HomeMy WebLinkAbout20000377.tiff PERFORMANCE BOND
Bond No. S-700 4491
KNOW ALL MEN BY THESE PRESENTS: That
H & L Concrete, Inc.
Name of Contractor
P.O. Box 153, Greeley, CO 80632
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership, or Individual
Washington International Insurance Company
Name of Surety
300 Park Blvd. , #500, Itasca, IL 60143
Address of Surety
hereinai_fl called Surety, are held and firmly bound unto THE BOARD OF WELD COUNTY
COMN.ISSIONERS, 915 10th Street, Greeley, Colorado 80632, hereinafter caled
County, in the penal sum of
Sixty Six Thousand Three Hundred Fifty and 00/100
Dollars (866,350.00
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 COND_T:ON C^ THIS OBLIGATION is such that whereas, the Principal entered into
a certain contract with the County, dated the Sri day of .4T4AllA.e& , d1OoO ,
a copy cf which is attached and made a part hereof for the construction of:
TWO RIVERS PARKWAY GREEL=Y--OVELAND CANAL CONCRETE SOX CULVERT
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
n_
year guarantee period, and if he shall satisfy all claims and demands incurred
under such contract, and shall l 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, ana
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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(1Ja eat,
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D/-3i-,10:7?
2000-0377 � � �„ u,2pL i�,/
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 W=TtiESS WHEREOF, this instrument is executed in .� day of �AAJuARN
H & L Concrete, Inc.
ATTEST:
' Fri ipal
_r nci al Secre a y By miZfl Øietip(SEA-.' ) /
, )rY 5.414. P.O. Box 153, Greeley, CO 80632
Witness as tc P_incipal Address
P.O. Box 153, Greeley, CO 80632
Address
ATTEST: ,
•
ltk
AJ Suety Secretary
Rae L. Campbell Washington International Insurance.
(SEAL) r Company
l F y ^t \ .^.
Witness as t, Surety rttorey-i -tact Kathryn Y. c, royles
2900 S. College Ave . , #2A 300 Park Blvd. , #500 _
Address Address
Fort Collins, CO 80525 Itasca, IL 60143
NOTE: Cate 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 where the project is
located.
18
PAYMENT BOND
Bond No. S-700 4491
KNOW ALL MEN BY THESE PRESENTS: That
H & L Concrete, Inc.
Name of Contractor
P.O. Box 153, Greeley, CO 80632 _
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership or Individual
Washington International Insurance Company _
Name of Surety
300 Park Blvd. , #500, Itasca, IL 60143
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 cf
Sixty Six Thousand Three Hundred Fifty and 00/100
- Dollars 46,350.00
in a lawful money of the United States, for the payment of which the 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 $ a`' day of .TA41uAt'I 02000 ,
a copy of which is hereto attached and made a part hereof for the construction cf:
TWO RIVERS PARKWAY GREELEY-LOVELAND CANAL CONCRETE BOX CULVERT
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 cr modification thereof, including all amounts due for materials,
lubricants, oil, gasoline, coal and coke, repairs on machinery, ecuipment and
tools, consumed cr 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.
19
PROVIDED, FURTHER, that a final settlement between the County and the contractor
shall abridge the right of any beneficiary hereunder, whose claim may
unsatisfied.
IN WITNESS WHEREOF, this instrument is executed in S (number) counterparts,
each one of which shall be deemed an original, this the SZ day ofesTAj)UA.ey
1 OI O
H & L Concrete, Inc.
" Principal
ATTEST: a. 747 ------
(�/Qn EY/ �P: 'r 1 S rotary P.O. Box 153
(SEAL) Address
11 Y .17. ',/t �f .,./(41-t Greeley, CO 80632
Witness as tocgriincipal
P.O. Box 153
Address
Greeley, CO 80632
nSu _ySec_etary
Rae L. Campbell
(°F? ) 3Y rInternational Insurance
Washington
iT., 4_. -. Company
C L-W ti
Witness as `to Surety Att rnev lr-Fact ,
Kat yn Y. Broyles U
2900 S. College Ave. , #2A 300 Park Blvd. , #500
Address Address
Fort Collins, CO 80525 Itasca, IL 60143
NOTE: Cate 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 cn 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.
20
WASHINGTON INTERNATIONAL INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL BY THESE PRESENTS: That the Washington International Insurance Company, a corporation organized and existing under the laws
of the State of Arizona, and having its principal office in the Village of Itasca, Illinois does hereby constitute and appoint
DON R.BROYLES,KATHRYN Y.BROYLES, JEFFREY L.BROYLES,KATHRYN K. COULSON,DILYNN GUERN,SHERYL E.MEURER,
AMYAUGUSTYN, PAMELA J.HANSEN,LISA M.LOEFFLER, LAWRENCE E.LUTGEN,KEVIN W.MCMAHON,
AND NADINE BRANNON EACH IN THEIR SEPARATE CAPACITY
its true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety, any and all bonds and undertakings, recognizances,
contracts of indemnity and other writings obligatory in the nature thereof,which are or may be allowed, required, or permitted by law, statute, rule,
regulation,contract or otherwise,and the execution of such instrument(s)in pursuance of these presents, shall be as binding upon the said Washington
International Insurance Company as fully and amply,to all intents and purposes, as if the same has been duly executed and acknowledged by its
President and/or its principal officers.
This Power of Attorney shall be limited in amount to$7,500,000.00 for any single obligation.
This Power of Attorney is issued pursuant to authority granted by the resolutions of the Board of Directors adopted March 22, 1978,
July 3, 1980 and October 21, 1986 which read, in part, as follows:
1. The Chairman of the Board, President, Vice President,Assistant Secretary,Treasurer and Secretary may designate Attorneys-in-Fact, and
authorize them to execute on behalf of the Company,and attach the Seal of the Company thereto, bonds, and undertakings, recognizances,
contracts of indemnity and other writings obligatory in the nature thereof, and to appoint Special Attorneys-in-Fact,who are hereby authorized
to certify copies of any power-of-attorney issued in pursuant to this section and/or any of the By-Laws of the Company, and to remove, at any
time, any such Attorney-in-Fact or Special Attorney-in-Fact and revoke the authority given him.
2. The signatures of the Chairman of the Board,the President, Vice President,Assistant Secretary,Treasurer and Secretary, and the corporate
seal of the Company, may be affixed to any Power of Attorney, certificate, bond or undertaking relating thereto, by facsimile. Any such Power
of Attorney,certificate bond or undertaking bearing such facsimile signature or facsimile seal affixed in the ordinary course of business shall
be valid and binding upon the Company.
IN TESTIMONY WHEREOF,the Washington International Insurance Company has caused this instrument to be signed and its corporate seal to be
affixed by its authorized officer,this 26th day of April, 1999.
WASHIN INTER ATIONAL INSURANCE COMPANY
Steve • erson, Senior Vice-President
STATE OF ILLINOIS)
COUNTY OF COOK)
On this 26th day of April, 1999, before me came the individual who executed the preceding instrument,to me personally known, and, being by me duly
sworn, said that he is the therein described and authorized officer of the Washington International Insurance Company;that the seal affixed to said
instrument is the Corporate Seal of said Company;
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal,the day and year first above written.
OFFICIAL SEAL 2i�4�nZ6v of r�
YASMtN A PATEL 7` 1
NOTARY MANX,STATE OF ILLINOIS
MY COMMISSION EXPIRES:08/18/02 Yasmi A. Patel, Notary Public
..4tS, v My Commission Expires August 18, 2002
CERTIFICATE
STATE OF ILLINOIS)
COUNTY OF COOK)
I,the undersigned,Vice President of WASHINGTON INTERNATIONAL INSURANCE COMPANY, an ARIZONA Corporation, DO HEREBY CERTIFY
that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked, and furthermore that Article III, Section 5
of the By-Laws of the Corporation, and the Resolution of the Board of Directors,set forth in the Power of Attorney, are now in force.
Signed and sealed in the County of Dupage. Dated the
�QJC/moday of , 19
Jams . C' arpente ice-President
PERFORMANCE BOND
Bond No. S-7O0 4491
KNOW ALL MEN BY THESE PRESENTS: _...._
H & L Concrete, Inc.
Name of Contractor
P.O. Box 153, Greeley, CO 80632
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership, or Individual
Washington International Insurance Company
Name of Surety
300 Park Blvd. , #5OO, Itasca, IL 60143
Address of Surety
hereinafter called Surety, are held and firmly bound unto THE BOARD OF WELD COUNTY
COMMISSIONERS _15 10th Street, Greeley, Colorado 80632, hereinafter_a_ led
County, in the penal sum of
Sixty Six Thousand Three Hundred Fifty and 00/100
Dollars (566,350.00
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 CF THIS OBLIGATION is such that whereas, the Principal entered _ ,t_
a certain contract with the County, dated the 5 T"— day of .TANUA£N , o2oao ,
a copy of which is attached and made a part hereof for the construction of:
TWO RIVERS PARKWAY GREELEY-LOVELAND CANAL CONCRETE BOX CULVERT
NOW, THEREFORE, _f the Principal shall well, truly and faithfully perform
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 ___ ay 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 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 thereuncer or the specifications
accompanying the same shall in any ways affect its obligation on this bond, anc
it does hereby waive notice cf any such change, extension of time, alteration cr
addition to the terms of the contract of the work or to the specifications.
0//3/7200/
O {
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 54! day of TIA UUA R4 _
—, A8t.
ATTEST: H & L Concrete, Inc.
Fri ipal
( C1p 1 SE Etary 2y ��e�'"
- 77
(SEAL)
111111111
CA-t27. P.O. Box 153, Greeley, CO 80632
Witness a_ to Principal Address
P.O. Box 153, Greeley, CO 80632
Address
ATTEST 1 , of '
k. �
—Y < .
Surety Secretary Washington International Insurance
Rae L. Campbell Company
E L� ` Y)
y
C
Witness as to Surety At crney-- react, Kathryn Y. • royl.es
2900 S. College Ave. , #2A 300 Park Blvd. , #500 _
Address Address
Fort Collins, CO 80525 Itasca, IL 60143 _
NOTE: Date of bond must not be prior to date of contract. If contractor is a
-rtnership, 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.
18
PAYMENT BOND
Bond No. S-700 4491
KNOW ALL MEN BY THESE PRESENTS: That
H & L Concrete, Inc. _
Name of Contractor
P.O. Box 153, Greeley, CO 80632
Address of Contractor
a Corporation , hereinafter called Principal, and
Corporation, Partnership cr Individual
Washington International Insurance Company
Name of Surety
300 Park Blvd. , #5OO, Itasca, IL 60143
Address of Surety
hereinafter called Surety, are held and firmly bound unto THE BOARD CF WELD COUNTY
COMMISSIONERS, 915 10th Street, Greeley, Colorado 30632, hereinafter called
County, in the penal sum of
Sixty Six Thousand Three Hundred Fifty and 00/100- - --
Dollars (S66,35O.OO
in lawful money of the Cnited States, for the payment „r which the sum well and
a "r
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 5 day of J,,UuAtY , data ,
a copy of which is hereto attached and made a part hereof for the construction cf:
TWO RIVERS PARKWAY GREELIY—LGVELAND CANAL CONCRETE BOX CULVERT
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 fur.nishino materials for or performing labor in
the prosecution cf the work provided for in such contract, and any authorized
extension cr modification thereof, including all amounts due for materials,
lubricants, oil, gasoline, coal and coke, repairs cn 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.
FRCV:_DED, 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 .
19
PROVIDED, FURTHER, that a final settlement between the County and the contractor
shall abridge the right of any beneficiary hereunder, whose claim ., a_
unsatisfied.
IN WITNESS WHEREOF, this instrument is executed in a (number) counterparts,
each one of which shall be deemed an original, this the • t8 day of TA,UUA,2y
H & L Concrete, Inc.
'Principal
ATTEST: EY
1 S cetary P.O. Box 153
(SEA_) Address
C��C„4� l-lfotc (ea /ic(CA Greeley, CO 80632
Witness as o Trincipal
P.O. Box 153
Address
Greeley, CO 80632
ATTEST: N
94
. .Suety S4acr tar,y,
Rae L. Campbell
Washington International Insurance
(SE, ) Company
1 2Y CA . \ 11.1 As-
wrtn4 ss stc Surety At oor�a'ey*}a-F>ct
Kat1 yn Y i Broyles t
2900 S. College Ave., #2A 300 Park Blvd. , #500
Address Address
Fort Collins, CO 80525 Itasca, IL 60143
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 cn 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.
20
WASHINGTON INTERNATIONAL INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL BY THESE PRESENTS: That the Washington International Insurance Company, a corporation organized and existing under the laws
of the State of Arizona, and having its principal office in the Village of Itasca, Illinois does hereby constitute and appoint
DON R.BROYLES,KATHRYN Y.BROYLES,JEFFREY L.BROYLES,KATHRYN K. COULSON,DILYNN GUERN,SHERYL E.MEURER,
AMY AUGUSTYN,PAMELA J.HANSEN, LISA M.LOEFFLER, LAWRENCE E.LUTGEN,KEVIN W.MCMAHON,
AND NADINE BRANNON EACH IN THEIR SEPARATE CAPACITY
its true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, recognizances,
contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required, or permitted by law, statute, rule,
regulation,contract or otherwise,and the execution of such instrument(s)in pursuance of these presents, shall be as binding upon the said Washington
International Insurance Company as fully and amply,to all intents and purposes, as if the same has been duly executed and acknowledged by its
President and/or its principal officers.
This Power of Attorney shall be limited in amount to$7,500,000.00 for any single obligation.
This Power of Attorney is issued pursuant to authority granted by the resolutions of the Board of Directors adopted March 22, 1978,
July 3, 1980 and October 21, 1986 which read, in part, as follows:
1. The Chairman of the Board, President,Vice President, Assistant Secretary,Treasurer and Secretary may designate Attorneys-in-Fact, and
authorize them to execute on behalf of the Company,and attach the Seal of the Company thereto, bonds, and undertakings, recognizances,
contracts of indemnity and other writings obligatory in the nature thereof, and to appoint Special Attorneys-in-Fact,who are hereby authorized
to certify copies of any power-of-attorney issued in pursuant to this section and/or any of the By-Laws of the Company, and to remove, at any
time, any such Attorney-in-Fact or Special Attorney-in-Fact and revoke the authority given him.
2. The signatures of the Chairman of the Board,the President, Vice President,Assistant Secretary, Treasurer and Secretary, and the corporate
seal of the Company,may be affixed to any Power of Attorney, certificate, bond or undertaking relating thereto, by facsimile. Any such Power
of Attorney,certificate bond or undertaking bearing such facsimile signature or facsimile seal affixed in the ordinary course of business shall
be valid and binding upon the Company.
IN TESTIMONY WHEREOF,the Washington International Insurance Company has caused this instrument to be signed and its corporate seal to be
affixed by its authorized officer,this 26th day of April, 1999.
WASHIN INTER ATIONAL INSURANCE COMPANY
Steve erson, Senior Vice-President
STATE OF ILLINOIS)
COUNTY OF COOK)
On this 26th day of April, 1999, before me came the individual who executed the preceding instrument,to me personally known, and, being by me duly
sworn, said that he is the therein described and authorized officer of the Washington International Insurance Company; that the seal affixed to said
instrument is the Corporate Seal of said Company;
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal,the day and year first above written.
OFFICIAL SEAL 2� ^ 4r &k '
YASMtN A PATEL 1
NOTARY PUBLIC,STATE OF ILLINOIS
MY COMMIS&ON EXPIRES:08/18/02 Yasmi A. Patel, Notary Public
.w0r,,, My Commission Expires August 18,2002
CERTIFICATE
STATE OF ILLINOIS)
COUNTY OF COOK)
I,the undersigned,Vice President of WASHINGTON INTERNATIONAL INSURANCE COMPANY, an ARIZONA Corporation, DO HEREBY CERTIFY
that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked, and furthermore that Article III, Section 5
of the By-Laws of the Corporation, and the Resolution of the Board of Directors, set forth in the Power of Attorney, are now in force.
Signed and sealed in the County of Dupage. Dated the
day of�,� �4 , 19
C X2'u J�t�Pin�6.
Ja s . Carpente ice-President
ACORD CERTIFICATE OF LIABILITY INSURANCSR MC DATE(MMIDDm)
COM-1 07/20/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MIMS INTERNATIONAL, LTD. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR MI
901 DULANEY VALLEY RD # 610 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. a7
TOWSON MD 21204 7
Phone: 410-296-1500 Fax:410-296-1741 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AMERICAN HOME ASSURANCE CO. h I
INSURER B:
AMERICAN MEDICAL RESPONSE INC INSURER C:
2821 SOUTH PARKER RD, # 1105 INSURER D:
AURORA, CO 80014
1 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. "f,)
INSR POLICY EFFECTIVE PDATE(MM//OD/Y)LTR TYPE OFINSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000.
A X COMMERCIAL GENERAL LIABILITY RMGL1737483 09/01/99 09/01/02 FIRE DAMAGE(Any one fire) f 1,000,000.
I CLAIMS MADE I X OCCUR MED EXP(Any one person) $ 50,000.
X PROFESSIONAL LIAB PERSONAL&ADV INJURY $ 5,000,000.
INCLUDED GENERAL AGGREGATE $ 10,000,000.
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 5,000,000.
POLICY JECT in LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A X ANY AUTO RMCA5273144 09/01/99 09/01/02 (Ea accident) $ 5,000,000.
_X ALL OWNED AUTOS
BODILY INJURY f
X SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY f
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $ --AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
-j OCCUR CLAIMS MADE AGGREGATE -
__
DEDUCTIBLE f __
RETENTION S S
WCSIAIU- O FN.
WORKERS COMPENSATION AND X TORY LIMITS ER
EMPLOYERS'LIABILITY
A BMWC4066221 09/01/99 09/01/02 E.L.EACH ACCIDENT S 5,000,000.
E.L DISEASE EA EMPLOYEE $ 5,000,000.
E.L.DISEASE-POLICY LIMIT S 5,000,000.
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION
WELDCO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
WELD COUNTY 30 DAYS WRITTEN NOT •THE CERTIFICATE HOLDER NAM TO THE
DEPARTMENT OF HEALTH LEFT,BUT FAILURE TO D• •SH L IMPOSE NO OBLIGATION 0 ILITY OF
1517 - 16TH CT.
GREELEY, CO 80631 ANY KIND UPON THE IN - TS AGEN OR RES ATI .
•
FELICIA M. r 'Vat--NTs •
ACORD 25-S(7197) f " A RD CORPORATION 1988
KLi / 3i-,2craD
ACORD CERTIFICATE OF LIABILITY INSURANCE, MC
SR COM-1
DATE(MM/00/YY)
C 07/20/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MIMS INTERNATIONAL, LTD. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
901 DULANEY VAT.T•FY RD # 610 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
TOWSON MD 21204
Phone: 410-296-1500 Fax:410-296-1741 INSURERS AFFORDING COVERAGE
INSURED INSURER A: AMERICAN HOME ASSURANCE CO.
INSURER 8:
AMERICAN MEDICAL RESPONSE, INC INSURER C:
2821 SOUTH
PARKER 0 RD, # 1105 INSURER D:
AINSURER 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.
ION
LTSRR TYPE OF INSURANCE POLICY NUMBER POLICY
ATTE Ml EFFECTIVE
PDATE IMMroDIYY) LIMITS
GENERAL LIABILITY "' EACH OCCURRENCE S 5,000,000.
A X COMMERCIAL GENERAL LIABILITY RMGL1737483 09/01/99 09/01/02 FIRE DAMAGE(Any one firs) $ 1,000,000.
CLAIMS MADE X OCCUR MED EXP(Any one person) $ 50,000.
X PROFESSIONAL LIAB PERSONAL SADV INJURY f 5,000,000.
INCLUDED GENERAL AGGREGATE $ 10,000,000.
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 5,000,000.
POLICY JEG X LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000.
A X ANY AUTO RMCA5273144 09/01/99 09/01/02 (Ea accident)
X ALL OWNED AUTOS F
BODILY INJURY I $
X SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) IS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
$
DEDUCTIBLE
RETENTION $ $
WLSTAIU- OIH-
WORKERS COMPENSATION AND X TORY LIMITS ER
A EMPLOYCRS'LIABILITY RMWC4066221 09/01/99 09/01/02 EL EACH ACCIDENT , $ 5,000,000.
EL DISEASE-EA EMPLOYEE$ 5,000,000.
E.L.DISEASE POLICY LIMIT $ 5,000,000.
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER I N ADDITIONAL INSURED:INSURER LETTER:_ CANCELLATION
WELDCO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
WELD COUNTY 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
DEPARTMENT OF HEALTH LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF
1517 - 16TH CT.
GREELEY, CO 80631 ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
FELICIA M. BUSCEMI
ACORD 25-S(7/97) " ACORD CORPORATION 1988
de/ti Brt,-/ . 0/ -3/-,2.O �`J
ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D°" 1
01/19/00 ,
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Glen Wall Ins . Services Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
911 28th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._
INSURERS AFFORDING COVERAGE
Greeley, CO 80634
INSURED HOFF RESOURCES INC. - ' INSURERAAMERICAN STATES INS
DBA MAXANNS INSURER B:
506 O ST INSURER C.
GREELEY, CO 80631-9539 INSURERD _ -
I 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 EFFECTIVE POLICY EXPIRATION
LTp LIMITS
LT DATE IM M/DDM1 DATE I MMIDDIW�
GENERAL LIABILITY - EACH OCCURRENCE i$1 , 0 0 0 , 0 0 0
X COMMERCIAL GENERAL LIABILITY I FIRE DAMAGE(Any one tire) $2 0 0 , 0 0 0
CLAIMS MADE X OCCUR , MED EXP(Any one person) $1 0 , 0 00
A ''
102-CD-072816-1 ' 01/18/00 01/18/01 PERSONALSADVINJURY s1, 000, 000
GENERAL AGGREGATE $2, 000 , 000
I GENL AGGREGATE LIMIT APIPLIES PER PRODUCTS-COMP/OP AGG s2 , 0 0 0 , 0 0 0
POLICY ''. JEOT 1 LOG I... ----
AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT
- ' ANY AUTO (Ea accident) $1, 0 0 0 , 0 0 0
ALL OWNED AUTOS BODILY INJURY $
Ix '
SCHEDULED AUTOS (Per person)
A X HIRED AUTOS I02-CD-072816-1 01/18/00 01/18/01 BODILY INJURY
, I (Per accident)
X NON-OWNED AUTOS I I
I PROPERTY DAMP SE $
I (Per accident)
GARAGE LIABILITY '' AUTO ONLY-EA ACCIDEN I $
I ANY AUTO OTHER THAN EA ACC I $ -- -
1 I AUTO ONLY ACG I $
I
EXCESS LIABILITY I EACH OCCURRENCE I $
OCCUR I CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE .s
I RETENTION $ III $
wo _--__._--J
WC STALL '-0TH
WORKERS COMPENSATION AND !TORY LIMITST ER•
EMPLOYERS'LIABILITY E .EACH ACCIDEN I $
I
E .DISEASE-EA EMPLOYEE S I
_ EL DISEASE-POLICY LIMIT S I
O _THER
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS --
CERTIFICATE HOLDER I I ADDITIONAL INSURED;INSURER LETTER: __ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIPe,IION
WELD COUNTY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_0 DAMS WHITTEN
PO BOX 758 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
GREELEY, CO 80632 IMPOSE NO OBLIGATION OR LIABILITY- -
OFFANY KIND UPON THE INSURER.ITS AGEN CS OR
RLPR€5ENTATIVES. 1 \�
AUTHORIID REPRES TATIV \ r L
ACQR4 25-S.(7/97) O AC RD CORPORATION 1988
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