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Home My WebLink AboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEDATE (MMIDDIYY) ACORDTa CERTIFICATE OF LIABILITY INSURANCE 04/01/2006 03/23/2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lockton Companies ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 444 W. 47th Street, Suite 900 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Kansas City Mo 64112-1906 ALTER THE COVERAGE AFFORDED BY THE POLI ES (816) 960-9000 INSURERS AFFORDING COVERAGE INSURED LAFARGE WEST, INC. 1060502 NORTHERN PAVING 1800 N. TAFT HILL ROAD FORT COLLINS CO 80521 T A VXTnAl rw Iiuvcl1 VGJ LAl'11 vvl rl1 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 AT MMIDDIYY POLICY EXPIRATION DATE [MMlDDlYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X1 CLAIMS MADE D OCCUR GL3314756 04/01/2005 04/01/2006 EACH OCCURRENCE 2,000,000 FIRE DAMAGE (Any one fire $ 500,000 MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ Excluded GEN'L AGGREGATE LIMIT APPLIES 17 POLICYF—1 PET PER: LOC PRODUCTS - COMPIOP AGG $ 2,000,000 A A A A B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA2651851 (AOS) CA2651853 (MA) CA2651852 (TX) CA2651854(VA) CA2651855 (OR) 04/01/2005 04/01/2006 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident) $ XXXXXXX PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LUUBILITY ANY AUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC AUTO ONLY: AGG XXXXXXX $ XXXXXXX EXCESS LIABILITY OCCUR CLAIMS MADE UMBRELLA DEDUCTIBLE FORM RETENTION $ NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX XXXXXXX XXXXXXX $ XXXXXXX C A B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC3599065 (AOS) WC3599067 (CO) WC3599068 (OR) WC3599066 WI /WC3599069(Ni)E.L. 04/01/2005 04/01/2006 OTH- X WC STATU- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE -EA EMPLOYEE $ 2,000,000 DISEASE -POLICY LIMIT I $ 2,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS THE GENERAL LIABILITY POLICY IS SUBJECT TO A PRODUCTS -COMPLETED OPERATIONS AGGREGATE ONLY. NO GENERAL AGGREGATE APPLIES AS THE POLICY WILL RESPOND TO EACH AND EVERY OCCURRENCE WITH A LIMIT OF LIABILITY SHOWN. THE CITY OF FORT COLLINS AND THE CITY OF FORT COLLINS ENGINEERING DEPARTMENT ARE ADDITIONAL INSUREDS (EXCEPT ON WORKER'S COMP) AS RESPECTS OPERATIONS OF THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. RE: ASPHALT OVERLAY PROJECT 2005 2257039 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ATTN: JAMES O'NEILL PO BOX 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL FORT COLLINS CO 80522 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S (7/971 For questions regarding this nnincate, contact the number listed in the 'Pruducee section abe" and specify the cuem code 'LAFNOdr. ®ACORD C PORATION 1988 R5643500A Shipped From AQUA BEN 1390 N MANZANITA ST ORANGE CA 92867-3602 Ordered 03/09/2005 Freight Requested 03/09/2005Order Taken By Delivery Line Description / Supplier Item addendum to blanket 5 SC Q o7 / 0 REQUISITION CITY OF FORT COLLINS Order Number Branch/Plant Ship To WATER RECLAMATION - DRAKE FACILITY CITY OF FORT COLLINS 3036 E DRAKE ROAD FORT COLLINS CO 80525 Quantity UOM Unit Price Extended Price Branch Plant LS .0000 30,000.00 503 Totals 'ram O P 03/25/2005 Page - 1 22902 - 000 - OR 1 Account Number Buyer Number 132000.534115 5 30,000.00 Ed Bonnette - Re: Addendum Page 1 From: Michele Warren To: Ed Bonnette Date: 3/28/2005 9:32:18 AM Subject: Re: Addendum No, it is Aqua Ben, poly charge number. Thanks for the catch M >>> Ed Bonnette 3/28/2005 8:43:53 AM >>> Good Morning Michele, Is req 22902 for Aqua Ben (PO 5500070) or for ACM -Texas (PO 5500069)? Req is to Aqua Ben, but it says addendum to 5500069 which is ACM -Texas. I'm thinking ACM is the one you really want - Ed Bonnette, C.P.M., CPPB Buyer City of Fort Collins, Colorado Purchasing Division 215 N. Mason, 2nd Floor P.O. Box 580 Fort Collins, CO 80522 Phone 970-416-2247 Fax 970-221-6707 email ebonnetteefcoov.com Date: 03/25/05 City of Fort Collins Page Number: 1 City of Fort Collins Purchase Order Number: 5501920 Delivery Date: 03/25/05 Buyer: DICK,OPAL Purchase Order number must appear on invoices, packing lists, labels, bills of lading, and all correspondence. Note: Line Oty/Units Description Extended Price 1 6106573-00 2,211.00 This order is rlQt/ialid over $2000 unless signed by James B. O'Neill II, CPPO, FNIGP City of Fort Collins Purchasing, PO Box 580, Fort Collins, CO 80522-0580 Phone: 970-221-6775 Fax: 970-221-6707 Email: info@ci.fort-collins.co.us Total $2,211.00 City of Fort Collins Accounting Department PO Box 580 Fort Collins, CO 80522-0580 No Text Date: 03/25/05 City of Fort Collins Page Number: 1 City of Fort Collins Purchase Order Number: 5501923 Delivery Date: 03/25/05 Buyer: HUME,JAMES Purchase Order number must appear on invoices, packing lists, labels, bills of lading, and all correspondence. Note: Line Qty/Units Description Extended Price 1 3 EACH 18,372.00 2005 SOLORIDER ALTEEA Per bid #5902, Attn: Jason Masek Dept: Golf City contact: Jim Hume, 970-221-6776 Total '.n This order is rhahalid over $2000 unless signed by James B. O'Neill II, CPPO, FNIGP City of Fort Collins Purchasing, PO Box 580, Fort Collins, CO 80522-0580 Phone: 970-221.6775 Fax: 970-221-6707 Email: info@ci.fortcollins.co.us $18,372.00 City of Fort Collins Accounting Department PO Box 580 Fort Collins, CO 80522-0580 O3/25/2005 FRI 09:54 FAX 970 221 6586 CITY OF FT COLLINS CLRS Q 003/007 OS Y%BOOS MASEK GOLF CAR TO 18:10 30FAX 970 All 0686 CITY OF FT COLLINS CLpS COMP PAGE 03 �,��I�Z7�0OS/OOO Po 7 Car shall have adequate ground dearenoe to dlmb 0 curb or obatmcVon Without high cantering. traverse a high Entry: Drhrer may enter car from either Ion or right side. Controfs: Car shall haWa hand operated Controls for acoeletaGon breaking, etaeling, dIrsiWanal control, and onfaff ewltch. Driver shall be with Ow left or right hand. Ida to open>Jte car ant; car shall have a swivding 89at with hand operated toclting/unlockl ng medmnlsm. SYch seat shall be able to w" a lull amoUnt ballow Opel adequate pcelluning to sd&M the bell. Seat Slag also bo able to place rider in a standing poeiBon. BeNs: Car shall provide both waist and Chest begs to lute u edC operator, q4' ire Transfer Bar. Car SWI be provided with a transfer bar to feciftle the operators era WiWt f}vrn car. "Mer(s): Car shall be prwAded with holder(s) for eseiettva devlces Stroh tee crutc or canes. Bag HoIW. tier shell be provided with a golf b" holder that proew is the gar atubs In a manner easily accessible to the operator in the aeeL Golor, VWIW or beige prefen'ed, however Omen is elroep[ablB, Accessories: I MI; holders). soorecard holier, and atonlge aw0vurwnt ere desirable. Any and all OQIOf aocessarles [IdYt;aiised 83 stertdard by m�trrPaehlrer the modeht listed. Camplanoe: Car SW have been tested to and passed the s(ap�W regtgrentarits cf the American National standards Insdtute (ANSO fcrfd mmplrettoe w6h the Amer," with CrMobligm Ate (ADN, SM1fen": Smndard are year parts and kkbor oommenuing hvm Me data ordelhroy. T•c tiilD IPROPORAL I+IAke�o�o R:d�„ Modal Ai Year �05 Base Prtom Par Unit S r �J Base Price For a un is S 16 3 7Z Iderl* iocatlan of the nearest aathaieed,tuvice facility: 5 03/25/2005 FRI 09:55 FAX. 970 221 6586 CITY OF FT COLLINS CLRS Q 004/007 03/23/2805 12:09 308-436-2800 aua aerJo MASEK GOLF CAR COMP PAGE 01 FAA "Yo xsl eJes CITY Or PT GOLLINS CLRS �ooeiooe aA FRINIGHT TE M6 FOB dent gnaw , Oislpht pmpmld. All I WQM dt %ma must be Induded In bld PH WI. 0-0 DEUVORY DsIIVary will oe*W—Z 1.._ OW M%r proper 110110CMIon of bid award. 10.0 CONTRAcwR'S STATEMENT set wo read and my Understand aN the oonddlons, dons, snd epec�l instrucaons nslr3ln pm-aWMhs 1.0 thmugh 9.o, I herby gar,* to comply MM so sold cons ons, spedd tnoumons, and spedfMgcns as stated ar IrooW. T)bB: PdmName: Trion lYlase. V Company: mmse.K C' C0 0";3 /23 a Street: 1$$ol E 1,77 Ave, Phones: 303 - 367- g08N aV p' Avropq t; 0 13001 1 Fg7cs: '3 03 - 3 67•so84 6 SoloRiderTm Design Features The SoloRiderTm Solution: • Four wheel automotive type suspension for a smooth ride • Ergonomic hand controls for disk brakes and accelerator • Seat -side transfer bars for easy entry and exit • Convenient front mounted golf bag holder • Assistive device holders securely transport crutches, etc. • Multi -position patented 3600 swivel seat locks in any position • Infinitely adjustable electric stand-up seat placing player from seated to standing position • Waist and chest belts and leather pad secure the operator safely in position • 12.3 to 1 direct drive axle, double reduction helical gear • Stability exceeds applicable A.N.S.I safety standards • 36 volt electric motor (similar to standard golf cars) • Regenerative speed controller to prevent runaway even on slopes • 3 high performance 12 volt EV145 deep cycle industrial batteries • Lightweight and well balanced (ground pressure about 7 psi) • 18x8.5-8 tires, ribbed on front and turf tread on rear • Low maintenance • Low center of gravity allows secure operation on slopes • Top speed of 14 mph keeps pace with standard cars • Full 7inches of ground clearance traverses curbs with ease • Operator amenities including cup holder, storage pouches seat basket and ball holder R5643501t4 Shipped From MASEK GOLF CAR CO 15801 E 17TH AVE AURORA CO 80011 Ordered 31252005 Freight Requested 3252005 Order Taken By Delivery REQUISITION CITY OF FORT COLLINS Ship To GOLF ADMINISTRATION CITY OF FORT COLLINS 215 N MASON, 3RD FLOOR FORT COLLINS CO 80524-4408 3/25/2005 Page- 1 Order Number 23028 - 000 - OR Branch/Plant 1 Line Description / Supplier Item Quantity UOM Unit Price Extended Price Branch Account Number Buyer _ Plant Number 1.000 masek golf car LS .0000 18.372.00 508 660400.544310 3 golf cars Totals -�- - 18,372.00 cuPnt*. 1 a1 na nwpmavor ACORQM CERTIFICATE OF LIABILITY INSURANCE (M 0DATE 3/24/3/24/MIDD/YVVY) OS PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WAUSAU SIGNATURE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3430 OAKWOOD MALL DR --STE 300 EAU CLAIRE, WI 54701 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 715 835-6174 INSURERS AFFORDING COVERAGE NAIC # INSURED OWEN AYRES AND ASSOCIATES INC ATTN TOM STUMM PO BOX 1590 INSURER A: WAUSAU BUSINESS INSURANCE COMP NY INSURER B: EMPLOYERS INSURANCE OF WAUSAU INSURER : WAUSAU UNDERWRITERS INSURANCE O. NSURER D: EAU CLAIRE, WI 54702-1590 INSURER E: Lei, 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. LTR N TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 01/01/06 LIMITS A GENERAL LIABILITY YYKY91503188065 01/01/05 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR DAMAGE TO RENTED $300000 MED EXP (Anyone person) $5 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE $2 OOOw, OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POUCYF-j PRO- LOC A AUTOMOBILE LIABILITY X ANY AUTO ASKY91503188025 01/01/05 01/01/06 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA AOC $ ANY AUTO - $ AUTO ONLY: AGG B EXCESSIUMBRELLA X I LIABILITY OCCUR CLAIMS MADE THCY91503188035 01/01/05 01/01/06 EACH OCCURRENCE $5 000 000 AGGREGATE $5 00O 000 DEDUCTIBLE X $ RETENTION $ 10000 'Ci WORKERS COMPENSATION AND WCJY91503188045 01/01/05 01/01/06 X WC $LTATU�jIMIT OTR- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $10O 000 E.L. DISEASE - EA EMPLOYEE $100000 OFFICERIMEMBER EXCLUDED? It yes, describe under E.L. DISEASE - POLICY LIMIT 1 $500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PROJECT: CITY OF FORT COLLINS CONSULTING ENGINEERING SERVICES. NORTH COLLEGE DRAINAGE IMPROVEMENT PROJECT AND FUTURE WATER, WASTE WATER AND STORM WATER FACILITIES CAPITAL IMPROVEMENTS - PROJECT #P959. (See Attached Descriptions) CITY OF FORT COLLINS PURCHASING DEPARTMENT PO BOX 580 FORT COLLINS, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE MI wnu C k"uI/U6J 1 013 #360565 KW2 a ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 2&S 12001/081 s u�cneee ACORD . CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/25/2005 PRODUCER (970) 484-2805 John C. Beckett 6 Associates, Inc. 220 Smith Street Ft. Collins CO 80524- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 NAIC # INSURED Roger Albrecht DBA: Bic Klean 145 West Swallow Road, Ste A2 Fort Collins CO 80525-2500 INSURER A: EVANSTON INSURANCE CO. INSURER B: INSURER C: INSURER D: INSURER E: nnvcnAn_ec 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 ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECnVE D TE (MMIDDD/YY) POLICY DN ATE ( MIDD/YY) LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 500,000 PREMISES E.E rrence $ 50,000. X COMMERCIAL GENERAL LIABILITY MED EXP (Any one on $ 1,000 CLAIMS MADE Fx_] OCCUR CLOS0300449 07/25/2004 07/25/2005 PERSONAL A ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ X POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO NO COVERAGE / / / / COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Par Pin) $ ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Par accident) $ HIRED AUTOS NON -OWNED AUTOS / / / / PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO NO COVERAGE / / / / $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY NO COVERAGE / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE / / / $ RETENTION $ _ NO COVERAGE / / / / WORKERS COMPENSATION AND yy� u TOR LIIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? / / / / If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER NO COVERAGE DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS i.vr rronUrn unr non f:A1JCPl 1 ATInid SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT CITY OF FORT COLLINS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PURCHASING DIVISION INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE PO BOX 580 FORT COLLINS CO 80522- ACORD 25 (2001108) w AL vKu L uKrulw I Tun T aeD *,,; INS025 (Of 08).05 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Pape f of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) INS025(010e).05 Page 2of2 03/28/2003 MON 10:57 FAX 9702216282 TRAFFIC OPS a006/006 qar 70 0$ 12%07e neeebe Merv! ARM FICATE OF TAG-p.00 SZW= DAMP ItI'D 7050 11 120TH ATS SUIT: 30 BROOKPS= CO 80020 w_ " �now seaC � CM CC 80022 Alx u .WOMB !'ROLE FOOD DISTITBUTIOW/ICi CITY OF FT OOZZINS RISK NAtf716F. mlr PO BOX SSO TB COLLImS Co 80522 a Ohour 90348aMo14 0/20/04 , 3120/05 IFS"` a*= suns i 750P000 s �s+r�wwr�a��rwuss�ne�w r�a�cwr�eers� �narMll+ew r�.� ■es �rnse Nq r NalAC4�i MMMM ■r was i!R ��ArM�w M r eiwa e>a� we�IIMM w lrlirrl M NM,i>• uer+s'sise,�w�un� s+ FWWM7fi LO 'd UL9IZZOL6 ON XVA 30NUNIA OAO Rd 98:80 I41 90OZ-5Z—M City of Fort Collins Page Number: 1 City of Fort Collins Date: 03/25/05 BLANKET Purchase Order Number: 5501922 Delivery Date: 12/31/05 Buyer: HUME,JAMES Purchase Order number must appear on invoices, packing lists, labels, bills of lading, and all correspondence. Note: Line Qty/Units Description Extended Price 1 1 lot 2,001.00 BLANKET ORDER TO COVER THE COST OF MISCELLANEOUS CAR WASHING SERVICES FOR FISCAL YEAR 2005. ALL INVOICES TO INCLUDE VEHICLE NUMBER AND DRIVERS NAME PRINTED AS WELL AS SIGNED. THIS PURCHASE ORDER IS FOR THE PROCUREMENT OF GOODS AND/OR SERVICES, AS NEEDED DURING THE CURRENT PHYSCIAL YEAR. DOLLAR AMOUNTS SPECIEFIED ARE ESTIMATES AND NOT A PROMISE TO PURCHASE ANY MINIMUM AMOUNT OF GOODS AND/OR SERVICES. Total clty of Fort G in Director of Purchasing and Risk Management This order is slid over $2000 unless signed by James B. O'Neill II, CPPO, FNIGP City of Fort Collins Purchasing, PO Box 580, Fort Collins, CO 80522-0580 Phone: 970-221-6775 Fax: 970-221-6707 Email: info@ci.fort-collins.co.us $2,001.00 City of Fort Collins Accounting Department PO Box 580 Fort Collins, CO 80522-0580 R5643500A Shipped From RICHIE'S EXPRESS CAR WASH LLC 3141 S COLLEGE AVE FORT COLLINS CO 80525-2628 Ordered 312312005 Freight Requested 3123/2005 Order Taken By Delivery REQUISITION CITY OF FORT COLLINS Ship To FLEET SERVICES - MAIN SHOP CITY OF FORT COLLINS 835 WOOD ST FORT COLLINS CO 80521 3/25/2005 Page - 1 Order Number 22995 - 000 - OR Branch/Plant 1 Line Description / Supplier Item Quantity UOM Unit Price Extended Price Branch Account Number Buyer Plant Number 1.000 1 lot LS .0000 2,001.00 550 —� 564112.529290 —_ 3 - BLANKET ORDER TO COVER THE COST OF MISCELLANEOUS CAR WASHING SERVICES FOR FISCAL YEAR 2005. ALL INVOICES TO INCLUDE VEHICLE NUMBER AND DRIVERS NAME PRINTED AS WELL AS SIGNED. THIS PURCHASE ORDER IS FOR THE PROCUREMENT OF GOODS AND/OR SERVICES, AS NEEDED DURING THE CURRENT PHYSCIAL YEAR. DOLLAR AMOUNTS SPECIEFIED ARE ESTIMATES AND NOT A PROMISE TO PURCHASE ANY MINIMUM AMOUNT OF GOODS AND/OR SERVICES. Totals 2,001.00 City of Fort Collins Page Number: 1 City of Fort Collins Date: 03/28/05 BLANKET Purchase Order Number: 5500070 Delivery Date: IZIJI u5 Buyer: BONNETTE, ED Purchase Order number must appear on invoices, packing lists, labels, bills of lading, and all correspondence. Note: THIS PURCHASE ORDER IS FOR THE PROCUREMENT OF GOODS AND/OR SERVICES, AS NEEDED DURING THE CURRENT CALENDAR YEAR. DOLLAR AMOUNTS SPECIFIED ARE ESTIMATES AND NOT A PROMISE TO PURCHASE ANY MINIMUM AMOUNT OF SUCH GOODS AND/OR SERVICES. Line Qty/Units Description Extended Price 2 1 LOT 30,000.00 ADDENDUM TO PO #5500070 (REQ #22902) Total $30,000.00 .... City of Fort Collins This order is alld over $2000 unless signed by James B. O'Neill II, CPPO, FNIGP Accounting Department City of Fort Collins Purchasing, PO Box 580, Fort Collins, CO 80522-0580 PO Box 580 Phone: 970-221-6775 Fax: 970-221-6707 Email: info@ci.fort-collins.co.us Fort Collins, CO 80522-0580