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HomeMy WebLinkAboutRESPONSE - BID - 5964 HAULING53 ., tlR461 You may attach a separate page with an equipment list— Please Include Finn name on It . TANDEMOUMP TRUCKS TANF-e-M'TRUMS P . -----® 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. FWMNAWFf► f�C�►'1 Cd Tr1,N c iC %N4 116. Are you a , P. . ice., or PC PRINT NAME —RA h FA /►2 P l� 1 �� ADDRESS 5137 0 f'.e1tR. wg t-e.n, j0k . &Ve4VAIJ . eQ Ji79'3* PHONE 970 663 y/BS CELL PHONE 970 '1,?Q cS % /& FAX MAIL rbi Fi9�rectii L� �.1 JmSi�, �a 5 SAJw=rj MM / . , CERTIFICATE OF INSURANCE This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ❑ STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: Name of policyholder Fairchild Trucking, LLC Address of policyholder Location of operations Description of operations 5137 Clearwater Dr Loveland, CO 80538 The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subiect to all the terms exclusions. and conditions of those Dolices. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD UMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Daft ;Expiration Date (at beginning of policy period) 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 ❑ Collapse Hazard Coverage Products — Completed $ ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Data : Expiration Data (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease - Policy limit $ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expirallon Data (at beginning of policy period) 1112968-EO406 Commerical Auto 11/04/05 11/04/06 one million THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NUTHER APrrwrAI r LILT NUN Ntvwl rveLT AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder Name and Address of Certificate Holder 10 --- - days before cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed City of Fort Collins on State Farm or its agents or representatives. Signature of Aurhor¢ed Reprosentative AGENT 02/14/06 Twe Date Agent's Code Stamp AFO Cade F625 558-M a3 04-1999 NNW In U.SA.