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Home My WebLink AboutCORRESPONDENCE - BID - 7355 HAULING SERVICESCity of art Collins April 8, 2013 J J's Trucking Attn: Stanley Pflipsen 221 W Douglas Rd #17 Fort Collins, CO 80524 RE: 7355 Hauling Services 2012 Dear Mr. Pflipsen: AN 19 2013 Financial services Purchasing Division 215 N. Mason St. 2n° Floor PO Box 680 Fort Collins, CO 80522 970.221.6775 970.221.6707-fax kgovcorNpurchasing The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions. The term will be extended for one (1) additional year, April 1, 2013 through March 31, 2014. 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 Stephen, CPPO, LEED AP, Senior Buyer at (970) 221-6777 if you have any questions regarding this matter. Sincer iy, John D. Stephen, CPPO, LEED AP Interim Director of Purchasing and Risk Management Signature / Date (Please indicate your desire to renew 7355 by signing this letter and returning it to Purchasing Division within the next fifteen days.) '®a A` b® CERTIFICATE OF LIABILITY INSURANCE °04/10/2013 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 Gary Cramer 1275 E Magnolia ST unit I 56oelarm Fort Collins CO 80524 �• TACT NAMONE: Gary Cramer PHON o 970 484 1374 Fuc No:970-093-0226 ADDRESS: a .cramer.b68o statefarrn.com INSURERS AFFORDING COVERAGE NAICN INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED PFLIPSEN, STAN DBA JJ'S TRUCKING 1230 HOFFMAN MILL RD FORT COLLINS CO 80524 INSURER B: State Farm Fire and Casualty Company 25143 INSURER C: INSURER D: INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- 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 ADD SUB POLICY NUMBER POLICY EFF MM/DDIYYYYI POLICY EXP JMMMD/YYYYI UNITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 PREMISES Ea ocareence E 300.000 COMMERCIAL GENERAL LIABILITY MED EXP(Any we person) $ 5,000 CLAIMS -MADE ❑ OCCUR 96-BS-LB79-2 04/22/2012 0412212013 PERSONAL S ADV INJURY $ 2,000,000 Businessowners Policy S 0412212013 0412212014 Businessowners Policy96-BX567-1 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2.000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea COMBINEDSINGLELI SINGLE MB a $ 1,000,000 BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS HIRED AUTOS NON -OWNED AUTOS 2125190-EO2-06G 1173516-DIO-06Z 2004261-D29-06K 11102/2012 0411012013 11/2912012 05102/2013 10/1012013 04/2912013 HUMBRELLA BODILY INJURY (Per actlaem) $ PROPERTYDAMAGE Per acdtlem $ LIAS OCCUR ❑ EACH OCCURRENCE I $ AGGREGATE S EXCESS LIAB CLAIMS -MADE DEO I I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICE/MEMBER EXCLUDED? NIA ❑ RV LIMITSER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) It yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101, AddlUorul Remarks Schedule, U more space is required) 88 KENWORTH TB00 DUMP VIN: 1XKDD29X5JS512834 72 MACK DUMP VIN: RS711LS12978 76 MACK R6 DUMP VIN: R686ST8447 City Of Fort Collins Purchasing 215 N Mason 2nd Floor Fort Collins CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2010105) The ACORD name and logo are CORPORATION. All of ACORD 1001486 132849.8 01-23-2013 PINNAA COL ASSURANCE ITEM 1. INSURED STAN PFLIPSEN DBA JJs TRUCKING 221 W. Douglas Road #17 Fort Collins, CO 80524 7501 E Lowry Blvd Denver, CO 80230-7006 303-361-4000 / 800-873-7242 www.pinnacol.com April 4, 2013 Policy #: 4154652 John C. Beckett & Associates, Inc. 220 Smith St. Fort Collins, CO 80524 (970) 484-2805 SP/11.00 ITEM 2. POLICY PERIOD:= FROM: 04/01/2013 TO 04/01/2014 12:01 A.M. MOUNTAIN STANDARD TIME ITEM 3. A. Workers' Compensation Insurance: Part One of the policy applies to the workers' compensation law of the states listed here: COLORADO B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3 A. The limits of our liability under par two are: BODILY INJURY BY ACCIDENT BODILY INJURY BY DISEASE BODILY INJURY BY DISEASE $100,000 EACH ACCIDENT $100,000 EACH EMPLOYEE $500,000 POLICY LIMIT C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: NONE (Please contact Pinnacol Assurance for information on coverage outside the state of Colorado) D. This policy includes the attached endorsements and schedules: 511 Other State Endorsement CAT09-_ __.— Catastrophe,(Other•than•Certified-Acts of Terrorism) TER09 Terrorism Risk Insurance Program Reauthorization Act ITEM 4. We will determine the premium for this policy by our manuals of rules, classifications, rates and rating plans. All information required below is subject to verification and change by audit. The statements of estimated advanced premium are also a part of this policy. 7501 E Lowry Blvd Denver, CO 80230-7006 Page 2 of 6 P UB408 - 04/04/2013 19:08,10 4154652 384765W P4ALL Participants by From: Alpha Sort Field To: J J 's Trucking (71) Pool Group: DOT (D1) Participant ID Name Home Base Street 1 Occupation Sheet 2 SSN Pool Group Him Data DOT Randoms City, State, Zip Terminated) Date DOT Administrations Tenn. Date Phone XXX-XX4830 Stan Pllipsen Dot XXX-XX4830 DOT Yes True No FMCSA XXX-XX-3435 Michael Ronick Dot XXX-XX-3435 DOT 03/29/2013 Yes True No FMCSA Records In this group: Pool Group: DOT lot): 2 Records in this company: J J's Trucking (71): 2 Total Records Primed: 2 3/29/2013 8:13:17AM Participants by Alpha Sort Field Page 1 of 1 TO THE MEDICAL EXAMINER: If the applicant is medically qualified, please complete the "MEDICAL EXAMINER'S CERTIFICATE" below. MEDICAL EXAMINER'S CERTIFICATE I certify that I have examined fz:bb., T!ir Iq in accordance with the Federal Motor Carrier Safely Regulations (49 CFR 391,41-391.49) and with knowledge of the driving duties, I find this person is qualified; and if applicable, only when: ❑ wearing corrective lenses ❑ driving within an exempt intracity zone (49 CFR 391.62) ❑ wearing hearing aid ❑ accompanied by a Skill Performance Evaluation Certificate (SPE) ❑ accompanied by a exemption ❑ qualified by 49 CFR 391.64 The information I have provided regarding this physical examination is true and complete. A complete examination form with any attachment embodies my findings comDletely and correctly. and is on file in my office. Si nature of Medical Examiner Telephone Date r _ ,",o, 1-9-7G)w" - 6IV 14-1-1 Medical Exam' a ame (Print) `�MD ❑ DD ❑ Chiropractor /V1 fn hysician Asst. O Advance Practice Nurse Medical Examiner's License or Certificate No./Issuing State 3z333 % Cr Signature of Driver Driver's License No. State I Address of Driver �t w. �ov�tcS �((7 (i { Cotltvs co SZs2't ! Medical Certificate xpimtion Date LA- G1 �s DISTRIBUTION: I COPY TO THE DRIVER, I COPY TO THE MOTOR CARRIER CSP 36(REV I/0)