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HomeMy WebLinkAboutARROWHEAD - CONTRACT - RFP - 22962 P982 BOBCAT BONDSSECTION 00615 PAYMENT BOND Bond No. RCN 0578468 KNOW ALL MEN BY THESE PRESENTS: that Arrowhead Trails, Inc (Address) 11121 County Road 240, Salida CO 81201 (an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal' and (Firm) Old Republic Surety Company (Address) 1501 42nd Street West Des Moines IA 50266 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 Ninety -Two Thousand Eight Hundred Sixty - Nine and c)2/100----- ($ 82�22 _)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 June .2005 , a copy of which is hereto attached and made a part hereof for the performance of The City of Fort Collins project, P982 Bobcat Ridge Natural Area Trail Design & Construction 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 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. 9/99 Section 00615 Page 1 Date: 5/24/05 Time: 8:21 AM To: M 91970-221-6707 Pinnacol Assurance Page: 002-003 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnaml Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 1 AFFr1RF)FTI RV TT4F Pr1T TOPPq RAT nut INSURED ARROW HEAD TRAILS INC. 11121 COUNTY ROAD 240 SALIDA CO 81201 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OP INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY IXFIRAT ION LIMITS LTR DAT mryad/ DAT meryda/ GENERAL IJA111UTY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO CLAIMS MADE 11 OCCUR PERSONAL &ADV INJURY OWNER'S & CONY RACTOR'S PROT EACH OCCURRENCE FIRE DAMAGE —file AUTOMOBILE LIABIL Y ANYAUTO COMBINED SINGLE LIMIT BODILY INURY ALLOWNFDAUTOS SCHEDULED AUTOS HIREDAUTOS BODILY INJURY NON OWNEDALTOS xeideN PROPERTY DAMAGE GARAGE LIABILITY AUI O ONLY - EA AMDENT OTHER THAN AUTO ONLY: ANY AUTO CESS LIABILITY UMBRELLA FORM WORKERS COMPENSATION AND NJ WC STATU- U OTHER ENIMMERS' LIABILITY TOAY LIMITS ... ' .. A 4000420 05/01/2005 05/01/2006 EL EACH ACCIDENT 1100 000 THEPROPRTETOR/PARTNERS/ INQ EL DISEASE - POLICY LIMIT $500000 IXECUTIVEOFFICERSARE: IX2 ELDISEASE-EA EMPLOYEE lOO OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESJSPECIAL IT EMS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL 836801 ........................ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF FORT COLLINS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 215 N MASON STREET PO BOX580 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FORT COLLINS CO 80522 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVE AUTHORIZED REPRESENTATIVE Janice Hurd PALLENSMCSRSWISr1 CbJNA/ 08:2130 4000410 LrdaledUWJSS Date: 5/24/06 Time: B:21 AM To: ® 91970-221-6707 CERTIFICATE HOLDER COPY Pinnacol Assurance Page: 003-003 CITY OF FORT COLLINS 215 N MASON STREET PO BOX580 FORT COLLINS CO 80522 POLICY NUMBER: 4000420 BUSINESS LOCATION: ARROW HEAD TRAILS INC CLASSIFICATION OF OPERATION CLASS DESCRIPTION 910205 PARKS N.O.C.-ALL EMPLOYEES & DRIVERS COVERAGE COVERAGE RATING EFFECTIVE EXPIRES TYPE 05/01/2005 05/01/2006 EM IN WITNESS WHEREOF, this instrument is executed in four (4) counterparts, each one of which shall be deemed an original, this 8thday of June , 2005 IN PRESENCE OF - (Corporate Seal) IN PRESENCE OF: By: IN PRESENCE OF: L�i ee Read Principal By: Arrowhead Trails, Inc itle)Danna Boone, Vice -President 11121 County Road 240, Salida CD 81201 (Address) By: By: Other Partners Surety Old Republic Surety Company (Attorney -in -Fact) By: a Eric B. Lun ber orne -In-Fact F' (Address) 1501 eet West Des Moines IA 50266 f�Swret� ��aq r�r NOTE, `;' Date of Bond must not be prior to date of Agreement. _a hip, all partners should execute Bond. If CONTRACTOR is 9/99 Section 00615 Page 2 �* OLD REPLBLIC II***** Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make; constitute and appoint: ERIC B. LUNDBERG, DIAHANN,L. GIORNO, KRIS BIELAK, TERRI L. PRINS, OF LAKEWOOD, CO its true and lawful Attorney(s)-in-Fact, with full power and authority, not exceeding $5,000,OOO, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (otherthan bail bonds, bankdepository bonds, mortgage deficiency bonds; mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardouswasteremediation bonds or black king bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED AN: AGGREGATE OF ONE MILLION ;DOLLARS($1,000,000)-------------------- ------ FOR ANY SINGLE OBLIGATION, REGARDLESS OF THE NUMBER OF INSTRUMENTS ISSUED FOR THE OBLIGATION. and to bind OLD REPUBLIC SURETY COMPANY thereby, and all:of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This document; is not valid unless printed on colored background and is multi -colored. This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. RESOLVED that, the president, any vice-president, or assistant vice president in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recog- nizances, and suretyshipobligations of all kinds; and said officers may remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER,that any bond, undertaking, recognizance, or suretyship obligation shall bevalid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be'required) by any secretary or assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant' secretary, and countersignedand sealed (if a seal be required) by a duly authorized attomey-in-fact or agent; or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys -in -fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by company to such person or persons. RESOLVED FURTHER,that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the cx> ny, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 20TH day of APRIL 2005. OLD REPUBLIC SURETY COMPANY _... oB qq`t SEAL ,g Assistant Secre President STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS On this 20TH day of APRIL, 2005 , personally came before me, JAMES E. LEE and DAVID G. MENZEL to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. Po ,'NOTAgy tp : N Notary Public s�,>tlatt° ,y 01/18/2009 a'jwwt9°°r' My commission expires: CERTIFICATE I, the undersigned, assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney, are now in force. 40-3595 , w" pa' SUgEry".6 3��° o : Signed and sealed at the City of Brookfield, WI this -day of •v core y o SEAL g _ MN e GKS INSURAN�C �,�iVCY, INC. Assistant?Azetary ORSC 22262 (3/04) SECTION 00610 PERFORMANCE BOND Bond No.RCN 0578468 KNOW ALL MEN BY THESE PRESENTS: that (Firm) Arrowhead Trails, Inc. (Address) 11121 County Road 240, Salida O 81201 (an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal' and (Firm) o c1 Republic Surety CompAny (Address) 1501 42nd Street, West Des Moines IA 50266 hereinafter referred to as "the Surety", are held and firmly bound unto 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 Ninety -Two Thousand Eight Hundred Sixty - Nine and 921100 - - - - - - - - - - - - - - ($92 j1Eq_,a2)inlawful 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 L,-,Lday of June 2o0 , a copy of which is hereto attached and made a part hereof for the performance of The City of Fort Collins project. P982 Bobcat Ridge Natural Area Trail Design & Construc ion. 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. 9l99 Section 00610 Page 2 IN WITNESS WHEREOF, this instrument is executed in four (4) counterparts, each one of which shall be deemed an original, this 8 t h day of June ,2005 . IN PRESENCE OF: Leanne Read (Corporate Seal) IN PRESENCE OF: IN PRESENCE OF: Principal Arrowhead Trails, Inc (Title) tYanna Boone, Vice -President Other Partners By: By: Surety Old Republic Surety Company Leanne Read Attorney -in -Fact Eric B. Lund er , e -In-Fact 1501 42nd Street e s Moines IA 50266 (Addresss) (Surety. Seal) -NO-r E: . Date of Bond must not be prior to date of Agreement. 'Partnership, atl partners should execute Bond. If CONTRACTOR is 9/99 Section 00610 Page 3 �* OLD REPLBLIC Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and appoint: ERIC B. LUNDBERG, DIA.HANN L. GIORNO, KRIS BIELAK, TERRT L. PRINS,, OF LAKEWOOD, CO its true and lawful Attorney(s)-in-Fact, with full power and authority, not exceeding $5,000,000, for and on behalf of the company as surety, to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (otherthan bail bonds, bankdepository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds, hazardous wasteremediation bonds or black lung bonds), as follows: ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED AN AGGREGATE OF ONE MILLION DOLLARS($1,000,000)-------------------- FOR ANY SINGLE OBLIGATION,' REGARDLESS OF THE NUMBER OF INSTRUMENTS ISSUED FOR THE OBLIGATION. and to bind OLD REPUBLIC SURETY COMPANY thereby, and all:of the acts of said Attorneys -in -Fact, pursuant to these presents, are ratified and confirmed. This document is not valid unless printed on colored background and is multi -colored. This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD REPUBLIC SURETY COMPANY on February 18, 1982. RESOLVED that, the president, any vice-president, or assistant vice president in conjunction with the secretary or any assistant secretary, may appoint attorneys -in -fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recog- nizances, and suretyship'' obligations of all kinds; and said officers may remove any such attorney -in -fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER,that any bond undertaking, recognizance, or suretyship obligation shall bevalid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (9 a seal be required) by any secretaryor assistant secretary; or (ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be required) by a duly authorized attomey-in-fact or agent; or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys-in-faet or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED FURTHER,that the signature of any authorized officer and the seal of the company may be affixed by facsimile to arty Power of Attorney or certification thereof authorong the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the oomparry; and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be affixed this 20TH day of APRIL 2005 . OLD REPUBLIC SURETY COMPANY 4 VJ COAIORftf � .{ ,o,.,SEAL I � Assistant Secre 'M 4 - President STATE OF WISCONSIN, COUNTY OF WAUKESHA - SS On this 20TH day of APRIL, 2005 , personally came before me, JAMES E. LEE and DAVID G. MENZEL to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say; that they are said officers of the corporation aforesaid, and that the seal affixed to the above -instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. Notary Public. 'r ey Q1/18/2009 `^f�K My commission expires: CERTIFICATE I, the under: foregoing and aM directors set fortl- 4-0-3'595 GKS INSURA assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of a Power of Attorney, are now in force. n wu y SugET� a Mff ov_ Signed and sealed at the City of Brookfield, WI this .day of CAL „A��%TCX, INC. ORSC 22262 (3/04) CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company it selection box is not checked. 6000 American Pky Madison, Wisconsin 53783-0001 Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.) Arrowhead Trails Inc Lonnie David (303) 451-1579 11121 County Rd 240 2770 Dagny Way Ste 116 Salida, CO 81201 Lafayette, CO 80026-8013 (065/311) 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 listed below. COVERAGES 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. TYPE OF INSURANCE POLICY NUMBER POLICY DAT LIMITS OF LIABILITY EFFECTIVE EXPIRATION Mo Day. Yr(Mo. Day, Yr Homeowners/ Bodily Injury and Property Damage Mobilehomeowners Liability Each occurrence $ 000 Boatowners Liability Bodily Injury and Property Damage Each Occurrence $ 1000 Personal Umbrella Liability Bodily Injury and Property Damage Each Occurrence $ ,000 Farm Liability & Personal Liability Farm/Ranch Liability Each Occurrence $ 000 Farm Employer's Liability Each Occurrence $ 000 Workers Compensation and Statutory •.♦••+#••••• Each Accident $ 000 Employers Liability t Disease - Each Employee $ ,000 Disease - Policy Limit $ ,000 General Liability General Aggregate $ 2,000 000 Products - CompletedO eraeonsAggregate $ 2,000 ,000 ® Commercial General Liability(occurrence) ❑ 05-X77578-01-00 4/30/2005 4/30/2006 Personal andAdvertlsin Injury$ 1,000,000 Each Occurrence $ 1.000 ,000 ❑ Damage to Premises Rented to You $ 100 000 Medical Expense (Any One Person) $ 5 000 Businessowners Liability Each Occurrancet t $ 000 Aggregatett $ ,000 Liquor Liability Common Cause Limit $ ,000 Aggregate Limit $ ,000 Automobile Liability Bodily Injury- Each Person $ '000 ❑ Any Auto ❑ All Owned Autos Bodily Injury - Each Accident $ ,000 ❑ Scheduled Autos Property $ El Hired Auto Damage 000 ❑ Nonowned Autos El,000 Bodily Injury and Property Damage Combined $ Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate $ 000 El Other (Miscellaneous Coveraaes) Additional Insured: City of Fort Collins DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS t The individual or partners shown as Insured ❑ Have ❑ Have not Landscaper elected to be covered as employees under this policy. t t Products -Completed Operations aggregate is equal to each occurrence limit and is included In policy aggregate. CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION " • Cityof Fort Collins LJ Should any of the above described policies be cancelled before the date '( expiration thereof, the company will endeavor to mail days) 215 N Mason St written notice to the Certificate Holder named, but failure to mall such PO Box 580 notice shall impose no obligation or liability of any kind upon the or representatives. 'TO days different Fort Collins, CO 80522 unless numcornber of days shown ® This certifies coverage on the date of issue only. The above described policies are subject to cancellation in conformity with their terms and by the laws of the state of issue. DATE ISSUED I PVTHPJ31ZED REPRE NTATIVVE 5/24/2005 r U-201 Ed. 5/00 Certificate Holder Stock No. 06668 Rev. 7/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE DENVER CO 80230-7006 1 AAR/IATIFII AV T P D T Tl TVC ➢M nvl INSURED ARROW HEAD TRAILS INC. 11121 COUNTY ROAD 240 SALIDA CO 81201 THIS IS O CERTIFY THAT THE POLICIES OF INSURANCE 11STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM AND 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 CO 1 TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECT% I POLICY EXP nON LIMITS Vol I CLAIMS MADE LJ OCCUR PERSONAL A ADV INJURY OWNER'S A CONTRACTOR'S PROT EACH OCCURRENCE PIKE DAMAG81 ®e Erzl MED 8XP we AlfrOMOBI LE LIABILITY ANY AUTO CtlA70NIHD SINGLE LIhET ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON -OWNED AUTOS aaidm[ PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACMENT ANY AUTO OTHER THAN AUTO ONLY: ............................ EACH ACCDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND WC STATII- OTHER "' EMPLOYERS' LlUnLITY TORY LIMITS A 4000420 05/01/2005 05/01/2006 EL EACH ACCIDENT 100.000 THE PROPRIETORIPARTNERS, INCL EL DISEASE - POLICY LIMIT 5000W EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE Slon,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECLUL rrEMB SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL 836801 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF FORT COLLINS EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 215 N MASON STREET PO BOX580 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FORT COLLINS CO 80522 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVI AUTHORIZED REPRESENTATIVE Janice Hurd KALL"SM CSR Sypo 0512N05 M:23:30 d000620 UplaleE: 1211511M 12:W:W UW133 Mai 24 05 08:31a P.2 insured's Name and Address Arrowhead Trails Inc 11121 County Rd 240 Salida, CO 81201 CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company it selection box is not checked. 6000 American Pky Madison, Wisconsin 53783-0001 Agent's Name, Address and Phone Number (Agt./Dist.) Lonnie David (303) 451-1579 2770 Dagny Way Ste 116 Lafayette, CO 80026-8013 (065/311) 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 listed below. COVERAGES This is to cenity, that policies of Insurance listed below have been issued to the Insured named above for the policy perlod inL5cated, notwithstanding any requirement, term or concflron of any contractor 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 pollees. TYPE OF INSURANCE POLICY NUMBER POLICY DATE LIMITS OF LIABILITY EFFECTIVE EXPIRATION (Me. Oil Yr (Mc Day. Yr Homeowners! Bodily Injury and Property Damage Mobilehomeowners Liability Each occurrence $ '000 Boatowners Liability Bodily Injury and Property Damage Each Oorurrence $ 1000 Personal Umbrella Liability Bodily Injury antl Properly Damage Each Occurrence $ ,000 Farm Liability g Personal Liability Farm/Ranch Liability Each Occurrence $ 000 Farm Employer's Liability Each Occurrence $ Q� Workers Compensation and Statutory Each Accident IS .000 Employers Liability t Disease - Each Employee $ '000 Disease - Policy ❑mlt $ '000 General Liability General Aggregate $ 2,000 000 Products - Completed OperattorisAggregate $ 2.000.000 ® Commercial General Liability (occurrence) ❑ 05-X77578.01-00 4/30/2005 4/30/2006 Personal andAdvertaln to u $ 1,000 Each Occurrence $ 1.000 ,Goo ❑ Dwane to Premises Rented to You $ 1I OW Medical Expense (Any One Person) $ 5 000 Businessowners Liability Each Occurrencet t $ '000 Aggregalett $ .000 Liquor Liability Oommon Cause Limit $ ,000 Aggregate Limit $ '000 Automobile Liability Body,Injury - EachPerson $ '000 ❑ Any Auto ❑ All Owned Autos Sadly Injury - Each Accident $ .000 ❑ Scheduled Autos $ CI Hired Auto Property Damage D00 ❑ Nonowned Autos ❑ Godly Irjury and Property Damage Combined $ ,ol Excess Liability ❑ Commercial Blanket Excess Eacn occurrencerAggregas $ ,000 Other fMiscellaneous Coveraees) Additional Insuretl: City of Fart Cogins CESCRIPTION OF OPERATIONS! LOCATIONS VEHICLES! RESTRICTIONS SPECIAL ITEMS t The individual or partners shown as Insured ❑ Have ❑ Have not Landscaper eteded to be, covered as ertyNoyaes most this policy. tt Products -Completed Operations aggregate is equal to each occurrence limit and is included in policy aggregate. CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION • City of Fort CollinsShould Y any of the above described policies be cancelled before the expiration date thereof, the company will endeavor to mail '( days) 215 N Mason St written notice to the Certificate Holder named, but failure to mail such PO 80x 580 noticppe shall impose no obligation or liabilityy of any kind upon the 'tof representatives. days unless different opt days Fort Collins, CO 80522 number shown -or OG This certifies coverage on the date of issue only. The above described policies are subject to cancellation in conformity with their terms and by the laws Of the state of issue. DATIESSILED 5/24/2005 1,#YTHI REP TIVE.' t P/7- y('( /[l III Ed. all Certificate Holder Stock No. 06668 Rev. 7102