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Home My WebLink AboutCORRESPONDENCE - BID - SNOW AND ICE ANNUAL (16)rIjPntdf- 7Q7nr QCORQM CERTIFICATE OF LIABILITY INSURANCE DATE I3*1 YY) 07/31/02 PRODUCER Flood & Peterson Insurance Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 211 First Street CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Eaton, CO 80615 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE 970 454-3381 INSUREDKEITSCOTT INSURERA. Progressive Companies �p.��_ _ 3500 3500 REAGAN COURT NSURERS — Pinnacol Assurance ^mob - ' INS C' WELLINGTON, CO 80549 INSURER D: INSURER E: nnvvewr_vo 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 - LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMMD DATE MM(DDNY)) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ I COMM CLAIMS EN RAL Lim ILITY CLAIMS MADE FIOCCUR FIRE DAMAGE (An, one tire) �MED $ EXP (Any one person) $ PERSONALS ADV IN JURY $ GENERAL AGGREGATE PRODUCTS-COMP/OP AGG --- - --- - - GEN'L AGGREGATE LIM ITAPPLIES PER: POLICY PE O- LOC A AUTOMOBILE - LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS CA044719542 05/11/02 05/11/03 ' COMBINED SINGLE LIMIT (Ea accident) �s BODILY INJURY (Per person) l, 000, 000 -- '- '$ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) - $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT -- $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG _-'- $ $ -- EXCESS LIABILITY OCCUR -� CLAIMS MADE t EACH OCCURRENCE _ $ _ AGGREGATE $ DEDUCTIBLE : RETENTION- B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY 9089790 I08/01/02 08/01/03 X WDv uMli 'OTH _.EI3_ E.L. EACH ACCIDENT _ _ $100,000 E.L. DISEASE - EA EMPLOYEE $100, 000 E.L. DISEASE - POLICY LIMIT $5 0 O 000 OTHER DESCRIPTION OF OPERATIONS20CATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Ft. Collins is listed as Additional Insured where their interest may appear. City of Ft. Collins Attn: Purchasing, PO Box 580 Ft Collins , CO John Stevens 80522 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL i 0 DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IM POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR AUTHORIZED 25s (7/97) 1 o f 2 S223182/M223181 RAT 0 ACORD CORPORATION ISM PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declarations Page/Amended Declaration Page with the policy jacket identified by the form and edition date indicated completes the above numbered policy. Previous Policy Number: Form 1050 Ed. 1194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 05/22/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 3 OF 4 E WELLINGTONN CT M CO 80549 1 ENDORSED EFFECTIVE: JUL 19, 2002 POLICY TERM: MAY 11, 2002 TO MAY 11, 200 A FLOOD & PETERSON INC This policy incepts the later of: 1. the time the application for insurance is executed on C PO BOX 578 the first day of the policy period; or 2. 12:01 a.m. on the first day of the policy period. NGR E E L E Y CO 8o632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T `rr, CA-76479 CPROGRElJW" PROGRESSIVE MOUNTAIN INSURANCE CO A PROGRESSIVE COMPANY P.O. BOX 94739, CLEVELAND, OHIO 44101 1-800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. SCHEDULE OF COVERED VEHICLES VEH NO DR NO TRADE YR NAME BODY VEH TER RAD DSC DSC TYPE SERIAL NO CLS NO ZIP IUS COD PCT 1-01 3 877 INTL DUMP TRUCK 2HSFBGUR2HCO84419 H72 26 80549 050 672 2-03 2 88 MACK DUMP TRUCK 1XP5DB9X4JN251953 H72 26 80549 050 672 LIABILITY PREMIUM BY VEHICLE VEH MED NO PAY UM/$UIM UM/PD PIP PIP/PPO 2 $$LIAB 53:856 551 $474 PHYSICAL DAMAGE PREMIUM BY VEHICLE VEH COMP OR FT/CAC COLLISION ON —HOOK VEH NO TYPE DED PREM DED PREM LIMIT DED PREM TOTAL 1 FT/CAC $1,000 $79 $2,500 $698 5 5 2 FT/CAC $1,000 $123 2,500 $1,079 S5 583 Any loss under Part III is payable as interest may appear to named insured and above loss payee: Frog Premium Budget: C8 Fin. Resp. Filed: For Whom: Case No: RIRO302%Factor Used: 81 .09 C4 AGO 02198 SCOT 12.0 CAICS11C F/R 092000 Countersigned: 1113 (12-02) By ADDITIONAL INTEREST COPY Authorized Representative CVMT0320001213L111303 PROORHOGIff" GOMMENCNE VEXIGLE INIVMNGE ADDITIONAL INSURED The person or organization named below is a person insured with respect to such liability coverage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this agreement will be excess insurance over any other valid and collectible insurance. NAME OF PERSON OR ORGANIZATION: CITY OF FORT COLLIN PO BOX 580 LIMIT OF LIABILITY Bodily Injury Property Damage Combined Liability FORT COLLINS CO 80522 each person/ each accident each accident $1.000,000 each accident All other parts of this policy remain unchanged. This endorsement changes Policy No.: 04471954-2 Issued to (Name of Insured): KEITN SCOTT Endorsement Effective: OS/11/02 Expiration: 05/11/03 Form No. 1198 (4-97) ADDITIONAL INTEREST COPY CVMT0809001637LI29801 STATE FARM GARY W. CRAMER, Agent da Auto -Life -Health -Home and Business am 2038 South College Avenue INSURANCE Fort Collins, Colorado 80525 Phone: Bus. (7yo) 484-1374 To Whom It May Concern: Please be advised that our insured, Chuck Hoffman has his 1988 Mack Dump Truck insured with our office. I have attached a copy of the insurance for the truck for further reference. Our office can be reached at the above phone number for any further questions or information. Sincerely, S EPTEMBER 26, 2002 AUTO POLICY STATUS H PHONE: ( ) 498-0449 HOFFMAN,CHUCK FIRE S50 6852-C21-06I-001 IRG: 0 DBA CHUCK HOFFMAN TRUCKING TERR: 007 1901 LONGWORTH RD 1988 MACK DUMP CLASS: 30600000 FORT COLLINS CO 80526-1516 TRUCK ACC FREE: NOT ELIG VIN: 2M2N187Y2JCO25615 BIRTH: DEC-31-36 STATUS:PAID DUE DATE: TERM DATE: TOT PREM: 757.80 AMT DUE: 0.00 OXD:SEP-21-92 COV DATE:MAR-14-02 PREV PREM: 757.80 A /1MM / 669.60 P3 INC LOSS 65.80 U 100 /300 22.40 AMT PAID: 757.80 DATE PAID: AUG-13-02 ODM 72162 09-92. NAME: HOFFMAN,CHUCK H PHONE: ( ) 498-0449 REPLACED POLICY: S506852-06H 001 POLICY FORM: 99065 EXCEP. & END: ADD'L INSURED - CITY OF FT COLLINS PURCHASING DEPT 256 W MOUNTAIN ST FORT COLLINS CO 80521, SEE FILE. REC CHG: COV. S NAMES S AMT PROORE.WE® aorxewouu va��e� nmwwce ADDITIONAL INSURED The person or organization named below is a person insured with respect to such liability coverage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this agreement will be excess insurance over any other valid and collectible insurance. NAME OF PERSON OR ORGANIZATION: CITY OF FORT COLLIN PO Box 580 LIMIT OF LIABILITY Bodily Injury Property Damage Combined Liability FORT COLLINS CO 80522 each person/ each accident each accident $t,000,000 each accident All other parts of this policy remain unchanged. This endorsement changes Policy No.: 04471954-2 Issued to (Name of Insured): KEITN SCOTT Endorsement Effective: O5/11/02 Expiration: o5/11/03 Form No. 1198 (4-97) ADDITIONAL INTEREST COPY CVMT08090016371-129801 SEP 25 2002 06:52 FR TO 4917570 P.01%01 ArbRD r'FRTIFICATF OF LIABILITY INSURANCE..., D °An q(M I°D/^Y --- I PRODUCER -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATiq- N�� Brown S Brown Inc - Ft Collins 125 S. Howes, Sth Floor Fort Collins CO 80522-226 Phone:970-492-7747 Fax:970-484-4165 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE SURER A: UNITED FIRE 6 CASUALTY Doug Weitzel Excavating & ppA y9 INSURER C 263D ,Hulbeiry St. INSURER 0: Ft Collins C0 H0521 ----- - _ jINSURER _E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 MAYBE 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. L A TYPEOF INSURANCE GENERAL LIABILITY X_I COMMERCIAL GENERAL LIABILITY POLICY NUMBER 60069729 POLICV EFFECTIVE DATE MMIDD/YY_ 07/01/021 POLI YEC %PRM) DATEjMXRRATI') LIMITS EACH OCCURRENCE 07/01/03 1 FIRE DAMAGE (Any one Ore) s500000 _ $100000 7 CLAIMS MADE OCCUR MED EXP(my one person) _ $5000 PERSONAL&ADVINJURY LAGRREGATE $ SD0000 $ 10D0000 I LOENERA� PRODUCTS. COMP/OP AGG -- -- GEN'LAGGREGATE LIMITAPPLIES PERK PRO. r� JECT I L POLICY! � $ 1000000 A AUTOMOBILE LIARILTY AUTO 60069729 07/01/02 07/01/03 COMBINED SINGLE LIMIT (an mode-0 S5000007, XANY mm BODILYpar JURY (ParrpereoN ALLOWNEDAUTOS SCHEDULED AUTOS � $ —� BODILY INJURY (Per acrJoentl $ HIREDAUTOS NON-OWNEC AUTOS � PROPERTY DAMAGE13 (Per Accident) II GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S J$,_x'. ANY AUTO EXCESS LASILITYr ^--IAA—UTO OTHER THAN EA ACC ONLY' AGG I MH OCCURRENCE $ S 1000000_ A , X u OCCUR CLAIMSMADE 1 60069729 07/01/02 07/01/03 _ A RGG 90ATE _ ---- $1000000 _ DEDUCTIBLE X RETENTION $ 1000Q — $ — - B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 14031492 07/01/02 07/01/03 TORY LIMITS ER E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $500000 EL. DISEASE -POLICY LIMIT $500000 OTHER — _.—__._—_—_ __ _ A 60067729 1 07/01/02107/01/02� Rental $10,000 Reimburse DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSENENTISPECIAL PROVISIONS Certificate Holder is named as Additional Insured, with respectS to General Liability. CERTIFICATE HOLDER Y IADDITIONAL OISUREO;INSURER LETTER: A CANCELLATION FTCCITY I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -U— OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL — — "RIND UPON THE INSURER, ITS AGENTS OR PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declarations Page/Amended Declaration Page with the policy jacket identified by the form and edition date indicated completes the above numbered policy. Previous Policy Number: Form 1050 Ed. 1 194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 07/26/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 1 OF 4 E 3500 REAGAN CT M WELLINGTON CO 80549 1 ENDORSED EFFECTIVE: AUG 23, 2002 POLICY TERM: MAY 11, 2002 TO MAY 11, 2003 A FLOOD & P ETE RSON I N C This policy incepts the later of: 1. the time the application for insurance is executed on G PO Box 578 the first day of the policy period; or 2. 12:01 a.m. on the first day of the policy period. N GRE E L E Y CO 80632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T `rr, CA-76479 PROORE� YE® E PROGRESSIVE MOUNTAIN N INSURANCE CO A PROGRESSIVE COMPANY COMMERCIAL P.O. BOX 94739, CLEVELAND, OHIO 44101 1-800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined In the policy and are subject to the terms and conditions contained In the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. SCHEDULE OF COVERAGES AND LIMITS OF LIABILITY COVERAGES A SINGLE LIMIT BODILY INJURY AND FULL TERM PRFMIIIM rNAorFc PROPERTY DAMAGE LIABILITY $1,000,000 EACH ACC $1712 D COMP OR FTCAC STATED AMT SEE PHYSICAL DAMAGE BY VEH FOR DED 202 E COLLISION OR UPSET -STD AMT SEE PHYSICAL DAMAGE BY VEH FOR DED $1777 1 UM/UNDERINSURED MOTORIST $ 25,000 /PERS. $ 50,000 /ACC. 55102 PERSONAL INJURY PROTECTION BASIC WITH $0 DED $948 WITHOUT WORKERS COMP I UNINSURED MOTORIST PROPERTY DAMAGE REJECTED ADDL INT 02 ADDED FILING FEES $75.00 TOT. CHARGES DUE TO CHANGE $25.00 TOTAL TERM PREMIUM $10,816.00 ATTACHMENT IDENTIFIED BY FORM NUMBER 1197 (08-93) 1198 (04-97) 1602 (o8-83) 1716 (02-97) 2004C (03-00) 3098 (12-96) 56 (02-97 8470 12- DRIVERS PAGE 2 COVERED VEH PAGE 3 LOSS PAYEE PAGE 4 PUC-N OTH-N ** THIS POLICY HAS SOME NON-STANDARD RESTRICTIONS, PLEASE READ IT CAREFULLY ** Any loss under Part III is payable as interest may appear to named insured and above loss payee: Prog Premium Budget: t8 Fin. Resp. Filed: For Whom: Case No: RtR0302 %Factor Used: C4 AGO 02235 SCOT 12.0 CAICS11C F77 Rj , 5Q 092000 Countersigned: By pp 1113 (12-$2) ADDITIONAL INTEREST COPY Authorized EVM oGntat 01213L711301 PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declarations Page/Amended Declaration Page with the policy jacket identified by the form and edition date indicated completes the above numbered policy. Previous Policy Number: Form 1050 Ed. 1 194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 07/26/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 2 OF 4 E 3500 REAGAN CT M WELLINGTON CO 80549 1 ENDORSED EFFECTIVE: AUG 23, 2002 POLICY TERM: MAY 11, 2002 TO MAY 11, 2003 A FLOOD & PETERSON INC This policy incepts the later of: 1. the time the application for insurance is executed on G PO BOX 8 the first day of the policy E 57 Y p y period; or 2. the l a.m. on the first day a the policy period. N G R E E L E Y CO 80632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T CA-76479 PROOREWE® PROGRESSIVE MOUNTAIN INSURANCE CO A PROGRESSIVE COMPANY cowmM MLva„„,a,„,u„Nca P.O. BOX 94739, CLEVELAND, OHIO 44101 1-800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. DRIVERS R NO DRIVER NAME LICENSE # 008 AIBLCADCMSCS REQ TUS 01-01 KEITH SCOTT 922088590 11/21/60 0 0 0 0 00 N M 02-02 BENJAMIN SCOTT 9772770135 04/04/82 0 0 0 0 00 N S 03-03 JUSTIN SCHLEPPY 961 31097 03/29/81 0 0 0 0 00 N S Any loss under Part III is payable as interest may appear to named insured and above loss payee: Prog Premium Budget: C8 Fin. Resp. Filed: For Whom: Case No: R/R0302%Factor Used: 41092000 , 0 C4 AGO 02235 SCOT 12.0 CAICS11C Countersigned: By 1113 (12-92) ADDITIONAL INTEREST COPY Authorized Reg.ritative 13L111302 PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declaration* Page/Amended Declaration Page with the policy jacket identified by the form and edition date indicated Previous Policy Number: completes the above numbered policy. Form 1050 Ed. 1 194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 07/26/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 3 OF 4 E WELLINGTONN CT M CO 80549 1 ENDORSED EFFECTIVE: AUG 23, 2002 POLICY TERM: MAY 11, 2002 TO MAY 11, 2003 A F LOOD & P ETERSON I NC This policy incepts the later of: 1. the time the application for insurance is PO BOX 578 executed on the first day of the policy period; or 2. 12:01 a.m. on the first day of the policy period. N GRE E L E Y CO 80632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T �.rr�/,p a 6479 PROGRESSIVE PROGRESSIVE PANv e///YY/Irer.ErMVaI�I BOX194739,�NTAIN CLEVELANDR,ANCE OHIOC441oi 1A800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. SCHEDULE OF COVERED VEHICLES VEH DR TRADE NO NO YR NAME BODY VEH TER RAD DSC DSC TYPE SERIAL NO CLS NO ZIP IUS COD PCT 1-01 3 877 INTL DUMP TRUCK 2HSFBGUR2HC084419 H72 26 80549 050 672 2-03 2 88 PETERBILT DUMP TRUCK 1XP5DB9X4JN251953 H72 26 80549 050 672 LIABILITY PREMIUM BY VEHICLE VEH MED NO PAY UMA IM UM/PD P15P PIP/PPO S5LIAB RI 2 53.856 W4 PHYSICAL DAMAGE PREMIUM BY VEHICLE VEH COMP OR FT/CAC COLLISION ON -HOOK VEH NO TYPE DEB PREM DED PREM LIMIT DED PREM TOTAL 2 FT/CAC $1,000 $123 g$ $2,500 $1$079 5 5 $5.583 Any loss under Part III is payable as interest may appear to named insured and above loss payee: Prog Premium Budget: C8 Fin. Resp. Filed: For Whom: Case No: R/R0302%Factor Used: 71 ,o c4 AGO 02235 SCOT 12.0 CAICS11C FIR 052000 Countersigned: By 1113 (12.92) ADDITIONAL INTEREST COPY Authorized resetative p 313L111303 PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declarations Page/Amended Declaration Page with the policy jacket identified by the form and edition date indicated completes the above numbered policy. Previous Policy Number: Form 1050 Ed. 1 194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 07/26/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 4 OF 4 3500 REAGAN CT M WELLINGTON CO 80549 1 ENDORSED EFFECTIVE: AUG 23, 2002 POLICY TERM: MAY 11, 2002 TO MAY 11, 2003 A FLOOD & P ETE RSON INC This policy incepts the later of: 1. the time the application for insurance is executed on G PO BOX 578 the first day of the policy period: or 2. 12:01 a.m. on the first day of the policy period. N GRE E L E Y CO 80632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T CA-76479 aPROOREll/W PROGRESSIVE MOUNTAIN INSURANCE CO A PROGRESSIVE COMPANY P.O. BOX 94739, CLEVELAND, OHIO 44101 1-800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the policy, including amendments and endorsementt MiappVtbe effective prior to the time changes are requested. VEH ZIP NO NAME ADDRESS CITY/STATE CODE 2 CH BROWN CO P 0 BOX 789 WHEATLAND WY 82201 w o � o � o s = g � o Sa� 8 � o � S 0 LOSS PAYABLE CLAUSE - FORM 1602 (8-83) oassess a WE AGREE WITH YOU TO CHANGE YOUR POLICY AS FOLLOWS: 1. WE WILL PAY THE LOSS PAYEE NAMED IN THE POLICY FOR LOSS TO YOUR INSURED AUTO, ffiffiffiffinin AS THE INTEREST OF THE LOSS PAYEE MAY APPEAR. o a 2. THE INSURANCE COVERS THE INTEREST OF THE LOSS PAYEE UNLESS THE LOSS RESULTS a FROM FRAUDULENT ACTS OR OMISSIONS ON YOUR PART. 3. CANCELLATION ENDS THIS AGREEMENT AS TO THE LOSS PAYEE'S INTEREST. IF WE CANCEL THE POLICY WE WILL MAIL YOU AND THE LOSS PAYEE THE SAME ADVANCE NOTICE. 4. IF WE MAKE ANY PAYMENT TO THE LOSS PAYEE, WE WILL OBTAIN HIS RIGHTS AGAINST ANY OTHER PARTY. Any loss under Part III is payable as interest may appear to named insured and above loss payee: Prog Premium Budget: t8 Fin. Resp. Filed: For Whom: Case No: R/R0302%Factor Used: C4 AGO 02235 SCOT 12.0 CAICSIIC F77R1 ,50 092000 Countersigned: By 1113 (12-92) ADDITIONAL INTEREST COPY Authorized Representative C pMT0320001213L111304 HAGIN aic RM CERTIFICATE OF LIABILITY INSURANCE W1TE,MMID 09/23/0/02 PRODUCER Flood & Peterson Insurance Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive P O Box 270370 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE 'INSURED Hageman Earth Cycle, Inc. Hageman Enterprises, LLC 3501 E. Prospect Road Fort Collins, CO 80525 INSURER A, Continental Western Grou INSURER B: INSURER C: INSURERO: INSURER E: 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. LTRNSR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE �WM POLICY EXRRATION DATE MM OMITS �A GENERAL LIABILITY CWP234489320 09/01/02 09/01/03 EACH OCCURRENCE $1 000 000 FIRE DAMAGE(My.f.) $100 000 X COMMERCIALGENERALLIABILTTY CLAMS MADE X OCCUR MED EXP (My am WrN ) s5,000 X PD Ded:500 PERSONAL S ADV INJURY El 000,000 GENERAL AGGREGATE s2 0 0 O 0 0 0 GENY AGGREGATE LIMIT APPLIES PER: POLICY PRO LOG PRODUCTS-COMP/OP AGO 52 000 000 A AUTOMURIIELIABILITY X ANY AUTO CWP234489320 09/01/02 09/01/03 COMBWEDSINGLE LIMIT (Ea sttldant) $l, 000, 000 ALL OWNED AUTOS SCHEDULED AUTOS BODILYINJURY (Par PeNon) $ X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Par ecc rrt) $ PROPERTY DAMAGE (Par=Iderrt) _— $ GAIVIGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC AUTOONLY: AGO S S A EXCESSUABILTY X OCCUR CLAIMS MADE CU236140820 09/01/02 09/01/03 EACH OCCURRENCE S1,000,�_ AGGREGATE s1,000,000 _ $ OEOUCTMLE X RETENTION E1 O 000 _ $ WOIINERSCOMPENSATION AND WCSTATU/ OTH- EMPLOYERS' UABILTTY E.L.EACHACCIDENT — -- $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONWENCLE&EXCLUSIONS ADDED BY ENDORSEMENT9PEGAL PROVISIONS City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30—DAYSWRITTEN RISK Management Dept. NOTICE TOTHE CERTIFICATE HOLD ER NAM ED TO THE LEFT, BUT FAILURE TO DO SOSHAM Atm: Darlene IMPOSE NO OBLIGATION OR LIABILITY,OF ANY IUND UPON THE INSURERJTS AGENTS OR P.O. Box 580 REPRESENTATIVES. I - Ft Collins , CO 80522 I AUTNORI2ED REPRE E • t9.. At, a •dF ACORD25-S(7197)1 OP 2 #M227692 NTK ® ACORD CORPORATION TRRR DATE OF NOTICE 09/16/02 ikii NOTICE OF REINSTATEMENT #### PROGRF.MYE® GONMENCl/�L VENIO4E INSVNNNGE PROGRESSIVE PO BOX 94739 CLEVELAND OH 44101 ISSUED BY PROGRESSIVE MOUNTAIN INSURANCE CO. PO BOX 94739, CLEVELAND OH 44101-4739 24 HOUR POLICY SERVICE 1-800-444-4487 24 HOUR BILL INQUIRY 1-800-999-8781 24 HOUR CLAIMS SERVICE 1-800-274-4499 INSURED: KEITH SCOTT THE INSURANCE POLICY LISTED BELOW WHICH WAS CANCELLED IS NOW REINSTATED AS OF THE DATE SHOWN. POLICY NUMBER I INCEPTION DATE PREMIUM DUE CA 04471954-2 05/11/02 REINSTATEMENT WILLTAKEEFFECT 09/22/02 12:01 A.M. $4,562.86 THANK YOU FOR YOUR PAYMENT. YOUR CANCELLATION DID NOT TAKE EFFECT AS INDICATED IN A PREVIOUS NOTICE. YOUR NEXT PAYMENT WILL BE $1,529.96. YOU WILL RECEIVE A BILL IN THE NEAR FUTURE. FLOOD & PETERSON INC PO BOX 578 GREELEY CO 80632 ADDITIONAL INTERESTS APPLY Form No. 6167 (1/92) LIENHOLDER CH BROWN CO P 0 BOX 789 WHEATLAND WY 82201 CORCV 24 RBD910 ADDITIONAL INTEREST COPY 02258 C4 C V MT011398430O L6167OXI CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company N selection box is not checked. 6000 American Pky Madison, Wisconsin 53783-0001 Agent's Name, Address and Phone Number (Agt./Dist.) Insured's Name and Address Kathy Collins Agency (139-309) Robert V Ewing 1119 W Drake Ste C-28 650 Redstone Ln Fort Collins, CO 80526 Bellvue, CO 80512 970-225-6866 This certificate Is Issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend. extend er atfar the ,..,a.a..e sa....asa 6.. N._ __„_,__ „_._I _.__. -.._ __-_._-_.._.....MMEM.. .,� ..o yvnmva nawv www. This is to certify that 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. POLICY TYPE TYPE OF INSURANCE POLICY NUMBER LIMITS OF LIABILITY Effective Expiration (Mo,De ,Yr) (Mo,Day,Yr) MobilHomeowners/ rlee Liability Bodily Injury and Property Damage Each Occurrence Boato ners LI Boatownee Liability Bodily Injury and Property Damage Personal Umbrella Liabllity Each Occurrence Bodily Injury and Property Damage Farm/Ranch Liability Each Occurrence Farm & Personal Liability Each Occurrence Farm Employers Liability Each Occurrence Workers Compensation and Statutory... . Each Accident Employee Liability + Disease - Each Employee General Liability Disease - Poll Limit ® Commercial General 05XB-0802 9/14/2002 9/14/2003 General Aggregate $ 600,000 Products - Completed Operations Aggregate $ 600.000 Liability (occurrence) ❑ Personal and Advertising Injury $ 300,000 ❑ Each Occurrence $ 300,000 Damage to Premises Rented to You $ 100,000 Businessownee Liabllity Medical Expense (An One Person) $ 5,000 Each Occurrence++ Liquor Liability A gregate++ Common Cause Limit Automobile Liability A re ate Limit Bodily Injury -Each Person ❑ Any Auto ❑ All Owned Autos Bodily Injury - Each Accident ❑ Scheduled Autos Property Damage ❑ Hired Autos Bodily Injury & Property Damage Combined ❑ Nonowned Autos Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate Other (Miscellaneous Coverages) DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS Roofing •The individual or panners shown as Insured `"" elected to be covered as employees under this policy. ++ Products.Completed Operations aggregate is equal to each occunence limit and is included in Policy oll a r ate. City of Fort Collins PO Box580 Fort Collins, CO 80522 ❑ Should any of the above described policies be canceled before the expiration date thereof, the company will endeavor to mail •(10 days) written notice to the Certificate Holder named, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, Its agents or representatives. •10 days unless different number of days shown. ® This certifies coverage on the date of issue only. The above described policies are subject to cancellation in conformity with their teens and by the laws of the state of issue. 9/14/2002 OEM ACORD. CERTIFICATE OF LIABILITY INSURANCE °sizMi/zooz" PRODUCER Country Truck Insurance 697-6099 P.O. BOX 659 Morrison Co 80465 ISSUED ON YTHIS CERTIFICATEMATTER RIGH S PONOF INFORMATION HE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED O'NEILL TRUCKING LLC 12378 N. CO. RD. 7 WELLINGTON, CO 80549 INSURERA: DIAMOND STATE INS. CO. INSURERS: PENN AMERICA INSURERC: 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. INBR ADD'L POLICY NUMBER POLICY EFFECTIVE DATEDATE POLICY EXPIRATION MM Y LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X CLAIMS MADE OCCUR PAC6223912 5/03/2002 5/03/2003 EACH OCCURRENCE $ 1,000,000 A PREIUIGGS Eaoo:urexz $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE OMIT APPLIES PER: POLICY PRO- LOC PRODUCTS-COM%OP AGG $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DS0500446 COLUCOMP $1,000 DED 2/26/2002 2/26/2003 COMBINED SINGLE UNIT$ (Eaa ident) 1,000,000 BODILY INJURY (Per Person) $ X BODILY INJURY (Pero Id.nt) $ PROPERTY DMAGE (Pere idwt) $ GAR AGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER AN EA ACC AUTO TO ONLY ADS $ $ EXCESSAIMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ WORI(ERSCOMPENSATIONAND EMPLOYERS' LIABILITY MY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ yes, tleeC,ibe urMer SPECIAL PROVISIONS below WC STATU- OTH- T RV I I E. LEACH ACCIDENT . $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER IS ADDTIONAL INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN CITY OF FT. COLLINS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PURCHASING & FINANCE DEPT IMPOSE NO OBLIGATION OR LIABILITY OF ANY MIND UPON THE INSURER, ITS AGENTS OR P.O. BOX 580 REPRESENTATIVES. FT COLLINS, CO 80522 AUTHORIZ ATIVE ACORD 25 (2DO1108) / 0 ACORD CURFORAUULY 1BUB 12-13-2001 10:48PM FROM P. 2 Sent By: FRONT RANGE INSURANCE GROUP; 9702258596; 0ct-24-01 70:52; Page 1(1 CERTIFICATE OF UA9tlITgf INSURANCE �q I pnowni bsnet RangeIoeurafmm Group otRYA140mn� fWas"upo"TTIEO0�fg1CATE p Knit* 9900, 2050 052,5 land THE T/ fort CQillar CO .aosza rAoasr97W.223-1904 bWAMWAFFOMM r o"roa XJWWLems tort Mow opsr, aw � AC"SaM$451 i 20/01/01 � 10/91/02 ipAlrtOs �`OcACr e,pw: aA 7a700"451 1/�Aw tXwtwt4w:mQmLftw wrvM AMOKY."Aoaowr A MAW �uroa s ommuspl at iam OCa [701Ams+Noe Efc"owwooc, i a I �'" I AC-CO-oo4473-4 1 10/01/01 ! 20/0110= A I granted A4- $5000 ACV CIA 7l2ooi6ssl 10/01/01 10/ol/Os A {hibreila/aSA00000 mmisiooaR4a1 1V/O1/01 l0/O1/02 xe additional ift~ed etatw be n 7 granted 0alag Shia am ilieety, neither aaY rarer Of subrepation be granted. CE MWATEMOLom M aes+q"�yM,,.,,w ralas�umna CeMiW7fON R`OIIEONl' s�aaA�l/lornny0lap�G"�p�outa¢swWRiAlr011ELn tarty/ M7aYNmm0i t11[amaMtlaaalmAJMtMYtIlmAa1L .ZQ... ta�itrAlllw TO MOm It XR*r Caneern +onea7b»n�Igq�76na�fll�Yafmm�a l@1.aRRYWi1e00WaW1 teetF11D01MA�MtMWia70Fam1ab�ret 111tMnMnt �Pt�Ome�OM ' ' ar►r+atm"mu �oao�s naAA ear OA001100oMOAUT= I AQ-mg CERTIFICATE OF LIABILITY INSURANCE DATE(MINDOIYY) PRDOUCER MAY 23 02 CEN-TEX TRANSPORTATION INSURANCE SERVICES, INC, LTMOINFERS NO R G TS UPON THE CERTIFICATEFINFOR HO LDER. . THIS CERTIFICATE P 0 BOX 27740 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AUSTIN TX 78755 POLICIES BELOW, PHONE; 612-342.8020 FAX! S12-33M288 COMPANIES AFFORDING COVERAGE COMPANY A: COI DsuranDe B ---- —`-" TUCKER, KEVIN JORDAN, RON uf11We1 ---" - �---I- p m ---- DBA T & J TRUCKING COMPANIY B: —COR1 -- -- — $739 NORTH TAFT HILL ROAD COMPgNy C; FORT COLLINS CO 80624 IODMPA-- NY D LIMITS SHOWN MAY HAVE BEEN REDUCED w I. . TYPE OFINSURANGE I GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR .......... GENL AGGREGATE LIMIT APPLIES PER; POLICY MI. . LOC AUTOMOBILE LZELITY =..1 ANY AUTO ALL OWNED AUrDS A �_X I SCHEOULEDAUTOS HIREDAUTps NON -OWNED AU'r 4 ....._.� ANY AUTO EXCESS LIABILITY OCCUR L_.._. CLAMS MADE DEDUCTIBLE RETENTION g WORKERS COMPENSATION AND COMPANY E; CLAIMS.y zo VC4R1�� nertnN is &VSJECT TO ALL THE TERMS, EXCLUSIONS ANO�CpNORItlN3 OF SUCH POLICIES. POLICY NUMBER v01JCY EPEECME _. POLICYE.TPIRATpN ...—" ..—.... LIMITS EACH OCCURRENCE 3 FIRE DAMAGE (Any D p FUe) g - MEp EXP (AIy pna Porevn) 5 PERSONAL SADV INJURY f GENERAL AGGREGATE g ---- _...__.. ... .... PRODUCTS-COMP/OP AGG 3 71 TRNISS864 MAY 26 02 MAY 26 03 COMBINED SINGLE UNIT iEP ecNBen9 i$ 750.000 BODILY INJURY (Pp Pereenl f BODII.Y INJURY (Pnl PWdml) 5 PRDPERTYDAMAGE g DESCRIPTION OF OPERATIONS/.00ATIONSA/EHICLES/------------ PECIAL ITEMS PER VEHICLE 8CHI:DULE ON FILE WITH THE INSURANCE COMPANY CITY OF FORT COLONS PO BOX Sao 21S NORTH MASON ST, FT COLLINS CO 808224580 FAX#970-221.6707 Attention: JOHN STEPHAN ACORD 25.8 (7/97) Certi6CBte# 657 scare ..._._..._. .. g E.L. EACHACCICENT 3 E. L. DISEASE -EA EMPLOYEE S ' E.L. DISEASE -POLICY LIMIT 'S Client#: 24703 QCQRQa CERTIFICATE OF LIABILITY INSURANCE 7001 of 23%oz PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER. ALTER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR THE COVERAGE AFFORDED BY THE POLICIES BELOW, P O Box 270370 Fort Collins, CO 80527 INSURERS AFFORDING COVERAGE INSURED Hageman Earth Cycle, Inc. Hageman Enterprises, LLC 3501 E. Prospect Road Fort Collins, CO 80525 wsuRERq: Continental Western Group INSURER B: INSURER — ---- — INSURERD: 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. NSR LTR T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M DrYY1 POLICY E%PIRATION DATE MM/DD/YY LIMITS A GENERALLIABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE n OCCUR X PD Ded: 500 �CWP234489320 09/01/02 09/01/03 EACH OCCURRENCE $1 00O 000 FIRE DAMAGE (Any one lire) $10O 000 MED EXP (Anyone person) $5 , 000 PERSONAL S ADV INJURY 1$1 000, 000 GENERAL AGGREGATE $2 0 0 O 00 O GEN'L AGGREGATE LIM ITAPPL IES PER: POLICY PRO- LOC JECT PRODUCTS-COMP/OP AGG $2 000 000 - A AUTOMOBILEUABIQTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOSBODILY NON -OWNED AUTOS iCWP234489320 09/01/02 09/01/03 COMBINED SINGLE LIMIT (Ea accident) $1 , 000,000 X BODILY INJURY (perperson) $ INJURY (Per accident) $ LX PROPERTY DAMAGE (Per accident) $ i GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: qGG _$ $ $ A EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $10 00O CU236140820 09/01/02 09/01/03 EACH OCCURRENCE $1, 0001 000 AGGREGATE $1 000,000 $ $ 'i EM WORKERS SP LIABDISAT:OH AND EMPLOYERS' LIABILITY WHY I-Im - OTH- ITCHY LiMIT E.L. EACH ACCIDENT �, $ E.L.DISEASE - EA EMPL OYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONStVEHICLESfEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: Snow Removal City of Fort Collins Purchasing Department 256 W. Mountain Ave. Fort Collins, CO 80521 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -10DAYS W RITTEN NOTICE TOTHE CERTIFICATE HOLDER NAM ED TOTHE LEFT, BUT FAILURE TO DO SO SHALL IM POSE NO OBLIGATION OR LIABILITY OF ANY IUND UPON TH E INSURERJTS AGENTS OR REPRESENTATIVES. y— A .. _ AUTHORIZED REPRES Al1VE Ii�IP6 AAA A I :U_- ACORD 25S(7197) l of 'J RM9079Q7 TTTV n ACORn CORPnRATInM1RRR State Farm Fire and Casualty Company SEP `L 3 2002 39136-2-F MATCH 00777 FIRE OVL 3001 8th Avenue Greeley CO 80638 *COPY' DECLARATIONS PAGE COPY* IINN TTp pp 00777 08.1880.22RF POLICY NUMBER 855 9543-A26-06D FORTWC1O6NG jGOAy80521 COLLINS - POLICY PERIOD AUG 06 2002 to JAN 26 2003 LONS NAMED INSURED: MICHAEL, DWIGHT DBA MICHAEL DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE. AGENT GARY CRAMER 2038 S COLLEGE AVE FORT COLLINS, CO 80525-1425 PHONE: (970)484.1374 1983 PETERBUILT 359 DUMP 1XP9D29XODP161U15 30600000 1983 ."u 25` —11*041111 1 SEP.30.2002 12:36PM INSURANCE MANAGEMENT NO.e39 P.2i2 ACID A CERTIFICATE OF LIABIL PROMMER Insuraaea MAnagamnt, Inc, sm 9. 60th Avanna CoOsDerae City CO B0022 Phenol 303-289-4486 NAY L1gq9i9111 i9 Tnd19 =a oaa763velnd COBOO 9Y kp^rrT mEmck mm CAw(AGE ANYWM r oY memo A S a mump M-7m HW AMM NPnw.NEDwfoe wwm wap =UR DAM WE PEDLCM69 RAPS IDN L Y www DCNFea"NYe ppiDYEAP4PRIYTT SA2A80086 The oertiPiesate hoiden is named as Anto Liability Cov4sage. City a Solt Cailips Purchasing Dlviaion 8 O Dole 380 Pert Collins CO 80522 ITY INSURANCE CSR aD "09/30" ASST891 09 80/02 THIR CORTIFICATR NI 13809P AS A MATTER OF INFORMATION ONLY AND CONPERS NO RIGHTS UPON THE CORTIF�CATR HOLDEIL THIS CERT1FICATE DOES NOT AMEND, RX7END OR ALTER THE COVERAGE AFFORDED OV THE POWDIRS BELOW. NSUNFRS AFFORDRIO COVERAGE TBAERA Wtjohixe Insurance Company nelAs� a �SuRpR P, NEupQr k INRR� m wa 07/08/02 1 07/08/03 in maspoats to t ERR• NDTWITHATANPING CERTIFIIDpCATEINpIcATMAYD6E l=I!P OR 7LUSIONS ANO CONDITIONS OF SUCH 4MTi 0cH=uR"W-A i Fits PN1AC5 NroNn Pil F mppv(M dm Ii9N i PIS4CPyFs,.nvpyuR+ F CHiFPKNGC�WYR i mcnum-wmwop� S c0MWS)4HDLp Li9T %$1,000,000 Icim l nlp i I=MPPY (perieiq�entl s NJrOPNW.EnAccDEM' s o1H�TrN'V ph�Dc i i MRD o(}P. Acc SAW PPPupRENCF F "DAtmTe S 4 i i A R ey.pnCNACCpKM S 5LoleeA",I5A9MKMEE % ELDPFw-pawoyuw i he A— CANCVLI.ATNXL CiTYB'Cl iHDYLO iM'PrrwrarniPiielceFu.eupwwoiNRFl.l.wnrww++a Emwnux PATFTNEISAFirw lnuw FaYAERYMI.�iN09iYPRTP hWI, 10 meww Errm NPTM%F To mE DeNrMICATR HDFpiRN!RFR TOTNF LFFT� iYT PMW'e TO W FPiNNJ. R1r0iF No oWPiTNRDA4ieN�Y M iNY xiNP DrDN TW MIicP941Ti AieR. PR ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) SBTRUl 07/19/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Management, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6075 E . 60th Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Commerce City CO 80022 Phone: 303-289-4485 INSURERS AFFORDING COVERAGWtIZ INSURERA: Is ire Insurance Arnold and Beverly Burns INSURERS: dba: A S $ Trucking #55 Loveland INSURER C: East 57th Loveland CO 80538 38 LINSURER D: 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. N LTR TYPE OF INSURANCE POLICY NUMBER LI YEFF TIVE DATE MDD/YY POLI EXPIRATI N DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR FIRE DAMAGE (Any one Nre) E MED EXP (Any one person) E PERSONAL S ADV INJURY $ GENERAL AGGREGATE E GEN'L AGGREGATE LIMIT "PLIES PER POLICY PRO. JECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) E $1 ,DOD ,ODD ALL OWNED AUTOS A SCHEDULED AUTOS BA2480056 07/08/02 07/08/03 BOr person) (Per person) $ X. HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) E GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS LIABILITY OCCUR CLAIMSMADE EACH OCCURRENCE E AGGREGATE E S DEDUCTIBLE S RETENTION E E WORKERS COMPENSATION AND C EMPLOYERS' LIABILITY T LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE E E.L. DISEASE -POLICY LIMIT It OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The certificate holder is named as ADDITIONAL INSURED in respects to the Auto Liability Coverage. CITYFCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Purchasing Division P 0 BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522 REPRESENTATIVES. PLEASE READ YOUR POLICY POLICY NUMBER CA 0-44-71-954-2 This Declarations Page/Amended Declaration Page with the policy jacket identified by the form and edition data indicated completes the above numbered policy. Previous Policy Number: Form 1 050 Ed. 1 194 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 05/22/02 *** DECLARATIONS T NAMED INSURED KEITH SCOTT PAGE 1 OF 4 E 3500 REAGAN CT M WELLINGTON CO 80549 1 ENDORSED EFFECTIVE: JUL 19, 2002 A POLICY TERM: MAY 11, 2002 TO MAY 11, 2003 F LOOD 6 PETERSON INC This policy incepts the later of: 1. the time the application for insurance is executed on G PO BOX 578 the first day of the policy period; or 2. 12:01 a.m. on the first day of the policy period. N GR E E L E Y CO 80632 This policy shall expire at 12:01 a.m. on the last day of the policy period. T CA-76479 PROGREWYAF PROGRESSIVE MOUNTAIN INSURANCE CO A PROGRESSIVE COMPANY com..—,1„a„.E P.O. BOX 94739, CLEVELAND, OHIO 44101 1-800-444-4487 The following coverage and limits apply to the described vehicle as shown below. Coverages are defined in the policy and are subject to the terms and conditions contained in the policy, including amendments and endorsements. No changes will be effective prior to the time changes are requested. SCHEDULE OF COVERAGES AND LIMITS OF LIABILITY COVERAGES A SINGLE LIMIT BODILY INJURY PROPERTY DAMAGE LIABILITY D COMP OR FTCAC STATED AMT E COLLISION OR UPSET -STD AMT I UM/UNDERINSURED MOTORIST PERSONAL INJURY PROTECTION WITHOUT WORKERS COMP I UNINSURED MOTORIST PROPERTY AND FULL TERM PREMIUM CHARGES $1,000,000 EACH ACC $7712 SEE PHYSICAL DAMAGE BY VEH FOR DED 202 SEE PHYSICAL DAMAGE BY VEH FOR DED $1777 $ 25,000 /PERS. $ 50,000 /ACC. $$102 BASIC WITH $0 DED $948 DAMAGE REJECTED VEHICLE 02 ADDED SURCHARGE CHANGED FILING FEES $50.00 TOT. CHARGES DUE TO CHANGE $3,943.00 TOTAL TERM PREMIUM $10,791.00 ATTACHMENT IDENTIFIED BY FORM NUMBER 1131 08— )) 1198 ((04-9y77)) 1602 (08-83) 1716 (02-97) 2004c (03-00) 3098 (12-96) 568b 02-97 8470 (12-86) DRIVERS PAGE 2 COVERED VEH PAGE 3 LOSS PAYEE PAGE 4 PUC-N OTH-N ** THIS POLICY HAS SOME NON-STANDARD RESTRICTIONS, PLEASE READ IT CAREFULLY ** Any loss under Part I I I is payable as interest may appear to named insured and above loss payee: Ping Premium Budget: c8 Fin. Resp. Filed: For Whom: Case No: R/R0302 %Factor Used: 8 1 , 09 c4 AGO 02198 SCOT 12.0 CAICSIIC F/R 092000 Countersigned: 1113 (12-92) By ADDITIONAL INTEREST COPY Authorized Representative CVMT0320001213L111301