HomeMy WebLinkAbout20030195.tiff ACORD M CERTIFICATE OF LIABILITY INSURANCE DAT�`AN'6 o Y'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
KEY LINDEN INSURANCE-LIVINGSTON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1313 W.PARK#14 __I - - __ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
LIVINGSTON MT 59047 --- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE: 406-222-4797
FAX: 406-222-4790 _ !INSURERS AFFORDING COVERAGE -
+ 5 NAIC#
INSURED .: t � r,�j � NSURER A: Travelers Insurance Company �MOUNTAIN CONSTRUCTORS,INC. (INSURER B.
P O BOX 405
PLATTEVILLE CO 80651 'DEC --, INSURER C:
� 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.
INT
N TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION l LIMITS
R DATE RAM/OD/TY) DATE
GENERAL LIABILI1Y 325D2701 JUL 28 02 JUL 28 03 EACH OCCURRENCE $ 1,000,UUO
X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED $ 300,000
PREMISES(Ea occurence)
CLAIMS MADE X] OCCUR MED.EXP(My One Person) $ 5,000
A PERSONAL BADV INJURY $ 1,000,000
GENERAL AGGREGATE .$ 2,000,000
J — __ _ _ _
GENII AGGREGATE LIMIT APPLIES PER: -G _ --
PRODUCTS-COMP/OP 2,000,000
1 POLICY PROJECT LOC — - —
AUTOMOBILE LIABILITY 325D2701 JUL 28 02 JUL 28 03 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) I$ 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) I$
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
- --- . PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT I,$
J ANY AUTO 1 MOTHER THAN EA ACC I$
(AUTO ONLY: AGG $
EXCESS/UMBERELLA LIABILITY 325D2701 JUL 28 02 JUL 28 03 EACH OCCURRENCE $ 2,000,000
X II. OCCUR • CLAIMS MADE AGGREGATE $ 2,000,000
- _
'1 DEDUCTIBLE $
X I RETENTION $ 10,000 $
WORKERS COMPENSATION AND I We STATI I 'OTHER '
'EMPLOYERS'LIABILITY _ TORY LIMITS •
ANY PROPRIETORJPARTNER/EXECUTE E.L.EACH ACCIDENT 'I$
N
OFFICER/MAMBER EXCLUDED? -
E.L.DISEASE-EA EMPLOYEE $
I if yes,describe under
I SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT $
OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONNEHICLES/EXCLUSIONS ADDED ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECT TO THE WELD COUNTY ROAD 51 ROADWAY IMPROVEMENTS
PROJECT.
CERTIFICATE HOLDER 11 ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
The Board of Weld County Commissioners INSURER,IT;S AGENTS OR REPRESENTATIVES.
915 10th Street
Greeley CO 80632 AUTHORIZED REPR TA
^
Attention: f//J/ /\'
ACORD 25((20O1/008) Certificate# 1998 Robert G PAntc
OOXZ3v " do 2003-0195
/- 15- dos
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(2001/08) Certificate#1998
,
PAYMEN[J3OND
Bond No.08635415
KNOW ALL MEN BY THESE PRESENTS: That
MOUN'T'AIN CONSTRUCTORS.INC.
Name of Contractor
P.O.BOX 405.PLA1TEVILLE,CO 80651
Address of Contractor
a Corporation ,hereinafter called Principal,and Corporation,
Partnership,or Individual
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
Name of Surety
'910 KESWICK ROAD.BALTIMORE,MD 21211,
Address of Surety
hereinafter called Surety arc held and firmly bound unto THE BOARD OF WELD COUNTY COMMISSIONERS,915
10th Street,Greely,Colorado 80632,hereinafter called County,in the penal sum of
ONE HUNDRED THIRTY THOUSAND FOUR HUNDRED FIFTY SIX AND 001100 Dollars(S 130,456.00)
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 OFTHIS OBLIGATION is such that whereas,the Principal entered into a certain Contract with
the County,dated ,a copy of which is attached and made apart hereof for the construction of:
ROADWAY IMPROVEMENT'S FOR WCR 51
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 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,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,perforated 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 terns of the Contract or to work to be performed thereunder or the
specifications accompanying the sante 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 insnoureut is executed.in_ 4 (number)counterparts,each one of
which shall be deemed an original,this the 2UQ7
MOUNTAIN CONSI'RUCCORS.INC%
Principal
EST:
lfiC Oy
Principal Secretary
;44 ,C (a)
(SEAL)
P.O.BOX 405
Witness as to Principal --- Address
P.O. BOX 405 PLATIEVILLE.CO 80651'
Address • ---
Platteville, CO 80651
FIDELITY AND DEPOSIT COMPANY Of MARYLAND
Surety
51. C
Witness as to Sure Robert O.Peals,Attorney-in-Fact
P.O. BOX 405 3910KESR'1CKROAD
Address Address
Platteville, CO 80651 _ BALTIMORE.MD 21211
NOTE: Dale of bond must nut 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.
PERFORMANCE BOND
Bond No.08635415
KNOW ALL MEN BY THESE PRESENTS: That
MOUNTAIN CONSTRUCTORS,INc
Name of Contractor
Y.O.BOX 405PLAT1'EVILLE,CO 80651
Address of Contractor
a Corporation . ,hereinafter called Principal,and
Corporation,Partnership,or Individual
FIDELITY AND DEPOSIT COMPANY OP MARYLAND
Name of Surety
3910 KESWICK ROAD.BALTIMORE,MD 21211
Address of Surety
hereinafter called Surety are held and firmly bound unto THE BOARD OF WELD COUNTY COMMISSIONERS,
915 10th Street,Oreely,Colorado 80632,hereinafter called County,in the penal sum of
ONE HUNDRED THIRTY THOUSAND FOUR HUNDRED FIFTY SIX AND 00/100 Dollars (S 130.456.00_
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 a copy of which is attached and made apart hereof for the construction of
ROADWAY IMPROVEMENTS FOR WCR 51
NOW,THEREFORE,if the Principal shall well,truly and faithfully perform its duties,all the undertaking,covenants,
teens,conditions,and agreements of said Contract during the original term thereof,and any extensions thereof which
may be granted by the Cannty,with or without notice to the Surety and during the one year guarantee period,and if
he shall satisfy all clair .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:my 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 tams 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_day of 2001.
MOUNTAIN CONSTRUCTORS.INC.
Principal
EST:
Principal Seem ry
(SEAL) By (s)
_ 1'O. BOX 405.PLATTEVILLE.CO 80651
Witness as to Principal Address
P.O. BOX 405 Platteville, CO 80651
Address
ATTEST:
NIA
Surety Secretary
FIDELITY'AND DEI'OSIT OMPAN - MA YLAND
;cull• ,_� Y—i�4F
Witness as to S ety Robert G.Peals,Attorney-in-Fact
P n ROX 405 1910 KES W ICK ROAD
Address Address
•
Platteville, CO 80651 JMLTIMORE.MD21211
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.
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
HOME OFFICE: 3910 KESWICK ROAD, BALTIMORE, MD 21211
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the State of Maryland, by PAUL C. ROGERS, Vice President, and T. E. SMITH, Assistant Secretary, in
pursuance of authority granted by Article VI, Section 2, of the By-Laws of said Company,which are set forth on the reverse
side hereof and are hereby certified to be in full force and effect on the date hereof, does hereby nominate, constitute and
appoint Kathryn D.BROYLES,D.N. BROYLES,Jeffrey L.BROYLES, im YPMA,Robert G.PEATS and Todd D.
BENGFORD,all of Bozeman,Montana, EACH its true wful age Attorney-in-Fact,to make, execute,seal and
deliver, for,and on its behalf as surety, and as its act an : any an. onds and undertakings and the execution of
such bonds or undertakings in pursuance of these prese Il be as 4 t.• g upon said Company, as fully and amply,to all
intents and purposes,as if they had been duly execute acknowl .y the regularly elected officers of the Company at
its office in Baltimore,Md.,in their own proper pe . This poi 'attorney revokes that issued on behalf of Kathryn D.
BROYLES,D.N.BROYLES, Jeffrey L.BROY d Kim `! ,dated April 4,2001.
The said Assistant Secretary does hereby cettitft the extraet forth on the reverse side hereof is a true copy of Article VI,
Section 2,of the By-Laws of said Company, ow in f
IN WITNESS WHEREOF, the said esidenta ssistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said F TY AN 1*POSIT COMPANY OF MARYLAND,this 31st day of July,A.D.
2002. • �
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
ACJ
t,
n
By:
T. E. Smith Assistant Secretary Paul C. Rogers Vice President
State of Maryland
County of Baltimore ss:
On this 31st day of July,A.D. 2002,before the subscriber,a Notary Public of the State of Maryland,duly commissioned
and qualified, came PAUL C. ROGERS, Vice President, and T. E. SMITH, Assistant Secretary of the FIDELITY AND
DEPOSIT COMPANY OF MARYLAND,to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn,
severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal
affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their
signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
A%
Carol J. Fader Notary Public
• My Commission Expires: August 1,2004
POA-F 180-3435
EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND
"Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior
Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee,
shall have power,by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident
Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to
authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations,
policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in
the nature of mortgages,...and to affix the seal of the Company thereto"
CERTIFICATE
I,the undersigned,Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify
that the original Power of Attorney of which the foregoing is a full, true and correct copy, is in full force and effect on the
date of this certificate; and I do further certify that the Vice-President who executed the said Power of Attorney was one of
the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in
Article VI, Section 2,of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the
Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on
the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically
reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or
hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and
binding upon the Company with the same force and effect as though manually affixed."
IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seal of the said Company,
this day of ,
Assistant Secretary
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