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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 7015 GENERAL PIPELINE CONSTRUCTION AND EMERGENCY PIPELINE REPAIR CONTRACTOR (9)City of
F6rt Collins
APR 19 2011
April 12, 2011
Hydro Construction Company
Attn: Mr. James E. Eurich, Vice President
301 East Lincoln Avenue
Fort Collins, CO 80524
RE: 7015 General Pipeline Emergency Repair
Dear Mr. Eurich:
Financial Services
Purchasing Division
215 North Mason Street
2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
970.221.6707 - fax
fcgov.com/Purchas/*ng
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:
The term will be extended for one (1) additional year, April 1, 2011 through March 31, 2012.
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 Opal F. Dick, CPPO, Senior Buyer at (970) 221-6778 if you have any questions
regarding this matter.
Sin ely, 7
Ja a B. O'Neill II, CPPO, FNIGP /U
Dire for of Purchasing and Risk Management
Signature
Date
(Please indicate your desire to renew 7015 by signing this letter and returning it to Purchasing
Division within the next fifteen days.)
Rev 07/08
City of
F6rt Collins
APR 19 2011
April 12, 2011
Hydro Construction Company
Attn: Mr. James E. Eurich, Vice President
301 East Lincoln Avenue
Fort Collins, CO 80524
RE: 7015 General Pipeline Emergency Repair
Dear Mr. Eurich:
Financial Services
Purchasing Division
215 North Mason Street
2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
970.221.6707 - fax
fcgov.com/Purchas/*ng
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:
The term will be extended for one (1) additional year, April 1, 2011 through March 31, 2012.
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 Opal F. Dick, CPPO, Senior Buyer at (970) 221-6778 if you have any questions
regarding this matter.
Sin ely, 7
Ja a B. O'Neill II, CPPO, FNIGP /U
Dire for of Purchasing and Risk Management
Signature
Date
(Please indicate your desire to renew 7015 by signing this letter and returning it to Purchasing
Division within the next fifteen days.)
Rev 07/08
3/8/2011 18:18 Remote ID Imprint ID
❑ 2/2
CERTIFICATE OF LIABILITY INSURANCEDATE
I
03/OMBM,'DOAYYYI
3/D/2D11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endomement(s).
PRODUCER 1-303-534-4567
CONTACT
NONE
IMA of Colorado, Inc.
PHONE FAX
A!C No EMI, AIC Rol:
E-MAIL
ADDRESS:
1550 17 th Street
Suite 600
PRODUCER
CUSTOMERIDII-
Denver, CO 80202
INSURERS) AFFORDING COVERAGE
HAD
INSURED
INSURERA: TRAVELERS IND CO
25658
Hydro Conatruction Company, Inc.
INSURER e: TRAVELERS PROP CAS CO OF AMER
25674
INSURERC: PINNACOL ASSUR
41190
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 20079027 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 WITH 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
TYPE OF INSURANCE
ADDLSUBR POLICY EFF PCUCYEXP
POLICY NUMBER N UD M60D
UNITS
A
GENERAL UABIUTY
DTC08743RO16IND10
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
PREMISES aocmrtenm
$ 300,000
X COMMERVALGENERALLIABIUTY
CLAIMS MADE 1XI OCCUR
MED EXP(Any ore person)
$ 10,000
X PIS Ded:$5,000
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP ADS
$ 2,000,000
POLICY X PRO- LOC
JECT
$
B
AUTOMOBLEUABIUTY
X
ANV AUTO
DT8108743RO16TILIO
09/30/1
09/30/11
COMBINEDSINGLE LIMIT
(Ea acNtlenl)
$ 1,000,000
BODILY INJURY(Par person)
$
ALL OWNED AUTOS
BODILY:NJURY (Per amiaen0
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Paracticant)
$
X
NON -OWNED AUTOS
$
B
X
UMBRELLA UAB
X
OCCUR
OTSMCUP8743RO15TILIO
09/30/1
09/30/11
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
EXCESS LIAB
CLAIMS MADE
MXDEDUCTIBLE
$
g
RETENTION $ 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' UAMUTY YINER
PROPRIETOR,PARTNENEXECUTME❑
OFFICERIMEMBER EXCLUDED? N
NIA
2091550
04/01/1
04/01/12
X FCSTATUS OTH
ORIANY
E.L. EACH ACCIDENT
$ 1, 000,000
E.L.DISEASE EAEMPLOYEe
$ 1,000,000
(Mantlalory In NH)
I S66m,eoeunder
D SCRIPNON OF OPERATIONS 6Mmv
E.I. DISEASE. -POLICY LIMB
a 11000,000
DESCRIPTION OF OPERATIONS(LOCATIONS i YEHCLES IAKach ACORD 191, Atltlitional Remarks Schedule, it more space is required)
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
RE: `P1007 Water Wastewater Treatment & Site Infacture.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
James B. O'Neill
215 North Mason Streeet
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
I USA /'
Francine 01988.2009 ACORD CORPORATION. All rights reserved,
/1L.Vrtv Aa (cvvo/MV) I Be AUV KU name ann logo are registered marKS Or AL,UKU
20079027
3/8/2011 18:18 Remote ID Imprint ID
❑ 2/2
CERTIFICATE OF LIABILITY INSURANCEDATE
I
03/OMBM,'DOAYYYI
3/D/2D11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endomement(s).
PRODUCER 1-303-534-4567
CONTACT
NONE
IMA of Colorado, Inc.
PHONE FAX
A!C No EMI, AIC Rol:
E-MAIL
ADDRESS:
1550 17 th Street
Suite 600
PRODUCER
CUSTOMERIDII-
Denver, CO 80202
INSURERS) AFFORDING COVERAGE
HAD
INSURED
INSURERA: TRAVELERS IND CO
25658
Hydro Conatruction Company, Inc.
INSURER e: TRAVELERS PROP CAS CO OF AMER
25674
INSURERC: PINNACOL ASSUR
41190
301 East Lincoln Avenue
INSURERD:
Fort Collins, CO 80524
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 20079027 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 WITH 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
TYPE OF INSURANCE
ADDLSUBR POLICY EFF PCUCYEXP
POLICY NUMBER N UD M60D
UNITS
A
GENERAL UABIUTY
DTC08743RO16IND10
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
PREMISES aocmrtenm
$ 300,000
X COMMERVALGENERALLIABIUTY
CLAIMS MADE 1XI OCCUR
MED EXP(Any ore person)
$ 10,000
X PIS Ded:$5,000
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP ADS
$ 2,000,000
POLICY X PRO- LOC
JECT
$
B
AUTOMOBLEUABIUTY
X
ANV AUTO
DT8108743RO16TILIO
09/30/1
09/30/11
COMBINEDSINGLE LIMIT
(Ea acNtlenl)
$ 1,000,000
BODILY INJURY(Par person)
$
ALL OWNED AUTOS
BODILY:NJURY (Per amiaen0
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Paracticant)
$
X
NON -OWNED AUTOS
$
B
X
UMBRELLA UAB
X
OCCUR
OTSMCUP8743RO15TILIO
09/30/1
09/30/11
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
EXCESS LIAB
CLAIMS MADE
MXDEDUCTIBLE
$
g
RETENTION $ 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' UAMUTY YINER
PROPRIETOR,PARTNENEXECUTME❑
OFFICERIMEMBER EXCLUDED? N
NIA
2091550
04/01/1
04/01/12
X FCSTATUS OTH
ORIANY
E.L. EACH ACCIDENT
$ 1, 000,000
E.L.DISEASE EAEMPLOYEe
$ 1,000,000
(Mantlalory In NH)
I S66m,eoeunder
D SCRIPNON OF OPERATIONS 6Mmv
E.I. DISEASE. -POLICY LIMB
a 11000,000
DESCRIPTION OF OPERATIONS(LOCATIONS i YEHCLES IAKach ACORD 191, Atltlitional Remarks Schedule, it more space is required)
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
RE: `P1007 Water Wastewater Treatment & Site Infacture.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
James B. O'Neill
215 North Mason Streeet
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522
I USA /'
Francine 01988.2009 ACORD CORPORATION. All rights reserved,
/1L.Vrtv Aa (cvvo/MV) I Be AUV KU name ann logo are registered marKS Or AL,UKU
20079027
►coRb� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMMD"M
03/08/2011
03/OB/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 1-303-534-4567
CONTACT
NAME:
PHONE FAX
AC No:
INA of Colorado, Inc.
E-MAILADDRESS:
1550 17 th Street
Suite 600
PRODUCER
Denver, CO 80202
INSURERS AFFORDING COVERAGE
NAIC e
INSURED
INSURERA: TRAVELERS IND CO
25658
Hydro Construction Company, Inc.
INSURER B: TRAVELERS PROP CAS CO OF AMER
25674
INSURER C: PINNACOL ASSUR
41190
301 East Lincoln Avenue
INSURER D:
Fort Collins, CO 80524
INSURER E
NSURER F:
COVERAGES CERTIFICATE NUMBER: 20078930 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 WITH 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
I OF INSURANCE
ADDLTYPE
INSR WaD SUER POLICY NUMBER MMIDICOY EFF MM1DD EXP
LIMITS
A
GENERAL LIABILITY
DTC08743RO16INDIO
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES Ea oceunence
$ 300,000
CLAIMS -MADE I X OCCUR
MED EXP(Any one Person)
$ 10,000
X PD Ded:$5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGO
$ 2,000,000
POLICY X PRO- JFCT LOG
$
H
AUTOMOBILE
X
LIABILITY
ANY AUTO
DT8108743RO16TILIO
09/30/10
09/30/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per adedent)
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
$
X
NON -OWNED AUTOS
H
X
UMBRELLA LIAB I
X
OCCUR
DTSMCUP8743RO16TIL10
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
X
RETENTION $ 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE N
OFFICER/MEMBER EXCLUDED?
NIA
2091550
04/01/11
04/01/12
WC STATU- OTH-
X TOP
E.L. EACH ACCIDENT
$1,000,000-
E.L. DISEASE EA EMPLOYE
$ 1, 000, 000
(Mandate, in NH)
n yes, descrlhs under
DE SCRIPTION OF OPERATIONSbelow
E.L. DISEASE - POLICY LIMIT
$ 1, 000, 000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
3G\CDIa R14 ILIB91
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Opal Dick
700 Wood Street
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522 A`
USA J"
francine © 1988.2009 ACORD CORPORATION. All rights reserve
AI UKU LO (4UUS/UB) I ne AL,UKU name ana logo are reglsrerea marks Or AGUMU
20078930
3:l
►coRb� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMMD"M
03/08/2011
03/OB/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 1-303-534-4567
CONTACT
NAME:
PHONE FAX
AC No:
INA of Colorado, Inc.
E-MAILADDRESS:
1550 17 th Street
Suite 600
PRODUCER
Denver, CO 80202
INSURERS AFFORDING COVERAGE
NAIC e
INSURED
INSURERA: TRAVELERS IND CO
25658
Hydro Construction Company, Inc.
INSURER B: TRAVELERS PROP CAS CO OF AMER
25674
INSURER C: PINNACOL ASSUR
41190
301 East Lincoln Avenue
INSURER D:
Fort Collins, CO 80524
INSURER E
NSURER F:
COVERAGES CERTIFICATE NUMBER: 20078930 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 WITH 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
I OF INSURANCE
ADDLTYPE
INSR WaD SUER POLICY NUMBER MMIDICOY EFF MM1DD EXP
LIMITS
A
GENERAL LIABILITY
DTC08743RO16INDIO
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES Ea oceunence
$ 300,000
CLAIMS -MADE I X OCCUR
MED EXP(Any one Person)
$ 10,000
X PD Ded:$5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGO
$ 2,000,000
POLICY X PRO- JFCT LOG
$
H
AUTOMOBILE
X
LIABILITY
ANY AUTO
DT8108743RO16TILIO
09/30/10
09/30/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per adedent)
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
$
X
NON -OWNED AUTOS
H
X
UMBRELLA LIAB I
X
OCCUR
DTSMCUP8743RO16TIL10
09/30/1
09/30/11
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
X
RETENTION $ 10,000
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE N
OFFICER/MEMBER EXCLUDED?
NIA
2091550
04/01/11
04/01/12
WC STATU- OTH-
X TOP
E.L. EACH ACCIDENT
$1,000,000-
E.L. DISEASE EA EMPLOYE
$ 1, 000, 000
(Mandate, in NH)
n yes, descrlhs under
DE SCRIPTION OF OPERATIONSbelow
E.L. DISEASE - POLICY LIMIT
$ 1, 000, 000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
3G\CDIa R14 ILIB91
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Opal Dick
700 Wood Street
AUTHORIZED REPRESENTATIVE
Fort Collins, CO 80522 A`
USA J"
francine © 1988.2009 ACORD CORPORATION. All rights reserve
AI UKU LO (4UUS/UB) I ne AL,UKU name ana logo are reglsrerea marks Or AGUMU
20078930
3:l