Oil, Inc. i h L..J a v/ a UNITED NATIONAL INSURANCE CO
Monarch Transportation COMPANY
P.O. Box 3159 - C
Omaha NE 6S103-0189 COMPANY
(402) 391 5254 D THE HARTFORD `
THIS IS TO CERTIFY THAT THE POLICIES OF ' a Y +gI D
,..:""I?:"" Riff ff' i iA:: �i, .::•:,:,':‘....73:::;.(j.^ b q t., ,1 1 k
�., � INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ME
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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
coTYPE OPMSURANCE
POLICY NUMBER POLICY EFTECTWE POLICY EEMRATION 1.111115LTR GATE(MWDWP DATEPIWDOND
S OPMERALUAMLOT GENEiALAGOREGATE 92000000
COMMEACIALOENERALLAMAnYL7142619 01/01/03 01/01/04 PPIODUI:TB-COMPpP AOG 12000000
CLAIMS PERSONAL AMR/INJURY 91000000
- EACH OCCURRENCE 91000000
Mil • PPE DAMAGE(Any oneIs) 110000
MED DP(My one preen) 9 5000
A
AUTOMOBILE LIABILLTY
COMBINED SINGLE UNIT $
ANY AUTO 11APN239260 03/20/03 03/20/04 1000000
7•AUTOS
INJURY
1 - Ty Pawn)enon) i
HIRED PlITOS
■ BODILY INJURY S
(Per accident)
NONOWNED AUTOS
III PROPERTY DAMAGE 9 i
GARAGE LIANIUTI AUTO ONLY-EA ACCIDENT 9
I ANY AUTO / / / / OTHEiTHANAUTOONLY . ..
EACH ACCIDENT S
AGGFEGATE 1
EACH OCCURRENCE 1
. UMBRELLA FORM / / / / AGGREGATE $El OTHER IHAN UMBRELLA FORM WORKERS COMPENSATION AND I TOYUMMRB 1 IDA f.;'x .,.
LABIUM / / / / EL EACH ACCIDENT 9
THE PROPRIETOR/ INOL EL DISEASE•POLICY UMIT 9
PARTNEFEVEXEC'l.ITIVE
OFFICERS ARE: _ EXCL El-DISEASE-EA EMPLOYEE S
_
D OTHER RENT- 120000
CONTR 91MSGT707191 01/01/03 01/01/04 EQPT
DESCRIPTION OF OPEAATIOMSAOCATIONSNENICLESISPECUIL ITEMS
CERTIFICATE HOLDER IS NANED ADDITIONAL INSURED ON UNITED NATIONAL POLICED
L7142619. CERTIFICATE HOLDER IS MANED AS DESIGNATED INSURED ON COLUMBIA INS. CO. POLICY
POLICY 571APN239268
SHOULD AMY OF THE ABOVE DBSCNIBED PUUCG9 SE CANCELLED BEFORE THE
EPIRATION DATE THEREOF, THE manta COMPANY WEL ENDEAVOR TO MAIL
3 0 DAYS WHInEN NOTICE TO THE CENTFICATE HOLDER NAMED TO THE LEFT.
WELD COUNTY, COLORADO NUT FAT)$ TO MAIL SUCH NOTICE SHALLIMPOSE NO OBLIGATION Oft UA IUIY
915 10TH STREET OP ryrJ V ID UPON THE C01 ANY, RS AGENTS REPRESENTATIVES
AUTHO R R56EITA
MUMS CO 80632
i0 39Cd C 6Y10eN H alejle6- 11,30-0700,3 9PV66LEZ0b 2003-1077
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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYY)
10/25/2002
PRODUCER erla
LUMBERMEN'S UNDERWRITING ALLIANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8900 WARD PARKWAY, SUITE 150 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
KANSAS CITY, MISSOURI 64114-364
INSURERS AFFORDING COVERAGE
,INSURED ALLIANCE COMPENSATION&BENEFITS GROUP. INC. INSURER A, LUMBERMEN'S UNDERWRITING ALLIANCE
1022 LEAVENWORTH STREET INSURER R:
OMAHA,NE 68102 INSURER C.
INSURER O:
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.
TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVC'POLACY EXPIRATION
WLIRDATE(MMDDM') DATE(MMIDONI) LIMITS
GENERAL LIABILITY EACH OCCURRENCE 3
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Am/We fire) 3
CLAIMS MADE OCCUR MED EXP(My one person) S
PERSONAL&ADV INJURY
GENERAL AGGREGATE 5
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP OP AGG 5
POLICY _._ ECT _-_LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO
(Ea accaen0 s
ALL OWNED AUTOS
BODILY INJURY 5
SCHEDULED AUTOS (Pa person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per ac°Ceil) $
' PROPERTY DAMAGE S(Per ac°pen°
GARAGE LIABILITY AUTO ONLY•EA ACCIDENT
ANY AUTO - OTHER THAN EA ACC $
AUTO ONLY. AGO S
EXCESS LIABILITY EACH OCCURRENCE 5
OCCUR CLAIMS MADE AGGREGATE S
DEDUCTIBLE $
RETENTION 5 5
WORKERS COMPENSATION AND 279235 11-01-2002 11-01-2003 AT.TORV IAA LIMITS eR
A EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 1,000,000
• E.L.DISEASE.EA EMPLOYEE 5 1,000,000
E L.DISEASE•POLICY LIMIT $ 1,000,000
OTHER
i I
DESCRIPTION OF OPERATIONSILOCATIONSNEHCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
"COVERAGE EXTENDS TO THE EMPLOYEES OF MONARCH OIL "
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CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
MONARCH OIL DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ATTN:JUDY WALENZ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
P 0 BOX 3189 IMPOSE NO OBLIGATION OR LIABILITY OF ANY ND UPON THE INSURER,ITS AGENTS OR
OMAHA,NE 68110 R PRESENTATIVES.
A IZED REP ENTA OF INDEPEND INSURANCE AGENCY
PETER J BREZGIEL
ACORD 25-S(7/971 m ACORD CORPORATION 1988
C'.FMPRO\CERTPROS FPS
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PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS: That
Monarch Oil, Inc.
Name of Contractor
2200 Ave "H" East, Omaha, NE 68110
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership or Individual
Union Insurance Company
Name of Surety
P. O. Box 80439, Lincoln, NE 68501
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
Five Hundred Thirty Nine Thousand Nine Hundred Twenty-One andfl5/100
Dollars ($ 539,921.05
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 _ day of ,20 , a
copy of which is attached and made apart hereof for the construction of:
2003 SLURRY SEAL 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 premiums 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 the 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.
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IN WITNESS WHEREOF, this instrument is executed in I (number) counterparts,
each one of which shall be deemed an original, this the 11th day of April ,
2003 .
MONARCH OIL, INC.
Prin i 1 L _ 7
ATTEST:
,'//
BY
Principal Secretary
0. teve Walenz, Pre
Judith A. Walenz
(SEAL) \F\\``,1
kk{b1\ 2200 Ave "H" East, Omaha, NE 68110
Witness as to Principal Address
PO Box 3189, Qrnaha NE 6R1fll
Address
UNION INSURANCE COMPANY
Surety
CA-21;
BY -
Wit as to Surety Attorney-in-Fact Robert T. Cirone
P. 0. Bo 30553 , Lincoln, NE 68501 P. 0. Box 30553, Lincoln, NE 68501
Address Address
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.
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PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS: That
Monarch Oil, Inc.
Name of Contractor
2200 Ave "H" East, Omaha, NE 68110
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership, or Individual
Union Insurance Company
Name of Surety
P. O. Box 80439, Lincoln, NE 68501
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
Five Hundred Thirty Nine Thousand Nine Hundred Twenty-One andO5/100
Dollars ($ 39,921.05
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 _ day of , 20_, a
copy of which is attached and made apart hereof for the construction of :
2003 SLURRY SEAL 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 in full force and effect.
PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and
agrees that no change, extensicn 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 ways 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.
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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 in 7Tthday of April , 20ni .
ATTEST: MONARCH OIL, INC.
L�j� /�/ Princ
77/
Principal Secretary By (S)
Judith A. Walenz
(SEAL) Steve Walenz -11
cLQ Nk‘9.sz) 2200 A OwalLd NE
Witness as to Principal `Adr "sg�
PO Box 3189, Omaha, MR 6R103
Address
ATTEST: UNION INSURANCE COMPANY
Surety Secretary
S
� y
Wity BY
itn a o Sure ARobert,T. u ironee-in-Fact
P n anx 1(1553 rincnLn NP 6R Ol P. 0. Box 3055T, Lincoln, NE 68501
Address Address
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.
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NEBRASKA STATUTORY RIDER
The State of Nebraska Code, Section 44-4040 requires the name of the soliciting agent and the name and
address of the agency to be shown on each bond issued by a Nebraska Agent or for any bond issued to a
Principal or Insured residing in Nebraska.
This rider is to comply with the statutory requirements of the State of Nebraska.
Name of Soliciting Agent:
Robert T. Cirone
Name of Insurance agency represented by the soliciting agent:
Gene Lilly Surety Bonds, Inc.
Address of the Agency:
3440 "0" Street
(street)
Lincoln Nebraska 68510
(City) (State) (Zip)
A copy of this rider should be attached to the original and all copies of any bond issued.
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM
INSURANCE COVERAGE
Coverage for acts of terrorism is already included in your current bond/policy.
You should know that, effective November 26. 2002, under your existing
coverage, any losses causec oy certified acts of terrorism wouic de parilally
reimbursed by the United States unoer a formula established by federal law.
Under this formula, the United States pays 90% of covered terrorism losses
exceeding the statutorily established deductible paid by the insurance company
providing the coverage. The portion of your annual premium that is attributable to
coverage for acts of terrorism is: SC.00
Insurance Company: UNION INSURANCE COMPANY
Bond/Policy Number: 011-1.5 / 7 (1.540 !�
Policy Period: Wilk TO // /e)
Principal/Insured: M0r)axc_k u 1K '.
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CW25101202
i
._-- No. 20 479
POWER OF ATTORNEY
UNION INSURANCE COMPANY
Lincoln, Nebraska
NOTICE: The warning found elsewhere In this Power of Attorney affects the validity thereof. Please review ,
carefully.
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KNOW ALL MEN BY THESE PRESENTS: that the UNION INSURANCE COMPANY,a corporation of the State of Nebraska, having its
principal offices in the City of Lincoln,Nebraska does hereby make,constitute and appoint
Robert T.Cirone, Betty J. Kreifels,or James M. King of Lincoln, NE
its true and lawful Attorney-in-Fad,with the power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on
its behalf, as surety any and all bonds, recognizances, stipulations and undertakings, excluding, however, any bonds or undertakings
guaranteeing payment of loans,notes or the interest thereon,provided however no single obligation will exceed
One Million and No/100 ($1,000,000.00) Dollars
and the execution of such bonds or undertakings, in pursuance of these presents,shall be as binding upon the said corporation,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 said
corporation at its office in Lincoln,Nebraska,in their own proper persons.
The UNION INSURANCE COMPANY further certifies that this Power of Attorney is granted and is executed and sealed under and by
authority of the following resolutions adopted by the Board of Directors of the Union Insurance Company on April 15,2002:
"RESOLVED, that any officer, bond manager or branch manager may appoint attorneys-in-fact or agents with authority as defined or limited in the
instrument evidencing the appointment in each case,for and on behalf of the Company to execute and deliver and affix the seal of the Company to
bonds and related obligatory certificates and documents; and any one of said officers, bond managers or branch managers may remove any such
attomey-in-fact or agent and revoke any power of attorney previously granted to such person,whether or not such officer,bond manager or branch
manager appointed the attorney-in-fact or agent;and further
RESOLVED,that any bonds and related obligatory certificates and documents shall be valid and binding upon the Company:
a)when signed by any officer,bond manager or branch manager,and sealed with the Company seal;or
b)when duly executed and sealed with the Company seal by one or more attorneys-in-fact or agents pursuant to and within the limits of authority
evidenced by the power of attorney issued by the Company to such person or persons,a certified copy of which power of attorney must be attached
thereto in order for such obligation to be binding upon the Company;and further
RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or
certification thereof authorizing the execution and delivery of any bonds and related obligatory certificates and documents of the Company and such
signature and seal then so used shall have the same force and effect as though manually affixed"
ll In Witness Whereof, UNION INSURANCE COMPANY has caused its corporate seal to be hereunto affixed and these presents to be
duly executed by its Bond Manager this 3rd day of April,2003.
UNION INSURANCE COMPANY
Cis
-E
By: Maurice F. Loeb,Bond Manager
WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE BACKGROUND WITH RED AND BLUE BORDER.
STATE OF NEBRASKA )
ss
LANCASTER COUNTY )
On this day,before the undersigned,a Notary Public in and for said County and State,personally came the above named officer of
. the UNION INSURANCE COMPANY, to me personally known to be the individual and officer who executed the preceding instrument,
and they acknowledged the execution of said instrument to be the voluntary act and deed of the UNION INSURANCE COMPANY and
1 his voluntary act and deed as an officer of said corporation, and that the seal of said corporation was affixed to said instrument by the
authority and direction of said corporation.
Witness my hand and my Notarial Seal at Lincoln, Lancaster County, Nebraska,the day and year last written above.
cBrmNANCYJ.MCMEewulu' yy,C yt,-��
NANCY J.MCMEEN /9" � cfilli
_. My conrtfa Fs 24.2004 U
Notary Public
CERTIFICATE
I, the undersigned, Assistant Secretary of UNION INSURANCE COMPANY do hereby certify that the original Power of Attorney, of
which the foregoing is full,true and correct copy,is in full force and effect.
In witness whereof, I have h unto subscribed my name as Assistant si Secretary, and affixed the corporate seal of the corporation this
/1/C day of_C Li , „1dO, 3.
694...ef 62•24,,,
SEAL-
%It 01
Form SPA-E Assistant Secretary
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