HomeMy WebLinkAbout20000721.tiff ACORD.. CERTIFICATE OF LIABILITY INSURANCEP ID ZB DATE IMM/DD/YY,
RANBL01 02/25/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lockton Companies of Colorado HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4500 Cherry Creek Dr. 5. , #400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver CO 80246-1532 COMPANIES AFFORDING COVERAGE
COMPANY
Panne No. 303-753-2000 Fax No. 303-753-2099 A TRAVELERS INDEMNITY COMPANY
---53-20
INSURED __ -
COMPANY
B THE TRAVELERS INDEMNITY OF IL
Randall & Blake, Inc. — -- - --- - - - -- -- ---
dba Intermountain Resurfacing COMPANY
Inc. M41 C WAUSAU BUSINESS INSURANCE
1601 W. Belleview Avenue COMPANY
Littleton CO 80120 D
COVERAGES
THIS IS TO CERTIFY THAT 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 CONTRACTOR 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
A X COMMERCIAL GENERA,LIABILITY DTEHCO784F8693TIA99 07/03/99 07/03/00 PRODUCTS-COMP/OPAGG $ 2,000,000
CLAIMS MADE [-X] OCCUR PERSONAL&ADV INJURY $ 1,000,00 0
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
X Per Project XCU INCLUDED FIRE DAMAGE(Any one tire; $ 300,000_
Aggregate Applies MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000 ,000
A X ANY AUTO DT810784F8693TIL99 07/03/99 07/03/00
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)
- _-- — — -- - PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY.
EACH ACCIDENT*5 _
AGGREGATE .$
EXCESS LIABILITY - EACH OCCURRENCE $ 4,000,000
B X UMBRELLA FORM DTSMCUP784F8693TIL99 07/03/99 07/03/00 AGGREGATE $ 4,000,000
OTHER THAN UMBRELLA FORM $
WC STATU- OTH-
WORKERS COMPENSATION AND X TORY LIMITS I_ _ Eft
EMPLOYERS LIABILITY I EL EACH ACCIDENT $ 100,000
THE PROPRIETOR/C X NU 231000064746 01/01/00 01/01/01 EL DISEASE POLICYLIMIT 7$ 500,000
PARTNERS/EXECUTIVE
--- - -- - - -OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE $ 100,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
As respects to 2000 Slerry Seal project.
CERTIFICATE HOLDER CANCELLATION
WELC009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL LED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Weld County
1111 H Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVE',.
Greeley CO AUTHORIZED REPRESENTATIVE I
1
ACORD 25-S(1(95) f✓ L. M iggM -r? a xT -4
�v vj- :,�(�, o3//3/acrco J 2000-0121
i ACCEPTANCE OF NOTICE
Receipt of th! above Notice of Award is hereby acknowledged by
(---t � � rP� .. ' T.[l�Dlm( �u�k a; l Sul ,c.f U7
this the �"' day of �la.!\1L1"l , 2000.
/
BY: J 1
Title: a. � � _ % (Yl . 1 t . I.
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 of Colorado.
15
Bond No. 929140046
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS: That
RANDALL & BLAKE, INC. dba INTERMOUNTAIN RESURFACING
(Name of Contractor)
4901 So. Windermere Street - Littleton, CO 80120
(Address of Contractor)
a Corporation ,hereinafter called Principal,
Corporation,Partnership,or Individual
and NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
(Name of Surety)
CNA Plaza - Chicago, IL 60685
(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
Eight Hundred Thirty Eight Thousand Three Hundred Seventy Nine and 45/100 Dollars
($ 838,379.45 ) 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 CQNDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the County, dated the
3 r
day of a1.eirA 2000 ,a copy of which is attached and made a part hereof for the constmction of:
2000 Slurry Seal Project
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform it's 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 (1) 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 delault,
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 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 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.
S-3172/GEEF11/97 Page 1 of 2
Bond No. 929140046
IN WITNESS WHEREOF,this instrument is executed in 3 (number) counterparts, each one of which
shall be deemed an original, this are day of Li•A a > , 7C13(1
ATTEST: RANDALL & BLAKE, INC. dba INTERMOUNTAIN
/ RESURFACING
Principal
Primal Secretary
455'1' By (5)
(SEAL) 1�
�! Witness trinCi t �. ) - J Y
// 4901 So. Windermere Street - Littleton, CO 80120
Address
4901 So. Windermere Street- Littleton, CO 80120
Address
ATTEST:
i C1 act. 7 NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
Surety C.,�w+le.p /,r Surety
[ 1
(SEAL) /
� L UVGa7� By Ahlw,
fitness as to Surety Attorney-in-Fact
Sue Wood, Surety Account Executive Debbie Poppe, Attorney-in-Fact
4500 Cherry Creek Drive So., #400 _ CNA Plaza
Address Address
Denver, CO 80246 Chicago, IL 60685
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.
S-3172/GEEF11/97 Page 2 of 2
Bond No. 929140046
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS: That
RANDALL & BLAKE, INC. dba INTERMOUNTAIN RESURFACING
Name of Contractor
4901 So. Windermere Street- Littleton, CO 80120
Address of Contractor
a Corporation ,hereinafter called Principal.and
Corporation.PattOad or Iatyttlt;lyXX
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
Name of Surety
CNA Plaza - Chicago, IL 60685
Address of Surety
hereinafter called "Surety", are held and firmly bound unto THE BOARD OF WELD COUNTY COMMISSIONERS, 915 - 10th Street,
P. O. Box 758, Greeley,Colorado 80632, hereinafter called"County", in the penal sum of
Eight Hundred Thirty Eight Thousand Three Hundred Seventy Nine and 45/100 Dollars
(5 838,379.45 ) 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 Se LA day of r-J\Wain , 2000 ,a copy of which is hereto attached and made a part hereof for
the construction of: 2000 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 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 premiums on said work, and for all labor, performed on such work whether subcontracted 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.
S-3171/GEEF 11/97 Page 1 of 2
Bond No. 929140046
IN WITNESS WHEREOF,this instrument is executed in 3 (number)counterparts, each one of which
shall be deemed an original, this 3ret day of d'A ,h , ii:n O.
RANDALL & BLAKE, INC. dba INTERMOUNTAIN
RESURFACING
Principal
ATTEST: 1 ' ' _..-._. ( )
LA
c�ipa/l Secretary
Asti.
(SEAL) c �l
(,^ �^�}l j ! 4901 So. Windermere Street- Littleton, CO 80120
Witness to Principal Address
/L ti-/ a 77. J1, Ql NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
Surety
ATTEST:
/ VGEg BY:4 ,4 .,,Liz-}
Wtlness as to Surety ttarney-in-Fact
Sue Wood, Surety Account Executive Debbie Poppe, Attorney-in-Fact
4500 Cherry Creek Drive So., #400 CNA Plaza
Address Address
Denver, CO 80246 Chicago, IL 60685
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 57(1 as
amended)and be authorized to transact business in the state where the project is located.
S-3171/GEEF 11/97 Page 2 of 2
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That CONTINENTAL CASUALTY COMPANY, an Illinois corporation, NATIONAL FIRE
INSURANCE COMPANY OF HARTFORD, a Connecticut corporation,AMERICAN CASUALTY COMPANY OF READING,
PENNSYLVANIA, a Pennsylvania corporation(herein collectively called"the CCC Surety Companies"), are duly organized and existing
corporations having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signature and seals
herein affixed hereby make, constitute and appoint
William M.O'Connell, Jr., Sarah Finn, Sue Wood, Debbie Poppe, Shelley Czajkowski, Kimberly D. Johnson, Individually
of Denver, Colorado _
their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf
bonds, undertakings and other obligatory instruments of similar nature
-In Unlimited Amounts-
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their corporations
and all the acts of said Attorney, pursuant to the authority hereby given are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Laws and Resolutions, printed on the reverse
hereof, duly adopted, as indicated, by the Boards of Directors of the corporations.
In Witness Whereof,the CCC Surety Companies have caused these presents to be signed by their Group Vice President and their
corporate seals to be hereto affixed on this 15th day of September , 1999
CONTINENTAL CASUALTY COMPANY
2�ryc�w\<T` WSU9,a erg oat, NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
`� y AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA
p°NVa47p ,y L ;0 • 0oo a acocata4r. x AA///// ,/ c,Ip�y//�j
9U SEAL/ F IVL I.I / / '`� t . �I!'/et a aA
s
1997 MFPTfsiee •
Marvin J.Cashion Group Vice President
State of Illinois, County of Cook, ss:
On this 15th day of September , 1999 , before me personally came
Marvin J. Cashion,to me known,who, being by me duly sworn,did depose and say:that he resides in the City of Chicago, State of Illinois;
that he is a Group Vice President of CONTINENTAL CASUALTY COMPANY, NATIONAL FIRE INSURANCE COMPANY OF HARTFORD,
and AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA described in and which executed the above instrument; that he
knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals;that they were so affixed
pursuant to authority given by the Boards of Directors of said corporations and that he signed his name thereto pursuant to like authority,
and acknowledges same to be the act and deed of said corporations.
DIANE AL SEAL' •• (�
•• FAULKNER •2 /y--�� I
Notary Pubar,State of Wined : ...t VO-L_ r�u/�
• My Commission Expires 9/17/01
ip
My Commission Expires September 17, 2001 Diane Faulkner Notary Public
CERTIFICATE
I, Mary A. Ribikawskis,Assistant Secretary of CONTINENTAL CASUALTY COMPANY, NATIONAL FIRE INSURANCE COMPANY OF
HARTFORD, and AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA do hereby certify that the Power of Attorney herein
above set forth is still in force, and further certify that the By-Law and Resolution of the Board of Directors of each corporation printed on the
reverse hereof are still in Ip force. testimony whereof I have hereunto subscribed my name and affixed the seals of the
said corporations this 3 day of )..A(1 N C 1'1 . An( )
CONTINENTAL CASUALTY COMPANY
t�UlSLLt0p` �, NSURf,� Mr Ott. NATIONAL FIRE INSURANCE COMPANY OF HARTFORD/IlV? F s AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA Co i z a v I t �..�j'/ is JULY 11mat, C---lift (2.... - -
%\1997// MAROC" • /
Mary A. Ribikawskis Assistant Secretary
(Rev.10/1/97)
Authorizing By-Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"Article IX—Execution of Documents
Section 3.Appointment of Attorney-in-fact.The Chairman of the Board of Directors, the President or any Executive, Senior or
Group Vice President may, from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys-in-fact,subject to
the limitations set forth in their respective certificates of authority,shall have full power'co bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto. The Chairman of the Board of Directors, the
President or any Executive, Senior or Group Vice President or the Board of Directors,may, at any time, revoke all power and authority
previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved,that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 3 of Article IX of the By-Laws, and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attomey is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"Article VI—Execution of Obligations and Appointment of Attorney-in-Fact
Section 2.Appointment of Attorney-in-fad.The Chairman of the Board of Directors,the President or any Executive, Senior or
Group Vice President may, from time to time, appoint by written certificates attorneys-in-fact to ad in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys-in-fad, subject to
the limitations set forth in their respective certificates of authority, shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto. The President or any Executive, Senior or Group Vice
President may at any time revoke all power and authority previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed byTaosufile-under and by the authonty of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved,that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 2 of Article VI of the By-Laws, and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attorney is made and executed pursuant to and by authority of the following Resolution duly adopted on February 17,
1993 by the Board of Directors of the Company.
"RESOLVED: That the President, an Executive Vice President, or any Senior or Group Vice President of the Corporation may, from
time to time, appoint, by written certificates,Attorneys-in-Fact to act in behalf of the Corporation in the execution of policies of insurance.
bonds, undertakings and other obligatory instruments of like nature. Such Attorney-in-Fact, subject to the limitations set forth in their
respective certificates of authority,shall have full power to bind the Corporation by their signature and execution of any such instrument
and to attach the seal of the Corporation thereto.The President, an Executive Vice President, any Senior or Group Vice President or
the Board of Directors may at any time revoke all power and authority previously given to any Attorney-in-Fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"RESOLVED:That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal
of the Corporation may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of
Directors on February 17, 1993 and the signature of a Secretary or an Assistant Secretary and the seal of the Corporation may be
affixed by facsimile to any certificate of any such power, and any power or certificate bearing such facsimile signature and seal shall be
valid and binding or the Corporation.Any such power so executed and sealed and certified by certificate so executed and sealed, shall
with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Corporation."
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