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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 Firm name on It. ANDEM DUMP TRUCKSMEN -----� 12 910 1031k4WAR10----� 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 Are yqV a Corporation, ParKdrship,_DBA, LLC, or PC SIGNATURE _�j( f�( J :j .ram ► n . PRINT NAME ADDRESS :VA © TA Lou<IV%A,j /C� 11 gos;3 g,-- PHONE �Ll - 5j f0 off- - 13 ?a CELL PHONE �V O " 4 k/ - 'Y J U FAX EMAIL 5 SA January 2005 AR. 6. 2006- 4:23PN4---.INSURANCE OFFICES NO.505^P. A MW. CERTIFICATE OF LIABILITY INSURANCE A o+rBPTR1Du2 PRODUCER ITHI8 CERTIFICATE IS ISSUED AS A MATTER OF INF Truck Znw mince $%maialista1 I 6075 East 60th Avenue CO=erc& City CO 80022 Phone:303-289-4485 A a R Tracking Burma c4ba LFvieVma 3 IN INSURERS AFFORDING COVERAGE ;WM-- . Wilshire Insures INSURER e: INSURER O! DOM 1/2 DATE P I MIDWr" I NMC S THE POLIGNO OF MIRANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSUM NAMED ABOVY FOR THE POLICY P010b NWCATED. WMMTWSTANDIMG ANY MWIF 4MiNT. TERM ORGONDrt1ON OF ANY CONTRAC.TORCrWR OOCUMNTT WTIR ReNWCTTO WHICH T)48 CW FICATE MAY N ISSUED OR MAY PGRTAN. THIN NSURANCEAPFORDED BYTME MOM DMICRRED MR&N B SUBJECT TO ALL THETERMB, E)fCLUS(0NS AND OONWTIONS OF SUCH POLIO. AGGREGATE LIMRSBHCMN MAY HAVE SEEN REDIM UfI PAID CLAIM& OF LTR LIT LIMITS GENERAL tIMMITY COMMERCIALW40IAL LUSS.IIY M -4m MADE ❑ OCCUR SAMOCCURRDft ; ISEB Tm FrEV— noe) ; MED FXP Ww we paean) ; PERSONAL AAOV INJURY B GENERALAOMOATE S GENLAGWGATE LWRTAPPLMS PER POLICY M M r7 LOD AWDUCTS•COMPTOPAGG S A AUTONgEM.E LU WfY ANY AUTO OWNED AUTOS SCHEOULEDALITOS HIREDAUTOS NONAW44WAUTOS BA2480056 07/08/0S 07/08/06 COM�utOLELIMIT hamf&wALL 81,000,000 EOWLYIWURY owpawa ") ; x Y mmu Gaddamo Y S PPRROPPER7, YY DAMAGG $ GARAM UAFJFIJTY ANYAUTO AUr0ONLY- EAACCOENT 8 OTIIERTHAN EAACC AUTO ONLY: AGO S S EXCEWJUftRELLAU,4WUTY OCCUR CLAIMS MADE DEDUCTIBLE R6FENTION S WORKBR$ COMPOlSAT10N AND SPLOYER$'LIAJ Taff ANYPRQ jW YPRICFWMEINL�RE%CLUD� I�yeede POR radar 9PECVLL NL7Eegx EACH OCCURRENCE $ AGATE ; s 6 I Iwo ; Et EACH ACCIDENT ; E.LDISEASE -EA2n2 S ILLOISEASE-POLICYLMAIT i S OTHER DRSCPoPTION OF OM MTMBi LOCA'TIONS) I EXCLUMMONS ADDED BYENDORS r SPECIAL PROVISIONS 970-221-6707 City Of Fort Collies Doha Stephen P 0 Box 580 Fort Collins CO 80524 CITYFCI$MOULCANYOFTNEANOVEDrXRM3EDPOLICIESBECANCELLEDBEFORETHEEXFfRATRW DATE THEREOF THE =UN61NSURER WELL ENDEAVOR TO MNL 10 DAYS WRITTEN NOTICE TO THE CRAWCATE HOLDER NAMED TO THG LKIET, SUr FAILURE TO 00.50 SHALL MPOBE NO OELIGATION OR LLWLTTY OF ANY KIND UPON THE INSURER, ITS AGENT$ OR R. 6. 2006- 4:20--INSURANCE OFFICE N0.505---P.2/2 IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this cerIfficate 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 oertifloate does not confer rights to the certificate holder In reu of such endorsement(s). DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitute a contract between the Ruing Insur+er(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 fisted thereon.