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Home My WebLink AboutRESPONSE - BID - 5964 HAULINGBID SCHEDULE 5964 Hauling You may attach a separate page with an equipment list Please Include Finn name on It. TANDEM DUMP TRUCKS OTHER EQUIP -(—LIST TYPE) Failure to provide said equipment with qualified drivers as listed in the bid submitted may result in the removal of the vendor's name from the City's bidding list for a period of three years. FIRM NAME_V A 14 IM i Ch w�,E' I :rZ69jj�-= t V%!i Are you a Corporation, Partnership, DBA, LLC, or PC SIGNATURE 1��• PRINT NAME ADDRESS Co Tos 6 y PHONE of -) 0-(.> 9 0- i S S Z CELL PHONE -T Z(D'-'A 0 A- o;)LO t 3 FAX EMAIL p$S w.', @_ V1n06.in _ 60 inn SA Ja ,y 200E 03/12/2006 22:35 9704930226 CRAMER STATE FARM PAGE 01 A CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certNies that [] STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois ® STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois has coverage in force far the fgtlowina Named Insured as shown below: NAMED INSURED: MICHAEL, DWIGHT dba MICHAEL TRUCKING ADDRESS CIF NAMED INSURED: 600 ENDICOTT ST. , .FORT COLLINS CO 80524-3225 POLICY NUMBER SSS 9543-A26-06K 055 2176-D08-06G EFFECTIVE DATE OF POLICY 01/26/06-07/26106 10/08/05-04/08/05 DESCRIPTION OF 83 PETZMUILT 359 97 PETERWILT VEHICLE Pig ViMI ROMP 1XP9D29X0DP161II15 DUMP D374171GL LIASIUIY COVERAGE ❑ YES ® NO ® YES ❑ NO ❑ YES ❑ NO ❑ YES . ❑ NO LIMITS OF LIABILITY a. Bodily Injury Each Person 500,000 Each Accident 500,000 b. Property Damage Each Acckk nt 500,000 c. Bodly Injury & Progeny Damage Single Umit Each Accident 500,000 PHYSICAL DAMAGE COVERAGES ® YES ❑ NO ® YES ❑ NO C] YES ❑ NO 0 YES ❑ NO a. Comprehensive $ 2000 GeaucGLle $ 2000 Deductiible S Deductible $ Deductible ❑ YES ® NO 0 YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO b. Collision $ 080A bis $ 2000 Deductibb $ Dedudble $ Deduetbin awptAYE� CAR DYES ®NO ❑ YES ONO Q YES ©NO ❑ YES ❑ NO HIRE2mn899 Aelttry 0 YES ® NO ❑ YES 0 NO ❑ YES 0 NO ❑ YES ❑ NO FLEET- COVERAGE FOR ALLOWMANDUCENSED MOTORVEHKXES CI YES ® NO ❑ YES Q NO ❑ YES ❑ NO ❑ YES ❑ NO Of tim Title Agent's Coda Number Dau OM Add of Cediflade Hntdw Name and Address of Aaent CITY OF FORT COLLINS CRAMER STATE RAM PO BOX 580 GARY CRAMER FORT COLLINS CO 80522 1275 E MAGNOLIA ST. #1 FORT COLLINS CO 00524 INTERNAL STATE FARM USE ONLY: l3 PA quest poumm t CeAMiosts of IneuMrft for ligbift0"ems.0. 122429.3 Rev. 07-2e,2003 ❑ Request p rifflo M Molder to be added as an Addb(onal Insured.