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HomeMy WebLinkAboutCORRESPONDENCE - BID - 6113 SNOW AND ICE REMOVAL (6)SEP-26-2012 13:17 OCCUPATIONAL HEALTH 970 297 6175 P.001 OCCUPATIONAL HEALTH SERVICES South Clinic 4674 Snow Mesa Drive, Fort Collins, CO 80521 970.495.8450 FAX 970.297.6599 Work Injury Medical Care • Physicals • Drug Screens • Injury Prevention Programs FAX To: da#1 5$ LG From: Compan Fax: a a l— 78 7 Pages: Phone: Date: %"q a — Re: i ri:�4 CC: • Notes/C ments: zV This transmission is Intended for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication Is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the U.S. Postal Service. Thank you for your cooperation. XTIM.9I-11►3 I I.T11 SEP-26-2012 13:17 OCCUPATIONAL HEALTH 970 297 6175 P.002 City of art Collins Purchasing July 9, 2012 Viney Trucking Attn: Kevin Viney PO Box 1446 LaPorte, CO 80535 RE: Renewal, 6113 Snow and Ice Removal Dear Mr. Viney: Financial services Purchasing Division 216 N. Mason St. 2n0 Floor Po Box 580 Fort collinaj co 80522 970.221.6776 970.221.6707- fax fcgovc rnlpurchasing The City of fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: Any person (contractor) who operates a commercial motor vehicle, as defined in §382.107, in intrastate or interstate commerce and is subject to the commercial driver's license requirement of 49 CFR part 383 must be included in an alcohol and controlled substances testing program under the Federal Highway Administration's rule. Documentation of proof must be submitted with this renewal prior to performing work for the City of Fort Collins. The term will be extended for one (1) additional year, September 16, 2012 through September 15, 2013. If the renewal is acceptable to your firm, please sign this letter in the space provided include a current copy of insurance naming the City as an additional insured and return all documents to the City of Fort Collins, Purchasing Division, P. O. Box 580, Fort Collins, CO 80522, within the next fifteen days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non -renewal. Please contact John D. Stephen, CPPO, LEED AP, Senior Buyer at (970) 221-6777 if you have any questions regarding this matter. Si rely, James B. O'Neill II, CPPO, FNI irector o Purchasing and Ri Management Signature Date (Please indicate your desire to new 6113 by signing this letter and returning it to Purchasing Division within the next fifteen days.) Rev 01108 SEP-26-2012 13:17 OCCUPATIONAL HEALTH 970 297 6175 P.003 f (912612012) Carol Viney - VIneyTrucking EOI for Crt r Of Fort Collins tit Page 1 ac - CERTIFICATE OF LIABILITY INSURANCE I' osi o+z'I THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOGS NOT AFFIRMATBIELY OR NEOATNELT AMEND, EXTENO OR ALTER THE COVERAGE AFFORDEDI. BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE OOPS NOT CONSTITUTE A CONTRACT 09TWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If Me pnUlcias holdor, Is an ADDITIONAL. INSURED, the poucy(Ir) must he ensonad. If SUBROGATION IS WAIVED, subject to the plms and com"I lane Of the Polley, eeailn Policies may require so endorasmum, A sratomom on this cardfkab dean net �snfer ttgnts to the dNmcala holder In Dom of mch ondor[amentts . Yxenuean DARYL ALEXANDER INS AGCY INC kaC 5205 S COLLEGE AVE rL Nm+93-2t9a uc nxieTazzl�sTa FORT COLLINS CO 80525-- ._wswerymPiWEp_N2 a NaNF tell 281?6 waVPl0.A� Nye �aml.Muwal Aut0mVbilgl "s""ce VINEY TRUCKING INC PO BOX 1446 wauneae LAPORTE CO 80535-146 THIS IS TO CERTIFY THAT THE POLICIES Of INSUNANCL• LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NLMEO ABOVE FOR THE POLICY PEMOD INDICATED. NOTIAT WANDINO ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTM OR OTHER DOCUMENT WRH RESPECT TD IAMCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE Ia URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, EXCLUSIONS AND COND1110NC OF SUCH POLICIES. LIMITSSHOYm NAY HAVE BEEN REDUCED DY PAID CLAIMS ___ �� x xeC ODLY1IP IJUIT[ T OFINWMNCqLi oaeRALuneyn ern DcaJRReuee t Cp.eohQl Ot DU,LwNUT, pal..OM.wentea n ewNSMAn" ❑ oeaw - sen • ', [ _. _ — PER80W.L6ADVINJUm` f GENERAL 400REOATE f C_P.Nvw REWTE UNR APPLIBB PER PFODV:I9.COMPgPnGC i -___.. _ jP0l-lCY�:]lpj& LOC f A AVTIIMOOKSUARsITY Y OLy 1122{174)RM ON17M12 0M1TY3013 a.an"D._ x,Dao.ao3 { ♦trYnuTO BODILYwJURY(PypMwol'.. nJORV NJVRr (vr [ M1. DMaAn x LnO, Idn uN0]TT.. AHIVREEDDAUTOE %t x AUTOa �. t um--uu CCCVN CAC,I OCOVnafNC! i M0-K Te '... t vCip3 Wa CLAIMrr x i W0U[NCOMF6NeAlgN MB[NKOWY.NIY YIN wvvMmlelrlRMIV M1NRTN6WIDtB`IJRW NRCFiuCMM0.0%C4VMVI ❑ IYnP"Iery NNnl HIA ❑ 'A MRS.... G e l., leLn nCGDEM { I.L. 06B/3E_-En EMP'-Ov t { ELM E-MIT v «oulveJvelsclPA aw.nAcalo.et,Aa.N�.w lM.w ml."MxN....c...M,.,,ux.9 18 LISTED AS ADDITIONAL INSURED. I.. CITY OF FORT COLLINS SHOULD ANY OF TNC AD= DCSCRIOCD POL C1E9 BE CANCELLED BEFORq THE EXPIRATION DATE TMERCOF, NOTICE 1MLL BE DELIVERED IN FINANCIAL SERVICES PURCHASING DIVISION ACCORDANCE WITH THE POLN:Y PRJY6NINS. PO BOX 68D AUTHongIOR}PssesNTAmre FORT COLLINS CO 80622-0580 IA wnI• nN"w rvaa.rcu. ACORD 26(201(iI04) The ACORD name and logo am Muttered maYRe or ACORO 10014116132849103 1�12 YIt811L���Y➢R7 SEP-26-2012 15:14 OCCUPATIONAL HEALTH 970 297 6175 P.001 OCCUPATIONAL HEALTH SERVICES South Clinic 4674 Snow Mesa Drive, Fort Collins, Co 80526 970.495.8450 FAX 970.297.6599 work Injury Medical Care + Physicals • brug Screens . injury Prevention Programs FAX To: From: Fax: 2 Ir-6 -7 o Phone: Date: Re: ui ` ,4 CC: • Notes/ - mments: This transmission Is intended for the use of the individual entity to wt►ich it is addressed and may contain information that is privileged, confidential, and or exempt From disclosure under applicable law. If the reader of this message is not the Intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication Is strictly prohibited. If you have recelved this communication In error, please notify us immediately by telephone and return the original message to us at the above address via the U.S_ Postal Service. Thank you for your cooperation. CDNFIDL SEP-26-2012 15:15 OCCUPATIONAL HEALTH 970 297 6175 P.002 Occupational Health Services Page 1 ;c Company Profile for Viney Trucking, Inc. JG e Company Information -- ----- Company Name: Main Address: NAICS Code: Company Type: User Code: Sales Rep: Last Contact: s. Mczr�o: Viney Trucking, Inc_ PO Box 1446 Laporte, CO 80535 48411 07/22/2004 Next Contact: ID. VINEY Alt Company III: Company #: FUN: Main Contact: Kevin Viney phone: 970-493-1403 Fax: 970-493-6263 Email: Client Since: 07/06/1998 Account Information Office # of Employees: 12 Active Self -Pay Billing Kevin Viney Bill To: Kevin Vine+ Phone: 970493-1403 Viney Trucking, Inc. Fax: 970-493-6263 2607 Broolclhill Road Fort Collins, CO 80524 Workers' Comp Billing Pin,nacol Assurance _ Bill TO: Pinnncoi Assurance -- plan: PINN P.O. Box 469013 PO Box 469013 Group. 7501 Ii. Lowry Blvd_ 7501 E. Lowry Boulevard Policy: 1963162 Denver, CO 80246 Denver, CO 80230 Phone: 888-852-2239 Phone: 3031361-4000 Fax: 303-361-5910 --- - Departrnents/Contacts ..M--- No Records Found Procedures Breath Alcohol Test Breath Alcohol Test Lavoice to: CO VWEY *** Breath Alcohol Test *** FAX & MAIL results to: Kevin Viney Fax #: 493-6263 Fee QC40 Pr.- ice 82075 25.00 $25.00 0'1600i4n o:1tiYST'OC7t2UtC?�Of2'ftiu+ct,a.uq)�TP,�AtCf�COMPA'WYRq�ri[-f: c7?,tu+)'4q SEP-26-2012 15:15 10/12/2010 OCCUPATIONAL HEALTH 970 297 6175 P.003 Occupational Health Services Page 2 Company Profile for Viney Trucking, Inc. Random Drug Screen UDC Comprehensive Invoice to: CO VMY THIS Is A DOT DRUG SCR-EEN. Use OHS/Quest COC. Conduct a 5-panel test. FAX & MAIL results to: Kevin Viney Fax #: 493-6263 Additional Collection Fee Observed Test Invoice to: CO VINEY Reasonable Suspicion Drug Screen UDC Comprehensive Invoice to: CO VEVEY THIS IS A DOT DRUG SCREEK, Use OHS/Quest COC. Conduct a 5-panel test_ FAX & MAIL. results to: Kevin Viney Fax M 493-6203 Additional Collection Fee Observed Test Invoice to: CO 'VDY EY Fee Code 990UC 990UC-01 990UC 990UC-01 P-t c nt 40.00 40.00 $80.00 40.00 i 40.00 $80.00 O:lSV',. fC7i2%RZPORTS(RLI:MALNTLNANCE'COMPA4YPRO17fL1.: v72-"0'10 SEP-26-2012 15:15 OCCUPATIONAL HEALTH 970 297 6175 P.004 UUL Lu LULL ifiu U;J1U1 rll (JLNLXHL WiKC f'M N(J. 620 Soard L MAT, F 111 COLLINS, GO 80524 GEMERALCAR,E MEDICAL CLINIC 1910) 402-6620 FAN I9701 492-"26 �§rP OCCUPATIONAL MEDICINE • URGENT CARE 9299 EASTMAN PARK 091V01 WINDSOR, CO 80550 (970) 674-0626 7/28/11 To. City of Fort Collins From: GelneralCare Medical Clinic Regarding: Viyney Trucking GmeralCare serves as the desigaatedprovider for'Viuey Tucking in Fort Coll' for their DOT physicals and drag screen collections. We lccep LOOT requixed paper prk her on file. If you have any questions or concerns please do not hesitate to contact our office. 411, Chacon, Office Administrator, Human Resourses TnTAT. P nnA SEP-26-2012 15:38 OCCUPATIONAL HEALTH 970 297 6175 P.001 OCCUPATIONAL HEALTH SERVICES South Clinic 4674 Snow Mesa Drive, Fort Collins, CO 80528 970.495.8450 FAX 970.297,6599 Work Injury Medical Care • Physicals • Drug Screens • Injury Prevention Programs FAX From. (&-td Ux-� Fax: 1-6 le - Pages: Phone: Date:° CC. ON This transmission Is Intended for the use of the Individual entity to which It is addressed and may contain information that Is privileged, confidential, and or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication Is strictly prohibited. If you have received this communication In error, please notify us Immediately by telephone and return the original message to us at the above address via the U.S. Postal Service: Thank you for your cooperation. V -11,7 f F, T .IJ SEP-26-2012 15:38 OCCUPATIONAL HEALTH 970 297 6175 P.002 VY-------- . .--- Employer Account Ft. Collins Market Employer Name: VlneyTrt,Oking (CCM) Phone: (070) 493-1403 Phye Address: 2607 SmokhIll Rd Mall Aodrass: 2607 Drovkhlll Rd City, state. Zip., Fart C011ino, Co 905241015 City, SLAW, 7jp: Fart CoAins. CO 80524101 S Empluysr Taa ID: Primary G4ntaot: Kevin Wney SIC Cade ❑Suspense Employer Print Drugstore Contact Phone: (970) 493-1403 Extt ❑ la Employer Subscriber Print RX Contact Fox: (970) 491-6263 Q COD Required Contact Role: Primary Contact Kaven Way Cell 070-218-178S esoond contact Carole Vlney Employ4r Netaa: Auto Communication Definition: S -T3= F9t1WSPnOtt Mothpd Sr2^JaOt WIC infury C 40O& MdRM employar NO Show Lade Fox Kevin WAY WIC j" LIJOW A Rothe Employsr Patlarit VIaR IR Farr Kevin Vi wy WIC Injuy 1Ntlal R f teehe Injury Aplivky, Status Reg FAX Kevin Vlney Norrinjury InWal S ReCtle Non-Ird"AWMIY States FaX Kevin Vlr*Y Wfo Injury Initial A Roche Patient Rekm* Report Fax t(avin Vlnejr WIC IMury Iniumi a Roche Redwo Appointment 1R Far Kevin Vlney Relattonehln NOhe Association Name: Notes: PlnnacolAssurance Po Box 499013 D8nVer, CO 902469013 Association Name: Stephan XMGht MD PO Box 25903 Ovedsnd Park, KS W=55003 Notes: AasoclStlon Name: Vlney Trucking 2607 Ofookh111 Rd Fort Collins. C0 805241016 Noma: rlmr_employerlcaaunt Contact Alkillowwo 'VlneyTnxxln9 FJIs►�r1?4 S vinew-kinIVOM n.00m 970.463d253 070-403�4M 'VlnayTn,rkln4 vinaytruok! Ip®msn.corn •Vlney Trud M vinevirucW,I�Qfnen-wm III D70-403-02M Nk►ey Tnr*ir4 w1noymkI 6@mttn.aam 070 40.U0263 •viney Truoklnp Aney1nrkipp®man mm 070■i0a-9249 wineyTrvddnp vl6ftft dn0@rrren.00re 070-40&02e3 Page 1 of AA/EEO EMPIDYSt m taco.1012 camp" Operome CM —uon MI RJOUL R."wea. print Data: 00/2012012 eVlolon Date: 07121V2012 SEP-26-2012 16:34 96% P.002 SEP-26-2012 15:38 OCCUPATIONAL HEALTH 970 297 6175 P.003 Employer Account Ft. Collins Market Employer Name: Mflay TruCking (CCM) Phone: (070) 493-1403 Phys Address- 2607 Brockhill Rd Matt Addrosa: 2607 9rookhlll Rd city, state, Zip. Fort C0111na, 00 805241015 City, State. Zip: Fort Conine, CO eo6241015 Emelovar_8eletlons.- Vlney Tricking Vlney Tmcking Vlney Trv*oa Location Location Location Billing Addrass: 2607 Brookhlll Rd Fart Collins CO B05241015 Primary Contact: Kevin Vlney Bllling tlnjury): Kevin Vlney Billing (Non Injury): Kevin Vlney Contact Phone: (970)403-1403 Ext: Contact Phone: (970)4G3-1403 Ext: Contact Phone: (970)463-1403 Contact Fax-, (970)493-6263 fit' Contact Fax: (970)493-6263 Contact Fax: (970)403.6263 Contact Rolm Primary Content Conhrct Role: primary Contact Contact Role: Primary Conlaa Pinneaol Assurance Plnnecol Aesurance Pinnecol Aaeurance WIC lneurance Carder WIC Insurance Candor WIC Insurance Cartier Billing Address: Primary Contaav WIG Claim 13iinng (Injury): WIC Ctalm biking (Nan Injury): IC CIvlro Contact Phone: (800)332-7611 Ext: Contact Phone: (800)332-7611 Ext: Contact Phone: (800)332-7611 Fax: (303)790.7220 Ext' Contact Fax: (303)790-7220 Contact Fax: (303)790-7220 Contact Workom Comp Claims Contact Role: Workers Comp Claims Contact Role: Workers Comp Claims Contact Role: Stephen Kracht MD Stephen Kracht MO Stephen Kracht MD Medical Review Offker Medical Review Officer Medical Review officer Billing Addmos: Primary Contact: Stephen Kracht MO Billing (Injury): Stephen Kracht MD Billing (Nan injury): Stephen KmcAt MD Contact Phone: (aW)382-2261 Ext: ContactPhone: (88epa2-2281 Ext: Contact Phone: Fax: (M)382-2281 Ext; Contact Fax: (013)489-4028 Contact Fax: (913)4W4029 Contact (913)486-4on Contact Bole: MRO Contact Contact Role: MRO Contact Contact Role: MRO Contact Setvlce Package: DOT Physical PrePlacement Employer Adrolp Notoa: Component: DOT Physical PrePlacement $80.50 Blll To: Employer Way TmCklnG Phone (970)4930403 Fax (970)493-6263 r„mr_ompl0yer account page 2 of 4 0 JON -2012 Coneenv.OpW"g Owponron Au raptue its"wao. AA 9EO Employer Print Date: 0212612012 Revision pate: 0712612012 SEP-26-2012 15:34 96% 1P.003 SEP-26-2012 15:39 OCCUPATIONAL HEALTH 970 297 6175 P.004 Employer Account Ft. Collins Market Employe Name: Piney Trucking (CCM) Phone: (070) 403-1403 Phys Addrnsa: 2607 Brookhlll Rd Mall Address: 2607 Brookhlll Rd City, State, Zip. Fort Calling. CO 805241016 City, State, Zip: Fort Collins, CO 805241015 gervlce Package: DOT Physical Racertiflcaition Eirtpleyer Admin Home: component: DOT Physical ReceRifioallon Bill To: Employer Mney Trudk ft ,,Phone (870)403-1403 Fax (970)493-6263 Service Package: Reg UDS Collect & BA7 Past Accident Employer Admin Notes: Component; Breath Alcohol Test Post ACddent $31.60 Bill To: Employer Way Tnicking Pl+one (970) 1403 Fox (970)493 63 Component: Regulated UDS Collect Poet A ddant $31.00 Bill Ta: Emplayar Viney TrutlGng Phone (970)493.1403 Fax (070)499-6263 r mr employar.Aecount Page 3 of 4 AA/EEO Employer 9 IWO.2012 ConooMn apafndnD CarpMWn AD R" R WY" Print Data: 001=012 Rovlalon oats: 0712SM12 SEP-26--2012 15:34 96i P.004 SEP-26-2012 15:39 OCCUPATIONAL HEALTH 970 297 6175 P.005 i1JfYVlYV ,r ..�. Employer Account Ft. Collins Market Phone: (A70) 493.1�403 Employer Name: Viney Truektng (GGM) Mall Address: 2807 Srookhlll Rd Phys Address: 2607 Brookhill Rd clly, State, Zip: Fort CotNne, Co SM241015 City. Stata. Zip: FOft CoNtne, C0 806241015 Service Package: Injury Car+ Employer Adrn1n Noteat HIBLUS CHARTIII All Referrals to therapy REQUIRE AUTHORIZATION from Plensool pew to ft 12th visit. olspenag mods from our oAnnacy preferred• If non -formulary made required, then writs Rx and attsoh to the EXPRESS SCRIPTS form (located ad rent desk), DO NOT uee OaeusCrl V Component Bill To: Ir4ury Care W/C Ineurenoe Canter Plnnacol AseuranCO phone(800)873.7x42 r tOr employe �aacount SEP-26-2012 15:34 F" (303)361-6000 Page 4 of 4 AAII=EO Employer to IM 4012 ConcanvR OP—*O CWW&tlan AA Rlghls ""rod' 96% Print Date: 09128/2012 RoVlelon Dale: 0712612012 P.005 TC)TQT. P nnR SEP-26-2012 15:40 OCCUPATIONAL HEALTH 970 297 6175 P.001/001 AM wL o ncxe OW G1 trepted right Improving America's heal lh, one pollenl at a Ilene. 0618 620 South Lemay Ave Fart Collins, CO 80524 Phone (970) 221 vB 1 1 Fox- _ (970) 221-5817 FAX i To: From. I Fax: /n Pages: jPhono: Date: ............... ....... ............................................ .................... ........... ..— - Comments: i Fllyw Am4d-- This fax cover sheet or conlenr may contain promotional Information about products or services offored by Conaenlra. If you would Ike to dlseenllnue receipt of these promotlonal announcements, please follow these simple steps: Wrlie your complete fax number here: ( )Check mark hero to confirm your requesl Mal the fax number o170ve not be used to send prom uanpl messages from Concenlro. This will discontinue only those faxes or cover sheets Thal contain a promotional measdOe• Concenlro, In accordance vAlh the FCC, recognizes lhal failure to comply wllh your request, wllhln 90 days, Is unlawful. Return 1h1s Gompleled tnformolton vto: Fax to: (970) 221-58) 7 Call to: (970) 221-S81 I E-mail 10: www.ctaudla-oleary®concenlra.com ""'CONFIDENTIALITY NOTICE`-••• NOTICE, Thts communfcollon 1s GonNdenllal and is Inlended only for the person named above- No one other than the named recipient is oulhorized to use the Informallon contained herein In any manner- Ir you have received this communlcollon In error, please tail the sender (collect if necessary) to Identify the error, If you have received this communication In erro(, please lelephone Concentra's HiPAA Holkne at 972-725-6676, SEP-26-2012 16:33 96% P.001 TC)TAT. P nni