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HomeMy WebLinkAboutRESPONSE - BID - 5964 HAULINGBID SCHEDULE 5964 Hauling You may attach a seperste page with an equipment list— Please include Firm name on It. EQUIPMENT YR MAKE MODEL CY.YDS. HP $/HR. TRACTOR/TRI_ $ TRUCKS $ $ $ TANDEM DUMP TRUCKS $ -5 cis sy s TANDEM DUMP TRUCKS W/PUP $ $ s $ $ 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 r;,�6-- & a a CK\� Are you a Corporation, Partnership, BA, LLC, or PC SIC -NATURE_ � PRINT NAME_ a T )E�,UJ (1 CA S ADDRESS CQi\ksa& PHONE qR 0 CELL PHONE 9 FAX 2 '�() _ EMAIL SA Jay 2005 Mar 16 2006 1:14PM HP LRSERJET 3330 APPLICATION FOR COMMERCIAL VEHICLE INSURANCE 1 E . 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INTURE OFYIIO�LIATIONS AND ALL LOSSES ROLT FIVE YEARS Debelbe Including tecbe DI aocidentMdafl n Eva came l. inniva AMOLNT MD H I f i f It c D D'S ( l 8 BLnIN w aua "C1O1�I.w.. ruBK.kj11'F15 ? r p ,"DDF YYIIem. act uEEw 10.E AW-Y4 N➢rMIDD•�F"TE F/MiDN1 NWNNfTgMIORfMLLiNE i ofanNAfIDN Df TEM pslwa] BmDY iglw eE PRNCPNLY OIEMEDe WTOtMRI FB xD- OL,mAWOrUniw umTEDUGE DYhrC,ffiME 00TWO, ICME: 1m;10r-Ter; m�-e.M ab W OrUnden DFca Nee wN ❑wHoot" (uCq I Y Elm-moan-2RODD ❑ILLY. DoHuRDHsus CD / U Hsi -T.DDD) {Lis®®®®�I®» ®©®a i 'Rn7F�iD cuopi` o I a®ead®MPa®mm®rw®wG©F ®1 to sD MI® M wnw Run Ana artouL EgIFAwelr. WBrNEw uvula DWY : 1 - Commercial - If used pledpmNharlElr M 2 - MSRP needed on ewnwelel COMN IIm �1 (RlGNeERRpRIral: a ter"c"r own fm101 pempYg whiclea for any Imm of DOmpraMrLhe R ❑ Yee ❑no i $ h%5 �.76 explain M Remarks section. or collision. Lay®. IFLWERaNELEBeUn IIaI CODE L oBi MAIUNdAmRla �CODG 0 e�ADWFMaWaklMalla IFTRALBR IB INYOLMDTFOLLOW-NGMUSWcowLID.(IINmw@lDwwwcowwopmAeDaakW,CwnpkW A Bepara* App$Wdbm) edrM wry rAR MwE orrsE IcexrwcnoN Na 77.7t r L r r a m .14 h.Ael I,, n ❑2W4EEL7M11HIORT NK ❑ MMFTRALM OR TANK ❑ POLE(PIOUNK ED OTHER Fa 04 WNEELTML810RTAMC o AATaED O LOWBOW MMOOL SUB -TR FOLLOWNO MUST BE OOMLEMO B[RW GwCRY KOUTAR WCCLTEF ACTLIkOWS 1LMYp1 eCh100LTtlm ACNALeGYe Omlt9meDCOL war FAAMWLawccwrarcmA OR MIINCRMLDYi F..C•LAW ME6caYEHAMNWE FaD11 TO FnCM lrT � O Of SCICOLIITICTN RGIAINa NUMNaLwNCRFTCNMDDftT" NOIAPF UMMM I CHURCH Ns- aHwlaAmus THE THE'Ne [ArPhlm qe'e ONLY FORM couEa�.oEarxerCAT'EaY GIiEMUIL EHIRY.FPa9WYGMaCl6E ENIEREQ CII�NBOEB To PATEANDTME VEHICLE ADENT•9 DE at1MP - den }"RQigk wCICATEDOVE/1dOEAMUealID.TMEMIMUM aN0lNl aeIDNYrrm LYIM THE DDAe TS MUG ANO lVelm AND L OUBJECT W To APPUCATION INBVEHICL N ! 4�: r ' ire, � BY: �" 1999 Design" J. MARTINEZ 1822 NORTHERN COLORADO F625 LAf�IT9 -i 500 500 f40 ❑AM /y1�GO PM mirOLS of nasFECTaR C MED MY. - 'A1 n� !❑"uu. D ❑ STATE FARM MUTIL4L AUT MlOSSL6 ® STATE FARM PURE AND ON - oEo AYr COLLISION Ic W INSURANCE COMPANY CASUALTY COMPANY I Q tl b at gygn(ngorl. INTO[% hereby bind& as of im rpwWad efgcIw, data Iw a period 0130 Jaya from such deft, the Insurance appled for, subject to all of the berme and wMMons of the vehicle policy and applude CMSg4l UNINSURED I uY Ta MOROJIVEH.1 endorsements In current Use by such Comparry. The Issuanoe by the Campy of the po" applied for voids NM binder. UNIN9URF,D pmo.a,aYn. I y Ul LJ MOTOR VEN.I� .� suUmfadM.d rhP appeoellos,you eIAaM IheC (1) Ybu have reed this application 12) your abetsrtMNs on tNa ID PRRTY IOPE ❑ IAb,seN I V DyAtIwHE I epplleesan this sA obnm, a() e6RNname made w any dhr gOutbM w tibia dW fw aubrrloDlb Insurance wfh company am correct and me made pert wails sppNwacn, (4) you era the Eck myner of the dascrbed vehicle ENDopa E419 •. except as c111eWir abets. and IS ee Arise and race selected N PI by you. IT ARHM Additional insured UNDERSTOOD AND AGREED THAT NO INSURANCE IS OFFECTINIE UNDER TILE AW90bm r (/U I UNLEBLTMEMNMRISCOMPLETEODESIGNATNOTECOMPANYACCEMNOTM (B) N) LAPPUCATMOR I TIE DATE THE POLICY OR BINDER IS ISSUED BY TIE COMPANY ACCEPTING TLB City of Fort Collins 'q V A C APFLIcwrNN. M Mmanfu b lin Anply PwWdo Imes, Inacmpbem, or MisMdng facts w irlar wdm tD so Insurance Purchasing Department N I 1w the purpose of dshLNdin f w attempting W daheud the company. POMMIM may MedM N denial Ineu damaeos. Any Inwrmum muni mt, Meant an 215 Mason FoYt Collins CO - 80524 i� ;lJ I Insanndo sanwra, no, of mes, and OWN w at awnpa y who knwMngl y pmwMs br eas, kmorlpW%, w mleleedMe facts or Informaton b s ILaF.as lment for. defrauding. O*mWtlne-delveal laws r OTHER paNMYIM w allotmentIM purpose o1 w. pmmyh~ w PREM,UM a110WN BFORe M09. 'a, "a"Nd rN11 reDalr! l0 • sertl,nnerd. w servedpeyMbe fiaur Insurance proceeds shallW reported to in*uAFBBOIKERWIEE CeloredbOlyYbn of Insurance TNMinWe Empowerment of RepMletcly Agencies. NprAATFA '- reporW cDselwr nations, IndWMV armR IakH allon, may be ones of In cwfunctien see, application, applicat. These pmv-1 In(Nmlation that mmM1s YdM detrminlne your eIILIMIRy far Insurance and the pdw you an lPa AOCCLNLAO: 1lInTgNC1116EfFts a04-MI m :eA1MNT O.E D $ Is . 135-4028 CO.11 Rev. OB-03-2003 Printed In U.S.A. SEE IMPORTANT MESSAGE ON OTHER SIDE OFFICE COPY