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HomeMy WebLinkAboutRESPONSE - BID - 5964 HAULINGBID SCHEDULE 5964 Hauling You may attach a separate page with an equipment list-- Please include Firm name on it. WISH 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_ � tkbd(;,hm- �►� C, Are ��ou a Corporation', Partnership, DBA,_ LLC, or PC SIGNATURE V A-\ PRINT NAME ADDRESS PHONE 170 % (o b CELL PHONE 9 Q - 243- 37/9 FAX EMAIL_�� C,ow:S10 Nk� SA Jwuwy 2005 CERTIFICATE OF INSURANCE This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY,Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder Waldo Trucking, LLC Address of policyholder 9925 Waldo Lane Wellington, CO 80549 Location of operations various Description of operations dumptruc The policies listed below have been issued to the subiect to all the tarmQ PvtAintinnix anti nvAitinne n holder for the policy periods shown. The insurance described in these policies is 'n^6,4G Tha U.N. ^f liehilih, eh,,,un , h.- a k__ ,ra a 6 - -:A J� POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Date Expiration Data LIMITS OF LIABILITY at begiming of policy Comprehensive BODILY INJURY AND Business Liability PROPERTY DAMAGE This insurance includes: ❑ Products - Completed Operations ® Contractual Liability ® Underground Hazard Coverage Each Occurrence $ ® Personal Injury ® Advertising Injury General Aggregate $ ® Explosion Hazard Coverage Products - Completed ® Collapse Hazard Coverage Operations Aggregate $ ❑ General Aggregate Limit applies to each project EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date iration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ Other Aaarenate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease - Policy Limit POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Dats ExDlratlon Date at beginning of policy period) Binderto 0 Name and Address of Certificate Holder City Of Fort Collins Fort Collins, Colorado SWO94 a 2-90 Printed in U.SA IT any of ule aescnbed policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 4 5 days before cancellation. If, however, we fall to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Signature of Authored Represent( ive Title b FRONTIER D. LAWSER 06-1478 NORTHERN COLORADO F625 ❑ Og. To be used for Commercially Rated Vehicles, School and °" Church Buses and Related Vehicles IXMI1 MPOLICY NO n REPLACE$POL YNO. VEN. VEH i-i• t_I ni < ttnUSE aTME APPUCMR'S NAME ,� - Ujj511_UME '�!-flRST NAME MIDDLE ` OIi1ER FIRE LIFE I4�AALLTGI ,i,I (( PRx! N-� L,� 1 Il�t� �. ..i_ 7 +CRY xA6URM1cE 0 0 u [[11'' APTAMR r 21P-CWE� ^ I"'Uw5 FF MURALLJf PI # OH J ' c0 ' (�G/')� l• _ � 13 AODpESS OF WIxGNU ML GARAGING MBAN ER D\JIRUE C SIUL RGIrEX ORY irA 1zw TOP w XdM tlw rn'ierz RmmNTmtltlNM co Mwr RECENT CWB41Y-EXP VIFNWE HOM•LWG ❑Mpg, POLnymws WRRerr MOMH-0AKYFAR LABILITY WITHTHS ❑Y� EKRMnON x RE NAn EOF ; W.OFY M BUgINEag REGNTEREDOMe ARAw,• OPN AR{wYAOaw AM ONRiERSWP Owe N•m•: DESCRIBE USEMIOBENS HAULED p(Ep Ip ES EVEN SEEN GNCHHI yEg Nag IFYMS NOr M1 SLYINSUREO;E%PLAIN. �Elpµ !L'Jl ❑ S o ❑ 1 m w. M urtrwc an .xr ,I• WRWO THERtSTSYEApa MM .. .... ... _.. . ............ LIST LLL DINERS /USE REMAFtYS FOp ,arN MNRM gTMU3 00 MRM r M •MC aBMIM a • vaanf'Iw.eNWN AC ws VKIlAnW4 819Pa16b11a OR REYIX'AnGA6 mwws LlCENxENUMSeiBWE anicAVE PE1AgNBMa ApplDNL DRNERg1 SIM IDIW,I�I IgNwc I I A Y roAPPllIAM I I I 1 1 I I I I 1 I 2, 11 1 1 I S. I I I 1 1 I 1 i 1 I 1 4. I � I 1 1 1 T. I I I I I I I I 1 1 1 I I I I I I I 1 ! I I I I 1 1 DOMµyppryEp PEOI1IPE YU NO AREANYPUR.ICUTILITYOR NIEAgTME ND IIFYE4 CANE NAMES OFCONMea0r1s m1nDLV® M M CEr1 R`MT Cp.MERCE WMN681W FLNOB pEOUxED> ❑ 1 DRIVE CHECKI`r) NATURE OF VIOLATIONS AND ALL LOSSES PAST FIVE YEARS AMOUNT NO. VIOL.! ACC. Detaile induding facts of accident/violation and connage involved. RID ' s I s s YEARMw .. MODEL VEHICLE nENIIFIGRW HO. //� �,- fg.. wN ear tR•crop L/ f'ic�c � 1 '• �� �, U • : ,e u n n n 'Y"E a`s �ww WMP siMrE O alNm kDu'+eF F WEgIR. GVW USE Of VEHICLE W �Nq OF1RIPg ppEEpp YA BEYONp wyAATTBImpH WILLTNE OESTHATIG/OF IENI (GNINN) AXGM MDIUS IC01alElE EYAI SLOCp d Tpllpl(gE g1NCMALLY OPBUTFDV CU6rOlARYTnln NO ❑L BF�Ua u QscN0W OtD.ue,7 NONE:^etaS; t6t-tsa; +gtaap; ovER zoo ( 0OUnderlr 0 eu6 []M.to.0D1-2o.ODD DREDAL ❑CHURCHgUS �I (451 - T,000) ODOMETER PFAD ANNWL MILEM;E EMSTeM 1 NO : Cow. B l� l� l� lid l� l� ®lam ®lu1©©b� l� l� MLA"', MY6mm 116a $ ❑H Owr 20,ODD aANA3EDR1 -,YES OW7000 MODei® :❑: !N✓r d®®®© SMdlWlxnaRm ®llal �""a AM"•� NO.OFRFARAMES ePECLLLEOUXNAEM- 1 COST NEW EWIG. CCIaI RD gASB 1 • CannlarcYl - M MNd praLl�e�rDy61 1 • M P 11 on mlmlaldel : s O❑note $ aawielle Raifraactlon. �V cry a In a op paths stew LEASED, IF LFABFA CANE LF88OR LIeI COpE dENHq.DER NAXANI AODRESB zV CODE Y ND: CODENULwEAORNIAE O O • f AODPE66 a pEMuaa IFTRAI INVOLVE IJIHE FOLLOWING MUST BE COMPLETED. (I Physkcl Damaya Coveralin Am Daaired, Canpleds A Separate AppBeafbn.) LENGDI L Y R MAKE 7 VETNCIEDErlTFGrIW ND. a ❑ 2 WHEEL TRAILER OR ❑ SEMFTRAILER OR TANK ❑POLE OR SUNK ❑OTHER ❑aWHEELTRAILEAORTANK ❑FTATBED ❑LOWWN L BUS -THE FOLLOWING MUST BE COMPLETED 9EAlan pEGLAAp aClnOL1DINI ACTWLaawa 9UngAaGnOLTERM ACr #Gwa DerzaQiJWOMT. FAaOpOn.6UPCONntiCIOR OR LaAaL11AAlIrVT EDYAXY nBEOFN4EBAIx MINE To FRcu ro ❑ YES ❑ND OFSCI,OG.06laCIN/alMaa MA.IeER DE6CRPTIONAIx APPROVED USETPFB-I CN1=Kw;S- SNOW WDMa THE aemAN10E BPFLPC A7'Pl1FD PoPa ONLY f31RTHE PRMetY Blf11Y.FNBaY CArnOlEFMIBiEd LTCDt801®ro N01U1®SY DME AM TIME VEHICLE AGE1rCBCDDE crxEnmDE REOLIEaIFRTHE PREMX,M gIDWN BB.OW WITNTIE GOANANYB RAEB AND MIFB AND X,6I�MprrH LOST SEN OF APPLICATION i Y IYF{,p ((J LI XI -2� INSPECTED Sr.xquTE , D. LAWSER 06•1478 MORTHFRN �rn nR400 F625 u ; �i) �. = I� � le LMED �� 0 MILD PAY. I -" P FiTlCIIVE ^ (V t COMPRE• ❑�' 1 U HENSIVE ❑Fete G STATE FARM MUTUAL AUTOMOBILE STATE FIRE D 111WAR MICE COMPANY CASUALTY COMA96W U COLLISION I DED.AMT. = m BlGonnlptom. Illinois, hereby b01ds as a BM requested elbc" date for a period a 30 days from slch data. Ifn imunarcel eppald for, sW*W to id a the tameWal and d t" a Ile velide poky and appaceae u U UNINSURED ..,; r MOTOR YEN.; ,'�('. "' `; 1 I andorgg remis in currera use by such CAmpeny.The Itmuarlce, by the Company a an poicy applied tor vdds [his DiRdel. UNINSURED: 1 U1 U MOTOR VEH.:�wao PROPERTY ❑ Nsp� I By eubRission of this application, you agree that (1) You have need this application, (2) your swarne la on Vitt I DAMAGE application are correct (3) aakmsnte weds on any GNa applications on Vitt dote for autonobae Inawxroe wah We company am correct le ct and amade pan a lla d" apptlyou ere pn, (4) ydo sob s a the detworbed Vehicle ENDORSEMENTS elmept as otltorwtee mated. and (s to Nnft and manages wen wbacbd by you. IT IS FURTHER UNDERSTOOD AND AGREED THATNO INSURANCE IS EFFECTIVE UNDER THIS AGREEMENT (A) UNLESSTHE BINDER a COMPLETED DMGNATNGTHE COMPANY ACCEPTINGTHiS APPLICATION OR • Z 0 (B) ANACCEPTING UNTIL THE DATE THE POLICY OR BINDER IS ISSUED BY THE COMPANY ACCEPTTHIS APPLICATION. : N Is unawla to knowingly provide faM, incomplete, ar misleading face or inform ucn to an Inoalanca U company Tar the purpose of dNlwdin8 or Nexnpthlp to dshaud Un ecrpw* Pxwlifes may lectllde YnplsaMnent, ens. denial of illslnalnn, and avN dome"& Any I numnce company or epee of an d Provides �muding for�ypnapow, i pcaoyhslda dahaant of a aanpti ng W 6hwd the polkylloMw or �� TDrALs ` iano nt with ne0eb to a eatloaad or awed pano yable lice Insurance promenle UrR be "Dried to Ur PREMIUM SHOWN B FOR 0 MOS. UNLESS OTHERWISE INDICATED I Colorado Division of INlonlrara wattle In Depwwwm d Regulatory Apanaaso. Co- rePaa. a km*oo aodl IdanMlaA new be aNrN in mljunctan wah tin apPNurtien. Trot avPACcaar Nd gECE1VED WE _ Llbnvmdan Hirt seek%wph MaaIIIg yourokAMy to Iwrornpe an Ise Price Van am p35-4028 CO.11 Rev. 06-03-2003 Printed in U.S.A. SEE IMPORTANT MESSAGE ON OTHER SIDE APPLICANTS copy