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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. TANDEM DUMP TRUCKS OTHER EQUIP (LIST TYPE)_ �1 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 - I `iL3 1 -ilC, 1111C7 /1G. Are you a Corporation, Partnership, DBA, LLC, or PC SIGNATURE i . �i•/�!✓�71 PRINTNAME L a. ADDRESS PHONE 9'!O—,6;6X-, 953,E w � I / . J Af i. 5 SA January 2005 hLb. Ll. IM 1U:41AM NO. h49 N. 1 CERTIFICATE OF INSURANCE Thls eartl8eats of Insurance Is NOT an hsuanea policy ad doaa not amend extend or alter the coveralls atlbrted by the odicin listed herein. Nobnithatandrq any requirement, term or condition of any contract or other document wi i respect to which this certi5oade may be Issued or may pertain; the Insurance afforded by the Padden described harsh Is subject to MI the teethe, exclusions and conditions of such prides which mhr subsfamiedy Amh coverage. Where rtho non is made to an Aggregate LindL those limits are Company's nWmum daborly under the Policy for the entire policy pow regetdlass of the numberof insura4, del anb Of oeeurronoea Ceetidosfa Is issued by Insureds Represenhtive. additional insured and other 4"Orsameatca way only be authorised by the CaMaar or its appoiated General agent. NAME OF INSURED T r- J Trucking, Inc Date 02/27/2006 P.O.ADDRESS 8739 N. Taft Hill Ad Ft. Collins CO 80524 Insurance Company Name: Columbia Tnsurapee Company Insurance Company Address: 3024 Hamey Street • Omaha, Nebraska - 08131-3580 POLICY NUMBER IONDS OF INSURANCE LIMITS EFFECTIVE EXPIRES MMERCIAL GENERAL LKSILI OO&WOnbeFOrri Claims -Made Form Ming -Operations 0 Produda/Comphead Operations 0 Other (Specify) N/A Oenerar Awrew Limit Produabi-Completed Operations Aggregate limit S _ N/A Paaons) 3 Advertising Injury Limit 5 _ N/A End+ Occurrence Limit S N/A Fire DWN$ Limit (Any One Fire) S _ _ N/A Medial Expense Llrhdt (Any One Person) 5 N/A Aggregate Link on Claims Expenses 5 _. N/A Manuscript endorsements sppliaable AUTOMOBILE LIABILITY Bodilylrtury each Person s N/A 05/26/2005 0$/26/20 71TIiN30B999 EachADddem s NtA 12:01 A.M. 12:01 A. Provenly Damage Each Accident 5 N/A Bodily Injury and Property Damage Combined Single Limit $ 1 GARAGE LWBILITY Bodily Injury and Property Damage Aufo Only Other then Auto Combined Sirens Limit S N/A S N/A N/A N fi�ekeepers Insurance O Le" Liability Lj Droa browse S 0 Direct Primary $ EXCESS LIABILITY E3 ALiamobile ❑ General Liaadry Name of Primary Insurer. N/A Primary Limits $ r9rbens Lhdis 5 General Aggregate Ltmk S N/A 0 Aggregats Limit inclusive of Claims Expensess N/A N/A Employer's Liability $ W/A N/A Other N/A DEZk;Rrrl rum OF OFEKAI iur4WLOGATruNSNENiQLE6 In the event of eny maberiel ahenge in ar eanceWan of said pooaes, the Inaursd's Represerrtative Issuing this Cute intends b, but is rat obligated to, nary the part' b wlam tilts CerdBeas to ad"W d of such change or cancellation. The COMPANY undertakes no responsiefiity by reason of any failure of the Insurada ROPMsentative In provide such naftedon. This Certificate Issued to: City of Fort Collins PO Box 580 Fore_Co fens, CO 90522-0516 M4O44b (OW2002) This Ceftilicaji *Lied by. By I rsa c Name of Insured's RepregilliffttiVe D6 y. ACORD. CERTIFICATE OF LIABILITY INSURANCE ATE0212812006 PRODUCER Pinnaccl Assurance 7501 E Lowry Blvd DENVER CO 80230-7006 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 BELOW. INSURERS AFFORDING COVERAGE NAIC Af INSURED T & J TRUCKING INC 8739 NORTH TAFT HILL ROAD FORT COLLINS CO 80524 INSURER A: Plnnacol Assurance 41190 INSURER B: NsuRER D: INSURER D: INSURER E: COVERAGES THE 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 W ITH 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDD/YYYY) POLICY EXPIRATION DATE(MM/DD/YYYY) LIMITS " GENERAL UANLITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea xcuaence) MED EXP (Any om parson) PERSONAL A ADV INJURY GENL AGGREGATELIMIT APPUERS PER: POIJCY PROJECTEl LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOLNLE LIABILITY ANY AUTO ALLOWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea acckera) BODILY INJURY (Per Perron) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHERTHAN EA ACC AUTO ONLY AGG EXCES=MBRELI MmLITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE AGGREGATE A WORKERS COMPENSATION AND EMPLOYERS' UALRLRY ANY PROPRIETORMARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED' It y., plea. Macrae.m r SPECIAL PROVISIONS bete 4054162 OW01/2006 03101/2007 WC STATLL U OTHER TORY LIMITS � E.L. EACH ACCIDENT $100000 E.L. DISEASE - EA EMPLOYEE 00 $100,0 E.L. DISEASE -POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL CERTIFICATE HOLDER CANCELLATION 892223 CITY OF FORT COLLINS ATTN: JAMES O'NESAL PO BOX 580 FORT COLLINS CO 80522 ACORD 25 2001108 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Kristin Trujillo Underwriter ACORD CORPORATION 1988 TRUUILKJ Un error r 0229A1a (N:25:Sa A 1152 Updobd: 12/15/11MM 12:N:N UW1W