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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. " 03 EFT19T17711M s /LJ ►� L�I+�FLl17 �iim 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"IlSll�2 R�cIV',�arc� Are you a Corporation, 0artnership, DBA, LLC, or PC PRINT NAME Cd�e.-d R J 12 ADDRESS iP0. L 6,i 3 3 NuNr✓, co SOG4x PHONE 9]y- 87-7- ,07, CELL PHONE ! %0 - i c( 1 - 1 431 FAX 3 70-- 7317 , 2 ( 9 7i EMAIL MIS�1�5�TRyck(rJ4 Ca a 6 1 cwn SA January 2005 02/27/2006 11:06 TRUCKERS EQUITY 3 19702216707 NO.467 9001 ACORIa CERTIFICATE OF LIABILITY INSURANCE OPID02 MISTLTR �IELRwI'6'"YI 02/27 06 PWD".k THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Truckers' Equity Agency, Inc. Mary L. sallcville B.O. Box 141090 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Arvada CO 80006-1090 Phone: 303-430-5725 Fax! 303-430-7698 INSURERS AFFORDING COVERAGE NAIC p INFI%iERA. Wilshire Insurance Company _ IIGMER B. I Misticr Tracking, Inc Edward Mistler WSURfRO "'— PO Sax 83 Nunn CO 80648 WYJ6Rc: IT COVERAGES TnEPOLIQW01I Ww"m LISTEGmE LuwrF DRLIrymrornFRauRmw�rtarearefscTUFPaLlcr oeweD.nIG+ED.rgmrcHarsxor+� A REOuIREmW.. TM M 00MMQN OFA 00NTTucrWONER DOGW W WMNFOK17TOwTEPI Tns OeRTIFOATE MAY N INUM OR WV'ERTALYTHE NEJ2ANCEAFFDPmCD"ws0CUGE8DE8CPo9E0 MENIBS.E.ERTVA{LTLc TCRYB, EFGW804AN0CmWr9NrWmIDI POLICIES. AGGREGATE L.urr$ PWwN GT KWE MEN REOL'M W PAD MARL. IN LTR R0 memunnam" ° Y=�A POLEWEFFNTK DATE pRuorvrq PDLrrbmwvN DArE MLDDurR LWRB cexowLLNDnYf Each 00MME"M _ E 1,000,000 A X Ool"IMAAL08,041600 Y DA2496043 05/12/05 05/12/06 IBEBz irE ��D $ $ 100,000 rsEa(Aft s 5,000 SWLLEInx LX-1 OMA -WXRRRI Fvtlo MSAOuw S 1,000,000 DRN�R +E F 2,000,000 -- Ci311ACCREGTELIMTCA�LIEEPs+ IMDUDTB•CDMP.ORAF: B 2, 000, 000 .— PWVY R LOC I ILSMIDIYf£L111ELRY AAYaVTO CLLSDWSNo.e Llxrt IEP aul0FM s 1Y000, 000 i Ma WNED ATM tlCiiLY1TMRr _ A X S DULEDA Os BA2496043 05/12/05 05/12/06 py.Y.Y WMRY E 11'111YMjpHl1 I nRaosuros T�i.bNN�AVT08 PROPERTY DA GE B v"Skm GMARCUAIII r 1 MITOOnLYEAACCIDfx7 S WIERTINW GACC F I W 4170 s AUTO 014Y. ADC arCSPNNDICLIAGaELRT CIOI Ocmilm Ce s _ DccuF ❑ C ms uAOE AOOREGAM s mucTM<E 8 8 RCTmN?,ft S I waazz O w WMNEI6cOARXM NMTMID TORY LMITB :0. W0.DYp5'tWERY FAfACNA®er. I F W MOPPETORPOPTARrEMNEOU W E;. D'scASGENFLOYFE i orFlCamllAS[:N f:TCw0E09 r mF. F.Iv�r w,IEc 8m31aILPRONPOu; kb+ ( i ei 09EA8E •PIXICY VWr B (HnER OCSCSmTgR D1 DFgATlorlfl l LDDR1RiIB! V FMFLR I r}[LDSgMS Mglp DY }IpDMEMEXT l EpFGLL ORQI9C W ENDORSEMENT NAMING CERTIFICATE HOLDER AS ADDITIONAL INSURED HAS BEEN REWESTED FROM CCHPANI a,cLT.L LnS.nL c nva.ucn CITY OE FORT COLLINS FAX 970-221-6767 PO SOX 580 FORT COLLINS CO 80522 FORTCOL ' I"-AIFtDi Tv.0 ADDNE DSGItmEDPDIIDIED REDMRDCLLCD6Kam1XA CTlNw1gN DATE TNEREDF. TNC MUM WIWm WU ENDEWNR TO ML 1101"Ta THEDERTSVAnNDLDC0.NAIfO MY Lfin. BDT FwLDLif TC DD M9 L IDBERDDDuwnpN [M vRRertr w Axr wnD V.D. Tv[INp111mL ITswcems rrL 30 OAYswmTTEsI AUWNVM DAEFREBEWrA c CERTIFICATE Of INSURANCE 03/06/06 000602003 THIS IS TO CERTIFY THAT we have issued to the insured a policy of insurance wfirh provides coverage as described below. THIS CERTIFICATE OF INSURANCE DOES NOT IN ANY WAY AMEND,EXTEND,ALTER, ORVARY THE COVERAGE AFFORDED BY THE POLICY OR POLICIES REFERRED TO HEREIN. UNTIL ITEM1. Policy Number BA2496043-57-02 Effective Date 02/27i`)66 Expiration Dm' CANCELLED ITEM 2. Name of Insured MISTLER TRUCKING, INC ITEM3. Addressof Insured PO BOX 83 NUNN CO 80648 ITEM 4. Name and Address of Certificate Holder r 71734 CITY OF FORT COLLINS If the policy is cancelled, we will endeavor to give written notice to the person to whom this 256 W. MOUNTAIN AVE. certificate is issued, but failure to give such PO BOX 580 notice will impose no obligation or liability L_ FORT COLLINS CO 80524 upon us. J ITEM 5. Description of Insurance POLICY COVERAGE LIMITS OF LIABILITY Bodily Injury/Property Damage Combined Single Limit $1, 000, 000 Each Person $ Automobile Bodily Injury Each Accident $ Liability Property Damage Each Accident $ Cargo Each Unit $NOCVG Less Deductible $ Aggregate $ Automobile Stated Amount or ACV $ NOCVG Physical Collision Less Deductible $ Damage g Specified Perlis Less Deductible $ Comprehensive Less Deductible $ Other GENERAL LIABILITY COMBINED SINGLE LIMIT $ $1,000,001 Coverage $ ITEM 6. Covered Autos Due to periodic chances in Schedule of Vehicles we do not furnish specific descriptions. You are listed as a certificate holder on this policy, ITEM 7. Description of Operations: ® Truckmen - Primary Liability; ❑ Non -trucking Liability only; ❑ Other (Explain) This certificate shall not be valid until countersigned by a duly authorized representative of GTRUCKERS' EQUITY E PO BOX 741090 N ARVADA T WILSHIRE INSURANCE COMPANY P.O. BOX 7006 LANCASTER, CALIFORNIA 93539-7006 AGENCY, INC. CO 80006-109 Authorized Represen Countersignature D6 9A 2 (9/91) ORIGINAL POLICY NUMBER: BA2496043 WA 143 05 99 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 02/27/06 Countersigned -�By: ? Named Insured: Mistler Trucking, Inc. (Authorized Representative) (lf no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement. Who Is An Insured (Section II, Part 1) of the policy is amended to include as an insured the person or organization shown in the schedule as an insured but only with respect to liability arising out of the operation of "covered autos" owned, maintained or used by the Named Insured, as listed in the Declarations. Schedule of person(s) or organization(s): 71734 City of Fort Collins Purchasing P.O. Box 580 Fort Collins, CO 80522 This endorsement shall take effect at 12:01 o'clock A.M., standard time at insured's address and shall terminate simultaneously with this policy. Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the undermentioned Policy other than as above stated. WA 143 05 99 Page 1 of 1 POLICY NUMBER: BA2496043 COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: City of Fort Collins Purchasing P.O. Box 580 Fort Collins, CO 80522 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who Is An Insured is amended to include as an insured any state or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard." CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 11