HomeMy WebLinkAbout20001117.tiff r ACO$ D CERTIFICATE OF LIABILITY INSURANCE,L ID R
ATCSI DA03AM4/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Linden/Bartels & Noe Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
3459 W 20th Street Suite 224 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_
Greeley CO 80634 •
P'hone: 970 -356-1133 Fax:970-356-4088 •
INSURERS AFFORDING COVERAGE
INSURED I INSURER A: Ohio Casualty Group
INSURER B.
Flat Coat Asphalt Specialists INSURERC
601A Innovation Drive
INSURER Di
Windsor CO 80550
�_ 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.
INSR TYPE!OF INSURANCE POLICY NUMBER POLICY EFTIVE POLICY EXPIRATI N LIMITS
LT R DATE(MM/DD/YY DATE MM/DD/VY
GENERAL LIABILITY �[ EACH OCCURRENCE $ 1,000, 000
A X COMMERCIAL GENERAL LIABILITY 52624989 03/03/00 03/03/01 FIRE DAMAGE(Anyone fire) $ 100,000
, CLAIMS MADE LX] OCCUR MED EXP(Any one person) - $ 5,000
' PERSONALBApV INJURY $ 1,000,000
• GENERAL AGGREGATE $ 2, 000,000
GEN'L AGGREGATE LIMIT APPLIES PER- :,PRODUCTS-COMP/OP AGG $ 2,.000.,000
POLICY X JECOT 1 1 LOC
AUTOMOBILE LIABILITY COMBINED SINGLET LIMIT
A X ANY AUTO 52624989 03/03/00 03/03/01
I, tdent) s500,000
ALL OWNED AUTOS BODILY INJURY
SCHEDU_ED AUTOS (Per person) $
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT _$
ANY AUTO OTHER THAN
EA ACC S
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE• $
OCCUR [II CLAIMS MADE : — RE -- - — - -- - -
AGGREGATE 9i
•
DEDUCTIBLE 15
RETENTION $ :
TS $'
WORKERS COMPENSATION AND TORY LIIMMITSI ' Eft;
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
E.L.DISEASE-EA EMPLOYEE $
E.L.DISEASE-POLICY LIMIT $
OTHER I
•
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: 2000 RUBBERIZED CRACK FILLING PROJECT; CERTIFICATE HOLDER IS NAMED AS
ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY.
CERTIFICATE HOLDER Y ADDITIONAL INSURED;INSURER LETTER: A CANCELLATION
WELD-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
WELD COUNTY 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
ATTN: ENGINEERING DEPT LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
P.O. BOX 758
GREELEY CO 80632 UPON THSINSURE TS AGENTS OR REPRESENTATIVES.
David Austin,
ACORD 25-S(7197) 0 O'I,I r/610x„,
2000-111
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��__;{ za ,. ACCEPTANCE OP NOTICE
:
ij! ., ' Receipt of the above Notice of Award is hereby acknowledged by
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* 7) .),• Flat Coat Asphalt Specialists
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qtly,... „ i ,, i,,;:_this the , day of March /
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* •1 .BY:
•: ,, •Title: Managing Member —
i
ay•pp
, ' 1 . IMPORTANT: Surety companies executing bonds must appear on the Treasury
'f' 'Department's most current list (circular 570 as amended) and be authorized to
µ' ', transact business in the State of Colorado.
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Bond No. 29553
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENT: that
Flat Coat Asphalt Specialists, LLC
(Name of Contractor)
601 A Innovation'Circle. Windsor, CO 80550
(Address of Contractor)
a Limited Liablity Company hereinafter called Principal, and
(Corporation, Partnership or Individual)
Pioneer General Insurance Company _
(Name of Surety)
67B0 E. Hampden Avenue, Denver. CO 80224
(Address of Surety)
hereinafter called Surety, are held and firmly bound unto
THE BOARD OF WELD C'OUllittOMMISSIONERS
(Name of Owner)
trite
915 10thStr et;�rteeley, Cblbradb 81)65V23
(Address of Owner)
hereafter called Owner, in the penal sum of dollars
($ 103,234.50 ) 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 present."One Hundred Three Thousand Two Hundred Thirty Four and 50/100
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal
entered into a certain contract with the Owner, dated the '8 day of March
2 0 0 o a copy of which is hereto attached and made a part hereof for the
construction of:
2000 RUBBERIZED CRACK FILLING PROJECT
•
NOW THEREFORE, if the Principal shall well, truly and faithfully perform its duties,
all the undertakings„ covenants, terms, conditions, and agreements of said contract
during the original.term thereof, and any extensions thereof which may be granted by
the Owner, with or without notice to the Surety and during the one year warranty
period, and if he shall satisfy all claims and demands incurred under such contract, and
shall fully indemnify and save harmless the Owner from all costs and damages which it
may suffer by reason of failure to do so, and shall reimburse and pay the Owner all
outlay and expense which the Owner may incur in making good any default, then this
obligation shall be void; otherwise to remain in full force and effect.
CF-6
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 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
or to the work or CO the Specifications.
PROVIDED, FURTHER, that no final settlement between the Owner and the
Contractor shall abridge the right of any beneficiary hereunder,whose claim may be
unsatisfied.
IN WITNESS WHEREOF, this instrument is executed in counterparts, each
(number)
one of which shall be deemed an original, this day of
CONTRACTOR AS PRINCIPAL
(Corp. Seal) Flat Coat Asphalt Specialists, LLC
Company Name
601 A Innovation Circle. Windsor, CO 80550
Company ss
Attest: ids) By o (s1
Witness as to Principal
4Nr-\KJQ, � sal
�.�//U� Ail ✓f '
601 A Innovation Circle, Windsor, CO 80550 / f.¢r✓ h 11Gd/3 7"""
Address Name and Title
SURETY COMPANY
(Corp. Seal) Pioneer General Insurance Company
Surety
6780 E. Hampden Avenue nejavc rn g0•22'
Address
Attest: ByG1 i,, (, 6'l a,f '1 ,
Atomey-ft -fact
Rae L. Campbell Surety Secretary Kathryn Y. Broy s
2900 S. College Ave., #2A 6780 E. Hampden Avenue Denver CO Rn924
Address Address
Fort Collins, CO 805 5
NOTE: Date of Bond must not be prior to date of Contract. If Contractor is
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 of Colorado.
BID NO. N/A
CF-7
Bond No. 29553
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENT: that
Flat Coat Asphalt Specialists, LLC
601 A Innovation Circle, Windsor, CO 80550
a 'Limited Liabtit<y Comuanv hereinafter called Principal and
Pioneer General Insurance Company
6780 E. Hampden Avenue, Denver, CO 80224
hereinafter called Surery„ are held and firmly bound unto
THE BOARD OF WELD COUNTY COMMISSIONERS
915 10th Street Greeley, Colorado 80632
• Any,
hereinafter called Owner, in the penal sum of dollars
-,„•41:03,23t50 Hit lawful, of the United States, for the payment of which
sum weft and`truly to-be made, we ourselves, successors, and assigns, jointly and
severally, firmly by these present, *One Hundred Three Thousand Two Hundred Thirty Four and 50/100
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal
entered into a certain contract with the Owner, dated the 8 day of March
2 0 0 0 , a copy of which is hereto attached and made a part hereof for the construction
of:
2000 RUBBERIZED CRACK FILLING PROJECT
NOW, THEREFORE, if the Principal shall 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 arty 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 by subcontractor or otherwise.
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
CF-4
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 this Bond, and it does hereby waive
notice of any such change, extension of time, alteration or addition to the terms of the
contract or to the work or to the Specifications.
PROVIDED, FURTHER, that no final settlement between the Owner and the
Contractor shall abridge the right of any beneficiary hereunder,whose claim may be
unsatisfied.
IN WITNESS WHEREOF, this instrument is executed in counterparts, each.
(number)
one of which shall be deemed an original, this day of
CONTRACTOR AS PRINCIPAL
(Corp. Seal) Flat Coat Asphalt Specialists, LLC
Company Name
601 A ovation Circle, Wi or, CO 80550
Company dress
Attest: By .—k 5 Es)
�n Witness as to Principal
t oH,is SAW' At /Alt ,41 i $4fj ems'
601 A Innovation Circle, Windsor, CO 80550
Address Name and itle
SURETY COMPANY
(Corp. Seal) Pioneer General Insurance Company
Surety
6780 E. Hampden Avenue, Denver, CO 80224
Address
•
Attest -
Atto -in •
-
Rae L. Campbell Kathryn Secretary Kathryn Y. Broyles
2900 S. College Ave., #2A 6780 E. Hampden Avenue. Denver CO 80224
Address Address
Fort Collins, CO 80525
NOTE: Date of Bond must not be prior to date of Contract. If Contractor is
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 of Colorado.
BID NO, N/A
CF-5
PIONEER GENERAL INSURANCE COMPANY
Denver, Colorado
POWER OF ATTORNEY .
KNOW ALL MEN BY THESE PRESENTS:
That the PIONEER GENERAL INSURANCE COMPANY,a corporation of the State of Colorado has its principal office in the Ciry of Denver,Colorado pursuant to the
following By-law,which was adopted by the Board of Directors of the said Company in 1990,to wit
'Article VI-Section 2-RESIDENT OFFICERS AND ATTORNEYS-IN-FACT.The President or any Vice-President,acting with any Secretary or Assistant Secretary,shall
have the authority to appoint Resident Vice-Presidents and Attorneys-In-Fact,with the power and authority to sign,execute,acknowledge and deliver on its behalf,as Surety:
Any and all undertakings of suretyship and to affix thereto the corporate seal of the corporation.The President or any Vice-President,acting with any Secretary or Assistant
Secretary,shall also have the authority to remove end revoke the authority of any such appointee at any time,does hereby make,constitute and appoint
*** JEFFREY L. BROYLES, MICHAEL D. PIERCE, RAE L. CAMPBELL *'*
*** KATHRYN Y. BROYLES, LAWRENCE E. LUTGEN, JOAN DELAUDER ***
*** RENEE STEIN, MARY M. POWELL ***
its true and lawful Attorney(s)-In-Fact,to make,execute,seal and deliver for and on its behalf,as Surety:
And any and all undertakings of suretyship
And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Company,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 Company at its offices in Denver,Colorado,in their cwn persons.
The following Resolution was adopted at the Regular Meeting of the Board of Directors of the Pioneer General Insurance Company,held on June 1,'990.
'RESOLVED,That the signatures of officers of the Company and the seal of the Company may be affixed by facsimile to any Power of Attorney executed in accordance
with Article VI-'Section 2 of the Company By-laws;end that any such Power of Attorney bearing such facsimile signatures,including the facsimile signature of a certifying
Assistant Secretary and facsimile seal shall be valid and binding upon the Company with respect to any bond,undertaking or contract of suretyship to which it is anached.'
All authority hereby conferred shall remain in full force and effect until terminated by the Company.
IN WITNESS WHEREOF,PIONEER GENERAL INSURANCE COMPANY has caused these presents to be signed by its President and its xorporate seal to be hereunto
affixed this 26th day of January . 2000 .
PIO R GENERAL INSURANCE COMPANYii d6.22/Secretary A1��,
e 7-
State of Colorado ) PRESIDENT •
ss. By •
County of Arapahoe ) .:-.0,,,✓
On this 26th day of January , 2000 ,before me personally came Robert H.Warburton
to me(known, who being by me duly sworn,did depose and say that(s)he resides in the County of Adams,State of Colorado;that(s)he is the President of the PIONEER
GENERAL INSURANCE COMPANY,the corporation described in which executed the above instrument;that(s)he knows the seal of the said corporation;that the sea affixed
to the said instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said corporation;that(s)he signed(his)(her)name by like order;and
that By-law,Anide VI-Section 2,adopted by the Board of Directors of sal ...‘ - ed to in the preceding instrument,is now in force.
re>ti ...' TAgA `�iIII
My Commission Expires it�N�•, ,� �,,.....:e?/ d Public �� L (_.‘_ow
� '�J �\ - �,a L,�-( 1
tkl>.•.4-48, �•.PPr -H
‘• °P C• , .
M. J. Frick , Secretary of PIONEER GENERAL INSURANCE COMPANY, do hereby certify that the abc ve and
foregoing is a true and correct copy of a Power of Attorney executed by said PIONEER GENERAL INSURANCE COMPANY,which is still in full force and effect.
00
Signed and sealed at the City of Denver,Colorado this 9 day of March ) 2 0
P133 //V 9.s. .f Seaetary
Client# : 37783 ANYUN
ACORD,M CERTIFICATE OF LIABILITY INSURANCE o3/(MV/,ioo
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Flood & Peterson Ins . Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P . O. BOX 578 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
4687 W. 18th Street
Greeley, CO 80632 INSURERS AFFORDING COVERAGE
INSURED INSURER A:Ohio Casualty Co
Deutcher, Merinda dba Anything —
INSURER B:
Underground Company
INSURER
7404 W. 12th Street D
Greeley, CO 80634 INSURER :
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.
INSRI POLICY EFFECTIVE POLICY EXPIRATION -
_LEL TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY)I LIMITS
A GENERAL LIABILITY 52430787 05/21/9905/21/00 .EACH OCCURRENCE - 1-$1, 000 , 000_
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one ire)$50 , 000
CLAIMS MADE X OCCUR ME DEW(Any one person) $5,_000
PERSONAL&AD V INJURY $1, 000 , 000
GENERAL AGGREGATE s2 , 000 , 000
GEN'L AGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OP AGO $2 , 000 e 000
POLICY PRO- 1 LOC I
' JECT A AUTOMOBILE LIABILITY 52430787 05/21/99 05/21/00 COMBINED SINGLE LIMIT $1 , 000 , 000
X ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS �, (Per person)
X HIRED AUTOS ' BODILY INJURY
(Per accident)
X- NON-OWNED AUTOS • PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY I AUTO ONLY-EA OCCIDENT $
ANY AU-0 OTHER THAN EA ACC $ _ .
AUTO ONLY: AGG $
A- I EXCESS LIABILITY 52430787 05/21/99 05/21/00 EACH OCCURRENCE $1 , 000 , 000
, 1I OCCUR CLAIMS MADE AGGREGATE $1, 000 , 00.0
DEDUCTIBLE
I XI RETENTION $10000 $
-- WC STATUS I IOrH
I WORKERS COMPENSATION AND ITORYLIMITS I. LER_.
EMPLOYERS'LIABILITY
E.L.EACH ACCIDENT $
E.L.DISEASE-EA EMPLOYEE $
E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
C-ERTIFICATE HOLDER ADDmoN,LINSURED;INSURER LETTER - . CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCESBE CANCELLED BEFORE THE EXPIRATION
Weld County DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAI L3_0._GAYS WRITTEN
c/o The Office of Public Works NOTICE TO THE CERTIFICATE HOLDER NAMED TOTFE LEFT,BUT FAILURE TO DOSOSHALL
PO Box 758 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER,ITSAGENTS OR
Greeley, CO 80632 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
P _
Rood 7'r.°t130n Instaan e , �=72C•
A-CORD 25-S(7/97)1 of 2 #149044 CHS ® ACORD CORPORATION 1988
(manaut-t Q da.- 01- 03.020
ACORD CERTIFICATE OF LIABILITY INSURANCEP ID MS CATE(MM1I/DDM
COULS,-1 03/27/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Linden Company HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4100 E. Mississippi Ave, #900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Denver CO 80246
Phone: 303-756-6700 Fax:303-756-7700 INSURERS AFFORDING COVERAGE
INSURED INSURER A: St. Paul Fire & Marine
INSURER B: CIGNA Insurance Co any
Coulson Excavating Co. , Inc. INSURER C.
3609 North County Road #13 INSURERD'
Loveland CO 80538 — ---- - --- -
_ I _ INSURER E:
COVERAGES ..
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEp.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MANEBE 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. _.,.
INI POLICY EFFECTIVE POLICY EXPIRATION
R _ -
TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY jQ(08301222 03/31/00 03/31/01 FIRE DAMAGE(A one fire) 5300000
j CLAIMS MADE LJ OCCUR MED EXP(Any one person) $ 5000
X Jobsite Pollution PERSONALS ADV INJURY $ 1000000
X Project Aggregate GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2000000
POLICY X JEOT LOC --- -- - -- —
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A X ANY AUTO 1(1(08301222 03/31/00 03/31/01 (Ea accident) $ 1000000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
X FIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS (Per accident)
_X Limited Pollution PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT$
ANYAU"O OTHER THAN EA ACC $
AUTO ONLY'. AGG $
EXCESS LIABILITY EACH OCCURRENCE $ 4000000
A X� OCCUR Li CLAIMS MADE 1(1(08301222 03/31/00 03/31/01 AGGREGATE $ 4000000
DEDUCTIBLE ' $
RETENTION $ $
WCSIAIU- O1H-
WORKERS COMPENSATION AND XLTORV LIMITS ER
EMPLOYERS'LIABILITY 0 - 0- -_----
C42887973 07/01/99 07/01/00 E.L.EACH ACCIDENT $ E5000
E .DISEASE-EA EMPLOYE $ 500000
EL.DISEASE-POLICY LIMIT I $ 500000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ALL OPERATIONS/ALL LOCATIONS. WELD COUNTY IS AN ADDITIONAL INSURED AS
RESPECTS GENERAL LIABILITY FOR ANY PROJECT COULSON EXCAVATING CO. , INC.
MIGHT PERFORM FOR THEM.
_CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER. CANCELLATION
WELD-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOF.TO MAIL 30 _ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE:TO DU SO SHALL
WELD COUNTY ENGINEER IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGIINTS OR
915 10TH STREET
P.O. BOX 758 REPRESENTATIVES.
GREELEY CO 80632 AUTHORIZED REPRESENTATIVE 1 , J 1/ti' CI
bez_Craig A. Herten, CPCU !ark
ACORD 25-S(7/97) .. ACORD CORPORATION 1991
(2.cna.e G 04-03-a00D
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