HomeMy WebLinkAboutWORK ORDER - RFP - P763 CURED IN PLACE PIPE (6)SECTION 00600
BONDS AND CERTIFICATES
00610 Performance Bond
00615 Payment Bond
00630 Certificate of Insurance
00635 Certificate of Substantial Completion
00640 Certificate of Final Acceptance
00650 Lien Waiver Release (CONTRACTOR)
00660 Consent of Surety
00670 Application for Exemption Certificate
SECTION 00630
CERTIFICATE OF INSURANCE
CONTRACTOR shall insert his own standard form for Certificate of Insurance.
EXHIBIT D
INSURANCE REQUIREMENTS
1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance
coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service
Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations
covered, effective dates and date of expiration of policies, and containing substantially the following
statement"
The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10)
days written notice has been received by the City of Fort Collins."
In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out
and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and
may deduct the cost of such insurance from any monies which may be due or become due the Service
Provider under this Agreement. The City, its officers, agents and employees shall be named as additional
insureds on the Service Provider's general liability and automobile liability insurance policies for any claims
arising out of work performed under this Agreement.
2. Insurance coverages shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life
of this Agreement for all of the Service Provider's employees engaged in work performed under this
agreement:
1. Workers' Compensation insurance with statutory limits as required by Colorado law.
2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease
aggregate, and $100,000 disease each employee.
B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this
Agreement such commercial general liability and automobile liability insurance as will provide
coverage for damage claims of personal injury, including accidental death, as well as for claims for
property damage, which may arise directly or indirectly from the performance of work under this
Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of
insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000
combined single limits for bodily injury and property damage.
In the event any work is performed by a subcontractor, the Service Provider shall be responsible
for any liability directly or indirectly arising out of the work performed under this Agreement by a
subcontractor, which liability is not covered by the subcontractor's insurance.
SECTION 00635
CERTIFICATE OF SUBSTANTIAL COMPLETION
TO: CITY OF FOR COLLINS
(OWNER)
DATE OF SUBSTANTIAL COMPLETION: PROJECT TITLE:
PROJECT OR SPECIFIED PART SHALL LOCATION: Fort Collins Colorado
INCLUDE:
OWNER: City of Fort Collins
CONTRACTOR:
CONTRACT DATE:
The Work performed under this contract has been inspected by authorized representatives of the OWNER,
CONTRACTOR, and the ENGINEER and the project (or specified part of the project, as indicated above) is
hereby declared to be substantially completed on the above date.
A tentative list of items to be completed or corrected is appended hereto. This list may not be exhaustive,
and the failure to include an item on it does not alter the responsibility of the CONTRACTOR to complete all
the Work in accordance with the Contract Documents.
0
ENGINEER
By:
DATE
AUTHORIZED REPRESENTATIVE
The CONTRACTOR accepts the above Certificate of Substantial Completion and agrees to complete and
correct the items on the tentative list within the time indicated.
By:
CONTRACTOR AUTHORIZED REPRESENTATIVE DATE
The OWNER accepts the project or specified area of the project as substan-
tially complete and will assume full possession of the project or specified area of the project at 12:01 a.m.,
on . The responsibility for heat, utilities, security, and insurance under the Contract
Documents shall be as set forth under "Remarks" below.
CITY OF FORT COLLINS, COLORADO By:
OWNER AUTHORIZED REPRESENTATIVE DATE
SECTION 00640
CERTIFICATE OF FINAL ACCEPTANCE
TO:
Gentlemen:
You are hereby notified that on the day of , the City of Fort Collins, Colorado, has
accepted the Work completed by for the City of Fort
Collins project,
A check is attached hereto in the amount of
($ ) as Final Payment for all Work done, subject to the terms of the Contract Documents which
are dated
In conformance with the Contract Documents for this project, your obligations and guarantees will continue
for the specified time from the following date:
Sincerely,
OWNER: City of Fort Collins
By:
Title:
ATTEST:
SECTION 00650
LIEN WAIVER RELEASE
(CONTRACTOR)
TO: City of Fort Collins, Colorado (OWNER)
FROM:
PROJECT:
CONTRACTOR
The CONTRACTOR acknowledges having received payment, except retainage from the OWNER for
all work, labor, skill and material furnished, delivered and performed by the CONTRACTOR for the
OWNER or for anyone in the construction, design, improvement, alteration, addition or repair of the
above described project.
2. In consideration of such payment and other good and valuable consideration, the receipt and
adequacy of which are hereby acknowledged, the CONTRACTOR voluntarily waives all rights, claims
and liens, including but not limited to, mechanic's liens, Miller Act claims (40 U.S.C.A. 270 a and b),
stop notices, equitable liens and labor and material bond rights which the CONTRACTOR may now
or may afterward have, claim or assert for all and any work, labor, skill or materials furnished,
delivered or performed for the construction, design, improvement, alteration, addition or repair of the
above described project, against the OWNER or its officers, agents, employees or assigns, against
any fund of or in the possession or control of the OWNER, against the project or against all land and
the buildings on and appurtenances to the land improved by the project.
3. The CONTRACTOR affirms that all work, labor and materials, furnished, delivered or performed to
or for the construction, design, improvement, alteration, addition or repair of the project were
furnished, delivered or performed by the CONTRACTOR or its agents, employees, and servants, or
by and through the CONTRACTOR by various Subcontractors or materialmen or their agents,
employees and servants and further affirms the same have been paid in full and have released in full
any and all existing or possible future mechanic's liens or rights or claims against the project or any
funds in the OWNER'S possession or control concerning the project or against the OWNER or its
officers, agents, employees or assigns arising out of the project.
4. The CONTRACTOR agrees to defend and hold harmless the OWNER, the lender, if any, and the
Surety on the project against and from any claim hereinafter made by the CONTRACTOR'S
Subcontractors, materialmen, employees, servants, agents or assigns against the project or against
the OWNER or its officers, employees, agents or assigns arising out of the project for all loss, damage
and costs, including reasonable attorneys fees, incurred as a result of such claims.
5. The parties acknowledge that the description of the project set forth above constitutes and adequate
description of the property and improvements to which this Lien Waiver Release pertains. It is further
acknowledged that this Lien Waiver Release is for the benefit of and may be relied upon by the
OWNER, the lender, if any, and Surety on any labor and material bonds for the project.
Signed this day of
CONTRACTOR
By:
ATTEST:
Secretary
STATE OF COLORADO )
)ss.
COUNTY OF LARIMER )
Subscribed and sworn to before me this day of
by
Witness my hand and official seal.
My Commission Expires:
Notary Public
SECTION 00660
CONSENT OF SURETY
TO: City of Fort Collins, Colorado (hereinafter referred to as the "OWNER")
CONTRACTOR:
PROJECT:
CONTRACT DATE:
In accordance with the provisions of the Contract between the OWNER and the CONTRACTOR as indicated
above, for
on bond of
(Surety)
hereby approves of the Final Payment to the CONTRACTOR, and agrees that Final Payment to the
CONTRACTOR shall not relieve the Surety Company of any of its obligations to the OWNER, as set forth in
the said Surety Company's Bond.
IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this day of
(Surety Company)
ATTACH: Power of Attorney and Certificate of Authority of Attorney(s)-in-Fact.
SECTION 00670
APPLICATION FOR EXEMPTION CERTIFICATE
Insert State certificate here.
DR 0172 (1vs6)
COLORADO DEPARTMENT OF REVENUE
DENVER CO 80261
(303)232-2416
CONTRACTOR APPLICATION
FOR
EXEMPTION CERTIFICATE
Pursuant to Statute
Section 39-26.1140)(a)wX)
U
DO NOT WRITE IN THIS SPACE
The exemption certificate for which you are applying must be used only for the purpose of purchasing construction and building
materials forthe exempt project described below. This exemption does not include
or apply to the purchase or rental of equipment,
supplies, and materials which are purchased, rented, or consumed by the contractor and which do become
not a part of the
structure, highway, road, street, or other public works owned and used by the exempt organization.
Any unauthorized use of the exemption certificate will result in revocation of your exemption certificate
by law. and other penalties provided
A separate certificate is required for each contract.
Subcontractors will not be issued Certificates of Exemption by the Department of Revenue. It is the responsibility of the prime
contractor to issue certificates to each of the subcontractors. (See reverse side.)
FAILURE TO ACCURATELY COMPLETE ALL BOXES WILL CAUSE THE APPLICATION
TO BE DENIED,
Registration/Account No. (to be assigned by DOR) Period
89 - 0170-750 (999) $0.00
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Trade nameIDEA,
Owner, partner, or corporate name:
Mailing address (City, State, Zip): Contact Person
E-mail address: Federal Employer's Identification Number: Bid amount for your contract:
Fax number: Business telephone number. Colorado withholding tax account number.
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Name of exempt organization (as shown on contract):
Exempt organization's number:
98 -
Address of exempt organization (City, State, Zip):
Principal contact at exempt organization: Principal contact's telephone number.
Physical location of project site (give actual address when applicable and Cities and/or County lies) where is
project located)
Scheduled Month Day Year
Estimated Month Dey Year
construction start date:
completion date:
./✓ t 4 j y
,: 2el.}5
Y
y
I declare under penalty of perjury in the second degree that the statements made in this applicatien are true and
complete to the best of my knowledge.
ignature of owner, partner or corporate officer.
Title of corporate officer:
F
Date:
UU NU I WRITE BELOW THIS LINE
SECTION 00610
PERFORMANCE BOND
Bond No. 929174365
KNOW ALL MEN BY THESE PRESENTS: that
(Firm). Insituform Technologies. Inc.
(Address) 702,Spirit 40 Park Driye Chesterfield MO 63005
(an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal' and
(Firm) National Fire Insurance Company of Hartford
(Address) P.O. Box 419375, Kansas City, MO 64179-0461
hereinafter referred to as "the Surety", are held and firmly bound unto City of F rt o ins 30q
Laporte Ave Fort Collins Colorado 80522 a (Municipal Corporation) hereinafter referred to as the
"OWNER", in the penal sum of Two hundred one thousand three hundred eighty-six _
dollars and no/100 (S 201,386.00 )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 CONDITIONS OF THIS OBLIGATION are such that whereas the Principal entered into a
certain Agreement with the OWNER, dated the 1st day of March 12001 , a copy of
which is hereto attached and made a part hereof for the performance of The City of Fort Collins
project, 2001 Insituform Projects
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the
undertakings. Covenants, terms, conditions and agreements of said Agreement 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 life of the guaranty period, and if the Principal shall satisfy all
claims and demands incurred under such Agreement, and shall fully indemnify and save harmless
the OWNER from all cost and damages which it may suffer by reason of failure to do so, and shall
reimburse and repay 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.
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 Agreement 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 Agreement 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.
PROVIDED, FURTHER, that the Surety Company must be authorized to transact business in the
State of Colorado and be acceptable to the OWNER.
IN WITNESS WHEREOF, this instrument is executed in four (4) counterparts, each one of which
shall be deemed an original, this 1 day of March ,2001 .
19'i-'*testing Officer
IN PRESENCE OF:
IN PRESENCE OF:
(Surety Seal)
Principal
Insotuform Technolo 'es inc.
BY: t
(Title) Salvatore Vitale
Area Vice President North America
702 Spirit 40 Park Drive, Chesterfield, MO 63005
(Address)
Other Partners
By:
By:
Sure'
National Fire Lurance Company of Hartford
Kathleen A. Petchulat
Attorney -in -Fact
By:r9.���
1910 Pine
St. Louis. MO 63103
(Addresss)
NOTE: Date of Bond must mtt be prior to date of Agreement. If CONTRACTOR is
Partnership, all partners should execute Bond.
SECTION 00615
PAYMENT BOND
Bond No. 929174365
KNOW ALL MEN BY THESE PRESENTS: that
(Firm) Insituform Technologies. Inc.
(Address) 702 Spirit 40 Park Drive Chesterfield MO 63005
(an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal' and
(Firm) National Fire Insurance Company of Hartford
(Address)P.O. Box 419375. Kansas City. MO 64179-0461
hereinafter referred to as "the Surety", are held and firmly bound unto the city of Fort Collins 300
Laporte Ave. Fort Collins..Colorado 80522 a (Municipal Corporation) hereinafter referred to as "the
OWNER", in the penal SUM Of Two hundred one thousand three hundred eighty-six _
dollars ($ 201,386.00 )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 CONDITIONS OF THIS OBLIGATION are such that whereas the Principal entered into a
certain Agreement with the OWNER, dated the 1 day of March 2001 , a copy of
which is hereto attached and made a part hereof for the performance of The City of Fort Collins
project, 2001 Insituform Projects
NOW, THEREFORE, if the Principal shall 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 Agreement and any authorized extension or modification thereof, Including all amounts
due for materials, lubricants, repairs on machinery, equipment and tools, consumed, rented 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 and agrees that
no change, extension of time, alteration or addition to the terms of the Agreement 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 Agreement 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 clalm may be unsatisfied.
PROVIDED, FURTHER, that the Surety Company must be authorized to transact business in the
State of Colorado and be acceptable to the OWNER.
IN WITNESS WHEREOF, this instrument is executed in four (A) counterparts, each one of which
shall be deemed an original, this I day of March , 2001.
IN PRESENCE OF:
Jo3 OA 1 th
,m
fe*oTjP $.,,,"sting Officer
ir�ne r
(Corporate, Seel)
IN PRESENCE OF:
M-
IN PRESENCE OF:
(Surety Seal)
Principal
Insituform Technologi Inc.
By: —
Salvatore 1
Ame lca
(Title)
702 Spirit 40 Park Drive Chesterfield MO 63005
(Address)
Other Partners
By:
By:
Surety
National Fire Insurance Company of Hartford
Kathleen A. Petchulat
(Attorney -in -Fact)
a;
By II"gou, ✓, C�u.t�dol
1910 Pine, St. Louis, MO 63103
(Address)
,si r
r
NOTE: Date of Bond must !fit be prior to date of Agreement. If CONTRACTOR is
Partnership, all partners should execute Bond.
State of Missouri }
County of St. Louis} ss:
On 3 -1 -01 , before me, a Notary Public in and
for said County and State, residing therein, duly commissioned and sworn,
personally appeared Kathleen A. Petchulat
known to me to be Attorney -in -Fact of National Fire Insurance Company of Hartford
the corporation described in and that executed the within and foregoing
instrument, and known to me to be the person who executed the said
instrument in behalf of the said corporation, and he/she duly acknowledged
to me that such corporation executed the same.
IN WITNESS WHEREF, I have hereunto set my and affixed my official
s ;eargl te1*1}Ithis ertificate above.
Notary Public —Notary Seal
STATE OF MISSOURI
St. Louis County
My Commission Expires October 11, 2004
Notary Public
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That Continental Casualty Company, National Fire Insurance Company of Hartford, Connecticut,
and American Casualty Company of Reading, Pa. (herein called "the CNA Companies"), are duly organized and existing corporations having
their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby
make, constitute and appoint
Stephen E. Ricci, Thomas C. Ricci, Jr., Kathleen A. Petchulat, Kathleen M. Hoffard, Individually
of St. Louis, Missouri
their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf
bonds, undertakings and other obligatory instruments of similar nature
-- In Unlimited Amounts ---
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their corporations
and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse
hereof, duly adopted, as indicated, by the Boards of Directors of the corporations.
In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to
be hereto affixed on this 22nd day of January, 2001.
F GOr1RArE Q = ;
ZO 2 s ~ JULY 11.
0 SEAL t y ,apt ism
i897
Continental Casualty Company
National Fire Insurance Company of Hartford, Connecticut
American Casualty Company of Reading, Pa.
State of Illinois, County of Cook, ss: Michael Gengler Group Vice President
On this 22nd day of January, 2001, before me personally came Michael Gengler to me known, who, being by me duly sworn, did depose
and say: that he resides in the City of Chicago, State of Illinois; that he is a Group Vice President of the Continental Casualty Company,
National Fire Insurance Company of Hartford, Connecticut, and American Casualty Company of Reading, Pa. described in and which executed
the above instrument; that he knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; that
they were so affixed pursuant to authority given by the Boards of Directors of said corporations and that he signed his name thereto pursuant to
like authority, and acknowledges same to be the act and deed of said corporations.
♦NNNN�N}/N��N�♦N♦♦♦� ♦♦♦♦♦♦
♦ OMC1AL SEAL
DIANE FAULKNER
nw.ry ►urw. sw. w iwnd. I
N♦NNNINNN♦♦N
My Commission Expires September 17, 2001 Diane Faulkner
CERTIFICATE
Public
I, Mary A. Ribikawskis, Assistant Secretary of the Continental Casualty Company, National Fire Insurance Company of Hartford,
Connecticut, and American Casualty Company of Reading, Pa. do hereby certify that the Power of Attorney herein above set forth is still in
force, and further certify that the By -Law and Resolution of the Board of Directors of the corporations printed on the reverse hereof is still in
force. In testimony Whereof I have hereunto subscribed my name and affixed the seal of the said corporations this day of
(Rev. 1/10/01)
Continental Casualty Company
National Fire Insurance Company of Hartford, Connecticut
American Casualty Company of Reading, Pa.
Mary A. Ribikawskis Assistant Secretary
Authorizing By -Laws and ResolL.,ons
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of
Directors of the Company.
"Article IX —Execution of Documents
Section 3. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Executive, Senior or
Group Vice President may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to
the limitations set forth in their respective certificates of authority, shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto. The Chairman of the Board of Directors, the
President or any Executive, Senior or Group Vice President or the Board of Directors, may, at any time, revoke all power and authority
previously given to any attorney -in -fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 3 of Article IX of the By -Laws, and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so
executed and sealed and certified by certificate so executed and sealed shall, with respectto any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of
Directors of the Company.
"Article VI —Execution of Obligations and Appointment of Attorney -in -Fact
Section 2. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Executive, Senior or
Group Vice President may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to
the limitations set forth in their respective certificates of authority, shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto. The President or any Executive, Senior or Group Vice
President may at any time revoke all power and authority previously given to any attorney -in -fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 2 of Article VI of the By -Laws, and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so
executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attorney is made and executed pursuant to and by authority of the following Resolution duly adopted on February 17,
1993 by the Board of Directors of the Company.
"RESOLVED: That the President, an Executive Vice President, or any Senior or Group Vice President of the Corporation may, from
time to time, appoint, by written certificates, Attorneys -in -Fact to act in behalf of the Corporation in the execution of policies of insurance,
bonds, undertakings and other obligatory instruments of like nature. Such Attorney -in -Fact, subject to the limitations set forth in their
respective certificates of authority, shall have full power to bind the Corporation by their signature and execution of any such instrument
and to attach the seal of the Corporation thereto. The President, an Executive Vice President, any Senior or Group Vice President or
the Board of Directors may at any time revoke all power and authority previously given to any Attorney -in -Fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"RESOLVED: That the signature of the President, an Executive Vice President or any Senior or Group Wice President and the seal
of the Corporation may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of
Directors on February 17, 1993 and the signature of a Secretary or an Assistant Secretary and the seal of the Corporation may be
affixed by facsimile to any certificate of any such power, and any power or certificate bearing such facsimile signature and seal shall be
valid and binding on the Corporation. Any.such power so executed and sealed and certified by certificate so executed and sealed, shall
with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Corporation."
ACM
CERTIFICAI " OF LIABILITY INSUR...dC STEODATE (MMI02/26/0
�2 /O1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lockton Companies/St . Louis HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1 Cityplace Drive, Suite 160 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Louis MO 63141 INSURERS AFFORDING COVERAGE
Phone:314-432-0500
iNsuacn I INSURER A: Liberty Mutual Fire Insurance
Insituform Technologies, Inc.
702 Spirit 40 Park Drive
Chesterfield MO 63005
COVERAGES
INSURERB: Liberty Insurance Corp. j
INSURER C:
INSURER D: #3
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI IHS I ANUINU
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 POLICY EFFECTRIF-WOUCY
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYV DATE MMIDDIYY EXPIRATION
LIMITS
EACH OCCURRENCE
$ 1,000,000
GENERAL LIABILITY
A X COMMERCIAL GENERAL LIABILITY RG2-641-004218-030 07/01/00 07/01/01
FIRE DAMAGE (Any one fire)
S 100,000
CLAIMS MADE X OCCUR',
MED EXP (Any one person)
$ 10,000
. X INDPNT CONTRACTOR'' BROAD Form FD/corm rJAL
PERSONAL a ADV INJURY
$ 1 , 000 , 000
X XCU BLKT WAIVER OF SUBRO.
GENERAL AGGREGATE
s2,000,000
--' GEN'L AGGREGATE LIMIT APPLIES PER: Blkt Additronal insured
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X PRO
JE- LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$ 1 000 , 000
A X ANY AUTO AS2-641-004218-020 07/01/00 07/01/01
(Ea accident)
,
'L ALL OWNED AUTOS BLXT ADDITIONAL INSQ D
BODILY INJURY
$
SCHEDULED AUTOS BLKT WAIVER OF SUBRO
(Per person)
X HIRED AUTOS
BODILY INJURY
$
(Per accident)
X NON -OWNED AUTOS
i
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
—
AUTO ONLY AGG
$
EXCESS LIABILITY
EACH OCCURRENCE
$ ;
OCCUR CLAIMS MADE
AGGREGATE
$
—f
S
DEDUCTIBLE
$
RETENTION $
$
WORKERS COMPENSATION AND
X TOLIMITS ER
RY
B EMPIOYERS'LIABIUTY !, WC7-641-004218-010 07/01/00 07/01/01
E.L. EACH ACCIDENT
$ 1,000,000
BLKT WAIVER OF SUBRO
E.L. DISEASE- EA EMPLOYEE.$ 1, 000, 000
E.L. DISEASE - POLICY LIMIT
$ 1 , 000 , 000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: 2001 CURED IN PLACE PIPE, MASTER SERVICE AGREEMENT AND WORK ORDER X
NO. 503-1-01. CITY OF FORT COLLINS IS INCLUDED AS ADDITIONAL
INSURED UNDER GENERAL LIABILITY AND AUTO LIABILITY AS RESPECTS
THE
OPERATIONS OF THE INSURED.
r�C�Tt CII"ATC uni IIGD m enmmnmAi pNSURFn• INSIIRFR LETTER: CANCELLATION
3FORT05 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILLK%tX1KWyO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ��IY/iLIZt
CITY OF FORT COLLINS IMOCOMML11113milig�Qypq$p) pyg 7gy7( 757CaQ
P.O. BOX 580
FORT COLLINS, CO 80522-0580
ACORD 25-S