HomeMy WebLinkAbout20010603.tiff I- ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(6/20YY)
02/16/2001
PRODUCER (303)824-6600 FAX (303)370-0118 I HIS LEKI II-ILA It IS ISSUED AS A MAII tR OF NHORMAI ION
Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
g l'' f� ^ HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
3773 Cherry Creek North Drive :' ' , I•
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sui to 800 •-- - INSURERS AFFORDING COVERAGE
Denver, CO 80209-3804 —., r'a
INSURED Quality Resurfacing Company ' '? `-C ',{I ,- laURERA: Travelers Property Casualty
PO Box 519 INSURER B: Pinnacol Assurance
Henderson, CO 80640-0519 RE , _ ) 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.
Inan ruuLY trrt6 l WE PUMA'EAPIKA DUN LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY)DATE(MM/DD/YY)
GENERAL LIABILITY DTC0754G6115 12/01/2000 12/01/2001 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(My one fire) $ 300,000
CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000
A X Blanket Addtl Insd PERSONAL BADVINJURY $ 1,000,000
X Job Site Pollution GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE��� LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
^7 POLICY I JECT n LOC
AUTOMOBILE LIABILITY DT810754G6115 12/01/2000 12/01/2001 COMBINED SINGLE LIMIT $
X ANY AUTO (Ea accident) 1,000,000
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
A X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
X $100 Comp Ded PROPERTY DAMAGE
X $250 Coll Ded (Per accident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY CUP754G6115 12/01/2000 12/01/2001 EACH OCCURRENCE $ 5,000,000
IOCCUR CLAIMS MADE AGGREGATE $ 5,000,000
A $
_
DEDUCTIBLE $
X RETENTION $ 0 $
WORKERS COMPENSATION AND 2288480 12/01/2000 12/01/2001 X I TOW Y LIMITS I IER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
100,000
B
E.L.DISEASE-EA EMPLOYEE $ 100,000
EL.DISEASE-POLICY LIMIT $ 500,000
OTHER 12/01/2000 12/01/2001 $5,004,111 Limit;$2,500 Ded
A Blanket Equipment Max Item $250,000 Limit
Coverage/ACV Valuation
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: 2001 Slurry Seal Project
Certificate Holder is named as Additional Insured under the General Liability as respects work
performed by Named Insured.
CERTIFICATE HOLDER I I 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
SO_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
The Board of Weld County Commissioners BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
915 10th St OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
Greeley, CO 80632 AUTHORIZED REPRESENTATIVE
Consie Hum/CAH (949-74.41.,
o AJGY2ici
ALORD 25-S(7(97) TES
(,Onou,st 2V / 2001-0603
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.
ALORD 25-S(7191)
Bond No. 19SB103481488BCM
•
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS: That
Quality Resurfacing Co.
• Name of Contractor
P. 0. Box 519 Henderson, CO 80640
Address of Contractor
a Corporation. , hereinafter called Principal, and
Corporation, Partnership or Individual
Travelers Casualty and Surety Company of America
Name of Surety
One Tower Square Hartford, CT 06183
Address of Surety
hereinafter called Surety, are held and firmly bound unto THE BOARD OP WELD
COUNTY COMMISSIONERS, 915 10th Street, Greeley, Colorado 80632, hereinafter
called County, in the penal Hum of Eight Hundred Fifty Six Thousand Eight
Hundred Sixteen and 60/100 _
Dollars ($ 856,816.60
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 19THday of February ,2e 01 a
copy of which is attached and made apart hereof for the construction of:
2001 SLURRY SEAL PROSECT
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, includinc all amounts due for materials,
lubricants, oil, gasoline, coal and coke, repairs oa 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 abr.Ldye the right of any beneficiary hereunder, whose claim may be
unsatisfied.
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IN WITNESS WHEREOF, this instrument is executed in two (number) counterparts,
each one of which shall be deemed an original, this the 19TH day of February,
2001. •
Quality Resurfacing Co.
Principal ,
ATTEST:
B;�� .....eer`i d.-
James Russo �
•
Principal Secretary .
(SEAL) L^
c.,.,µ40-se P. 0. Box 519
Witness as to Principal Address
9700 Alton Way Henderson, CO 80640
Address
Henderson, CO 80640 Travelers Casualty and Surety Company of
Surety America
ATTEST:
, .� -- BY c l 0-e t-
Witness as to Surety Attorne -in-Fact , Sue Martin
3773 Cherry Creek N. Dr. , #800 One Tower Square
Address Address.
Denver, CO 80209 Hartford, CT 06183
NOTE: ➢ate of bond must not be prior to dace of Contract. It 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.
MEMBER MOODY INSURANCE AGENCY,INC.
l[
N ASAP 3773 CHERRY CREEK NORTH DRIVE,SUITE 800
.anORALASSOCMON OF
DENVER,COLORADO 80209-3804
o�cm PHONE:(303)824-6600
22
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
TRAVELERS CASUALTY AND SURETY COMPANY
FARMINGTON CASUALTY COMPANY
Hartford, Connecticut 06183-9062
TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS
Naperville,Illinois 60563-8458
POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT
KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY,
corporations duly organized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford.
County of Hartford, State of Connecticut, and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, a
corporation duly organized under the laws of the State of Illinois, and having its principal office in the City of Naperville, County of
DuPage, State of Illinois, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make.
constitute and appoint: Evan E.Moody,Brad Moody,Sue Martin,Jody Anderson or Vera T. Kalba* *
of Denver, CO, their true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and
acknowledge,at any place within the United States,or, if the following line be filled in,within the area there designated
the following instrument(s):
by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the
nature of a bond,recognizance, or conditional undertaking and any and all consents incident thereto
and to bind the Companies,thereby as fully and to the same extent as if the same were signed by the duly authorized officers
of the Companies,and all the acts of said Attorney(s)-in-Fact,pursuant to the authority herein given, are hereby ratified and
confirmed.
This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are
now in full force and effect:
VOTED: That the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any
Second Vice President,the Treasurer,any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact
and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe
to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in
the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such
appointee and revoke the power given hint or her.
VOTED: That the Chairman,the President,any Vice Chairman,any Executive Vice President, any Senior Vice President or any Vice President
may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is
in writing and a copy thereof is filed in the office of the Secretary.
VOTED: That any bond, recognizance, contact of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer,the Corporate Secretary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary,or(b)duly executed(under seal,if
required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or
by one or more Company officers pursuant to a written delegation of authority.
This Power of Attorney and Certificate of Authority is signed and sealed by facsimile under and by authority of the following
Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY and
TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS,which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President,any Assistant Vice President,any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any
power of attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for
purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such power of attorney
or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and
certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
(8-97)
IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS
CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY and TRAVELERS CASUALTY AND
SURETY COMPANY OF ILLINOIS have caused this instrument to be signed by their Senior Vice President, and their corporate
seals to be hereto affixed this 2nd day of October, 1999.
STATE OF CONNECTICUT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
}SS.Hartford TRAVELERS CASUALTY AND SURETY COMPANY
FARMINGTON CASUALTY COMPANY
COUNTY OF HARTFORD TRAVELERS CASUALTY
B/ T ANDD SURETY COMPANY OF ILLINOIS
Pp iw[rr •J,,�i YANp• Ghsg%UAke .c,yp 64). '/ V
3 �,_ �P/ \p^' pr#��w•o�,f LJ}4pPPOR.,r.^�
9 ,y, Y 'HARfF0 . i.` z 1983 s g o By
c p ' ° George W. Thompson
�Jar° �y'bk�r �s <rrRo�s 9 P
6< • .P' r„ • "`' , s Senior Vice President
On this 2nd day of October, 1999 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly
sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY, FARMINGTON CASUALTY COMPANY and
TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, the corporations described in and which executed the
above instrument; that he/she knows the seals of said corporations; that the seals affixed to the said instrument are such corporate
seals; and that he/she executed the said instrument on behalf of the corporations by authority of his/her office under the Standing
Resolutions thereof.
" %Clair
Ailta
0My commission expires June 30, 2001 Notary Public
Marie C.Tetreault
CERTIFICATE
I, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,
TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY,stock corporations of
the State of Connecticut, and TRAVELERS CASUALTY AND SURETY COMPANY OF ILLINOIS, stock corporation of the
State of Illinois, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority remains in
full force and has not been revoked; and furthermore, that the Standing Resolutions of the Boards of Directors, as set forth in the
Certificate of Authority,are now in force.
Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut. Dated this day of
CJ�� Npp iCrFh� t os cm ,pr3 'q��b^ o a HARTFORD < G t 9ti 2 0�.+� ,�' % C0NN. e Itsc r�'a yw Qr INO‘s a Kori M. Johanson
'��/'� b1 rPa `y • �� AY1 s Assistant Secretary, Bond
Bond No. 19SB103481488BCM
•
•
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS: That
Quality Resurfacing Co.
Name of Contractor
P. 0. Box 519 Henderson, CO 80640
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership, or Individual
Travelers' Casualty and Surety Company of America
Name of Surety
One Tower Square Hartford, CT 06183 ,
Address of Surety
hereinafter called Surety, are held and firmly bound unto THE BOARD OF WELD
COUNTY COMMISSIONERS, 915 10th Street, Greeley, Colorado 00622, hereinafter
called County, in the penal sum of
Eight Hundred Fifty Six Thousand Eight Hundred Sixteen and 60/100
Dollars ($ 856,816.60 _)
in !.awful 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 19TH day of February , 2001 , a
copy of which is attached and made apart hereof for the construction of;
2001 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, 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 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 .
• ' 19
PROVIDED, FURTHER, that no final settlement between the County and the Contractor
shall abridge the right of any beneficiary hereunder, whose elaim may be
unsatisfied.
IN WITNESS WHEREOF, thin instrument is executed in 19THday of February2001 .
ATTEST: Quality Resurfacing Co.
Principal
James Russo ® P r
Principal Secretary �G''— ""`T�" (S)
(SEAT ) P. 0. BoX 519
Denderson, CO 80640
Witness as to Principal Address
9700 Alton Way, Henderson, CO 80640
Address
ATTEST:
N/A
Surety Secretary
Travelers Casualty and Surety Company of
(SEAL) ) America
By
Witness as to Surety At orxey-lu-Fact , Sue Martin
3773 Cherry Creek N. Dr. , #800 One Tower Square
Address Address
Denver, CO 80209 Hartford, CT 06183
NOTE:
Date of bond must nnt he 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.
tMEMBEA1MOODY INSURANCE AGENCY,INC.
NASf3P3773 CHERRY CREEK NORTH DRIVE,SUITE 800
DENVER,COLORADO 80209-3804
PHONE:(303)824.6600
,Iunw,usmODUNOf
SURETY BONO PRODUCERS
•
•
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