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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8106 UTILITY INFRASTRUCTURE CONSTRUCTION SERVICES FOR WATER, WASTEWATER, AND STORMWATER FACILITIES CAPITAL IMPROVEMENTS (3)Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
WORK ORDER
PURSUANT TO A MASTER AGREEMENT BETWEEN
THE CITY OF FORT COLLINS
AND
BT CONSTRUCTION, INC
WORK ORDER NUMBER: UHick-BTC-3
PROJECT TITLE: UHickory Street RR Bore-Final Design
ORIGINAL BID/RFP NUMBER & NAME: U8106 – Utility Infrastructure Construction
Services for Water, Wastewater, and
Stormwater Facilities CIP
MASTER AGREEMENT EFFECTIVE DATE: August 17, 2015
ARCHITECT/ENGINEER: U
OWNER’S REPRESENTATIVE:
WORK ORDER COMMENCEMENT DATE:
WORK ORDER COMPLETION DATE:
U
Merrick
Heather McDowell
U May 15, 2019
December 31, 2019
MAXIMUM FEE: (time and reimbursable direct U costs U$29,498.24
PROJECT DESCRIPTION/SCOPE OF SERVICES: UDesign assistance for the Hickory Street
waterline railroad bore, per the design schedule that defines the design meetings and tasks. See
attached supporting documentation.
Service Provider agrees to perform the services identified above and on the attached forms in
accordance with the terms and conditions contained herein and in the Master Agreement between
the parties. In the event of a conflict between or ambiguity in the terms of the Master Agreement
and this Work Order (including the attached forms) the Master Agreement shall control.
The attached forms consisting of UelevenU (U11U) pages are hereby accepted and incorporated
herein, by this reference, and Notice to Proceed is hereby given after all parties have signed this
document.
SERVICE PROVIDER: BT Construction, Inc.
By: Date:
Name: Title:
Page 1 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
May 15, 2019
John Beckos Project Manager
Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
OWNER’S ACCEPTANCE & EXECUTION:
This Work Order and the attached Contract Documents are hereby accepted and incorporated
herein by this reference.
ACCEPTANCE: Date:
Heather McDowell, Civil Engineer III
REVIEWED: Date:
Pat Johnson, Senior Buyer
APPROVED AS TO FORM: Date:
Name,City Attorney's Title
(if greater than $1,000,000)
ACCEPTANCE: Date:
Matt Fater, Director, Civil Engineering
ACCEPTANCE: Date:
Andrew Gingerich, Director, Water Field Operations
ACCEPTANCE: Date:
Ken Sampley for Theresa Connor, Deputy Director – Water Engineering &
Field Services
ACCEPTANCE: Date:
Kevin Gertig, Utilities Executive Director
(if greater than $1,000,000)
ACCEPTANCE: Date:
Gerry Paul, Purchasing Director
(if greater than $60,000)
ACCEPTANCE: Date:
Darin Atteberry, City Manager
(if greater than $1,000,000)
ATTEST: Date:
City Clerk
(if greater than $1,000,000)
Page 2 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
May 14, 2019
May 14, 2019
May 15, 2019
May 15, 2019
May 15, 2019
Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
ATTACHMENT A
WORK ORDER SCOPE OF SERVICES
Page 3 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
WWW.BTCONSTRUCTION.COM
BT Construction, Inc.
9885 Emporia Street
Henderson, CO 80640
Phone: 303-469-0199
Fax: 303-466-8309
April 3, 2019
The City of Fort Collins
700 Wood Street
PO Box 580
Fort Collins, CO 80522
Attn: Heather McDowell & Owen Randall
Re: 2019 Water System Improvements – Railroad Bores at Sharp Point Drive & Hickory Street. Design
Assist, Test Pit, & Potholing Services. Revised 4/3/19.
Ms. McDowell and Mr. Randall:
Thank you for the opportunity to be involved in the early stages of the 2019 Water System Improvements
at both Sharp Point Drive and Hickory Street. During discussions following test pits in February, the work
at Sharp Point Drive was deleted from the scope of this contract. Since a work order has not yet been
issued to us, I’ve taken this opportunity to revise our proposal. Additionally, we would like to try and
resolve our labor and equipment rates before issuing this work order.
This proposal includes design assist & estimating services, test pits, and potholing services for these two
project locations based on the revised scope. We have assumed that BTC will participate in a number of
design meetings as identified in Exhibit A. We have also assumed 1.5 days of test pits and 3 full days of
potholing as identified in Exhibit B. Our total proposal request is $29,498.24
WORK ORDER: 2019 Water System Improvements ‐ Railroad Bores @ Sharp Point Drive
& Hickory Street
Amount Sharp Point Project Hickory Project
Design Assist Costs $ 14,950.00 $ ‐ $ 14,950.00
Test‐Pits & Potholing $ 14,548.24 $ 3,331.76 $ 11,216.47
Totals $ 29,498.24 $ 3,331.76 $ 26,166.47
This proposal is based on our 2019 revised rates. Our rates in our APDS contract have not been
increased since 2017 and as your team should be aware, the cost of construction labor and equipment
continues to increase year after year.
If you look at our rate increase request for 2019 and compare it to our 2015 original rates, we’re only
asking for a 5.25% increase per year. This is in-line with, and actually a better rate than, some market
research we’ve done. For example, in 2018 alone one report suggested that owners should have
anticipated a 7-8% increase. I’ve also included our normal T&M rates we issue to clients along the front
range, which is well above and beyond what we’re asking for in the APDS program. BT Construction
needs to stay competitive in the construction market place and provide wages to our employees that keep
them working for us.
Page 4 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
WWW.BTCONSTRUCTION.COM
BT Construction, Inc.
9885 Emporia Street
Henderson, CO 80640
Phone: 303-469-0199
Fax: 303-466-8309
Please keep in mind that per the terms of our contract, this work will be performed on a Time and
Materials basis. This number is for budgetary purposes only and every effort will be made to work as cost
effectively as possible.
Please let me know if you have questions or require additional information.
Sincerely,
John Beckos, Project Manager
BT Construction, Inc.
CC: Erin Knibbe, Josh Livermore, File
Page 5 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
ATTACHMENT B
WORK ORDER COST OF SERVICES
Page 6 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
WORK ORDER: 2019 Water System Improvements ‐ Railroad Bores @ Sharp Point Drive & Hickory Street
Individual & Category Expenses Task Total
Type of Rate Labor Vehicle Labor Vehicle Labor Vehicle Labor Vehicle
Rates $110.00 $20.00 $110.00 $20.00 $110.00 $20.00 $90.00 $20.00
Task 1 ATTEND DESIGN MEETINGS $ 5,685.00
1.1 1/4/19 Kickoff Meeting and Field Visi 4.0 4.0 4.0 - - - - - $ - $ 960.00
1.2 1/18/19 Design Assist Meeting 3.5 3.5 3.5 - - - - - $ - $ 840.00
1.3 2/1/19 Design Assist Meeting 3.5 3.5 - - 3.5 3.5 - - $ - $ 910.00
1.4 2/15/19 Design Assist Meeting 3.5 3.5 - - - - 3.5 3.5 $ - $ 840.00
1.5 3/1/19 Design Assist Meeting 3.5 3.5 3.5 - - - - - $ - $ 840.00
1.6 3/15/19 Design Assist Meeting 3.5 3.5 - - - - - - $ - $ 455.00
1.7 4/12/19 Design Assist Meeting 3.5 3.5 3.5 - - - - - $ - $ 840.00
Task 2 DEVELOP ESTIMATE $ 3,700.00
2.1 Estimate Round 1 - 20hrs for Dave, 10hrs for John 10.0 - 20.0 - 2.0 - 2.0 - $ - $ 3,700.00
2.2 Estimate Round 2 - 20hrs for Dave, 10hrs for John 10.0 - 20.0 - - - - - $ -
Subtotal 45.0 25.0 54.5 - 5.5 3.5 5.5 3.5 $ - $ 9,385.00
Level of effort per labor category (hours 45.00 25.00 54.50 - 5.50 3.50 5.50 3.50 110.5
Total Costs per labor category, sub-consult. & expenses $ 4,950.00 $ 500.00 $ 5,995.00 $ - $ 605.00 $ 70.00 $ 495.00 $ 70.00 $ - $ 12,685.00
staff-weeks: 1.13 1.36 0.14 0.14
Allowable Overhead and Profit Margin - 15% $ 2,238.53
Total $ 14,923.53
Proposal Request $ 14,950.00
EXHIBIT A - DESIGN ASSIST
John Beckos, PM Dave Emm, Estim. Mark Wellensiek, Supt. Erin Knibbe, Proj Eng
Page 7 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
LINE # Name / Description Class / Vendor Dates TOTAL
ST
TOTAL
OT UM ST RATE OT RATE LABOR EQUIP OWNED
3
4 Name / Description Class 1/14 1/15 1/16 1/17 1/18 1/19 1/20 TOTAL
ST
TOTAL
OT UM RATE LABOR EQUIP OWNED
5 John Beckos Project Manager - - 4.0 - - - - 4.0 - HR $110.00 $440.00
6 John's Truck F-150 Truck - - 4.0 - - - - 4.0 HR $20.00 $80.00
7 Mark Wellensiek Superintendent - - 4.0 - - - - 4.0 - HR $110.00 $440.00
8 Supt. Truck F-150 Truck - - 4.0 - - - - 4.0 - HR $20.00 $80.00
9 Supt. Small Tools Small Tools - - 4.0 - - - - 4.0 - HR $12.00 $48.00
10 Foreman Foreman - 2.0 8.0 - - - - 10.0 - HR $83.00 $830.00
11 Foreman's Truck F-250 Truck - 2.0 8.0 - - - - 10.0 - HR $23.00 $230.00
12 Foreman's Tools Small Tools - 2.0 8.0 - - - - 10.0 - HR $12.00 $120.00
13 Operator Operator - - 8.0 - - - - 8.0 - HR $54.00 $432.00
14 CAT 320 Excavator CAT 320 Excavator - - 8.0 - - - - 8.0 - HR $88.00 $704.00
15 Laborer Laborer - - 16.0 - - - - 16.0 - HR $43.00 $688.00
16 CDL Driver Truck Tractor - 2.0 8.0 2.0 - - - 12.0 - HR $52.00 $624.00
17 Tractor (Mack Truck) Lowboy Trailer - 2.0 8.0 2.0 - - - 12.0 - HR $48.00 $576.00
18 Lowboy Trailer Lowboy Trailer - 2.0 8.0 2.0 - - - 12.0 - HR $31.00 $372.00
19
20 Name / Description Class 2/11 2/12 2/13 2/14 2/15 2/16 2/17 TOTAL
ST
TOTAL
OT UM ST RATE OT RATE LABOR EQUIP OWNED
21 Mark Wellensiek Superintendent 2.0 2.0 2.0 - - - - 6.0 - HR $110.00 $660.00
22 Supt. Truck F-150 Truck 2.0 2.0 2.0 - - - - 6.0 - HR $20.00 $120.00
23 Supt. Small Tools Small Tools 2.0 2.0 2.0 - - - - 6.0 - HR $12.00 $72.00
24 Pothole Truck (incl. 2 guys) Pothole Truck 1.0 1.0 1.0 - - 3.0 - DAY $1,950.00 $5,850.00
Subtotals $4,114.00 $8,252.00
Sharp Point $1,727.00 $1,105.00
Hickory $2,387.00 $7,147.00
Margin % 15% 15%
Sharp Point Margin $$ $304.76 $195.00
Hickory Margin $$ $421.24 $1,261.24
Sharp Point Total $2,031.76 $1,300.00
Hickory Total $2,808.24 $8,408.24
Totals $4,840.00 $9,708.24
Week 2 - Potholing of existing utilities on the proposed alignments for Hickory Street. It is assumed that there will be 3 days of potholing.
Week 1 - Test Pits to be done at two different locations. There is anticipated to be 2 test pits at the Sharp Point Project location and 1 test pit at the Hickory Project
location. BT Construction intends to staff the test pit project with a small 320 CAT excavator, a foreman, operator, and laborer. We will mobilize the equipment to the
site, and have the truck/trailer stay onsite to move to the subsequent test pits. Total project time is 1.5 days.
EXHIBIT B - TEST PITS & POTHOLING
Page 8 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
City of Fort Collins
2019 Revised Rates
8106 Utility Infrastructure Construction Services
For Water, Wastewater, Stormwater Facilities Capital Improvements
Construction Cost Factors T&M GMP
General Office Overhead and Profit Margin 15% 18%
Field Office Overhead and Profit Margin** N/A N/A
Margin on Subcontractors 6% 10%
Materials and Equipment Margin on Base Cost 6% 10%
Additional Factors (Bond) 1% 1%
Change Order Margin 15% 15%
Incidental Tools and Materials 15% 15%
Design Phase and Construction Phase General Conditions Billable Hourly Rates*
Key Staff Member Position Rate
Buck Bergstrom President/Executive Sponsor $150/HR
Dave Emm Senior Estimating Manager $110/HR
John Beckos Project Manager $110/HR
Erin Knibbe Project Engineer $90/HR
Eric Peterson General Superintendent $110/HR
Don Meyer Trenchless Superintendent $110/HR
Mark Wellensiek Trenchless Superintendent $110/HR
Marco Johnson Safety Manager $100/HR
Cliff Mondragon Traffic Control Supervisor $100/HR
BT Construction/BTrenchless Owned Equipment rates for Design Phase and General Conditions*
Office Vehicle $20/HR
Supervisor Pickup $23/HR
Field Billable Hourly Rates* Rate OT Rate
FOREMAN $83.00/HR $110.50/HR
OPERATOR Cat 245/365 (or equivalent) $65.50/HR $88.00/HR
OPERATOR REG $54.00/HR $72.00/HR
LABORER $43.00/HR $59.00/HR
PIPELAYER $49.00/HR $65.00/HR
DRIVER $52.00/HR $69.50/HR
*Not including overhead and profit
**Assumes Jobsite office only
Page 9 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
City of Fort Collins
2019 Revised Rates
8106 Utility Infrastructure Construction Services
For Water, Wastewater, Stormwater Facilities Capital Improvements
EQUIPMENT RATES
Description* Charge Rate *or equivalent size from other manufacturer
Excavators – 302 (Mini) $52.00
Excavators – 310 $76.00
Excavators – 320 $88.00
Excavators – 325, 33s $149.00
Excavators – 345 $258.00
Excavators – 365 $324.00
Skidsteers $60.00
Loaders – 928 (2.5 – 3.0 CY) $72.00
Loaders – 938 (3.0 – 4.0 CY) $86.50
Loaders – 950 (4.0 – 6.0 CY) $96.00
Backhoes 420 $49.00
Compactors 323 $48.00
Compactors 433 $73.00
Compactors 563 $86.50
Ford F150 $20.00
Ford F250 $23.00
Ford F350 $23.00
25 KW Generator $20.00
36 KW Generator $23.00
56 KW Generator $28.00
185 CFM Air Compressor $39.00
Lowboy Trailer $31.00
Flatbed Trailer $18.00
Tool Trailer/Connex Box $12.00
Side Dump Trailer $36.00
Boom Truck $54.00
Water Truck $31.00
Truck Tractor $48.00
Trenchless Equipment and Shoring is all job dependent. Various equipment configurations along with
supplemental rental items make a standard rate structure impractical. This equipment will be
determined for each project and the rates presented to the City for approval.
Page 10 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Rate Schedule for Potholing Services
UNTIL 12/31/2018
Standard Truck and Crew Rates (Includes (1) Operator & (1) Laborer (Up to 12ft in Depth) Up
to 10 hours: Assuming approx. 5 holes per day
Hourly Rate: $195.00 hour/ truck – Port to Port
Per Hole: Quoted by Specific Project
Daily Rate: $1,950.00 day/ truck
Overtime Rate: $292.50 hour/truck
Dump Fees: $ 90.00 Per Dump
Super Truck and Crew Rates (Includes (1) Operator & (1) Laborer: Assuming approx. 5 holes per
day (Over 12ft in Depth) Up to 10 hours:
Hourly Rate: $300.00 hour/truck – Port to Port
Per Hole Rate: Quoted by Specific Project
Daily Rate: $3,000.00 day/truck
Overtime Rate: $525.00 hour/truck
Dump Fees: $ 100.00 Per Dump
Additional Charges:
Core Drill Asphalt: $65.00 Per Hole
Core Drill Concrete: $75.00 Per Hole
Traffic Flaggers: $550.00 Per Day – Includes 2 Flaggers
Traffic Control above and beyond Road work ahead signs and cones (Lane Closures): $850.00/ Per Day
Traffic Control (Minor) Shoulder work and Right of Way: $450.00/Per Day
Permits at cost + 15%
Exclusions:
Dewatering of Any Kind
Erosion Control of Any Kind
Concrete / Asphalt Restoration quoted per project
Permits quoted per project
Hourly minimum is 4 hours
Per hole minimum is 4 holes
Page 11 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
2019 APDS Rates ‐ Analysis 4/3/2019
Charge Rates 2015 Initial Rates 2017 Rates 2019 Rates
(Pending)
Key Staff Members Increase from 2015 to 2017 Increase from 2015 to 2019
Buck Bergstrom, President/Exec. Sponsor $ 150.00 $ 150.00 0.00% $ 150.00 0.00%
Dave Emm, Senior Estimating Manager $ 90.00 $ 95.00 5.56% $ 110.00 22.22%
John Beckos, Project Manager $ 90.00 $ 95.00 5.56% $ 110.00 22.22%
Shawn August, Project Engineer $ 70.00 $ 75.00 7.14% $ 90.00 28.57%
Eric Peterson, General Supt. $ 90.00 $ 95.00 5.56% $ 110.00 22.22%
Don Meyer, Trenchless Supt. $ 90.00 $ 95.00 5.56% $ 110.00 22.22%
Mark Wellensiek, Trenchless Supt. $ 90.00 $ 95.00 5.56% $ 110.00 22.22%
Marco Johnson, Safety Manager $ 75.00 $ 80.00 6.67% $ 100.00 33.33%
Linda Kingery, Traffic Control Supt. $ 70.00 $ 75.00 7.14% $ 100.00 42.86%
BT Construction/BTrenchless Owned Equip Rates
Office Vehicle $ 15.00 $ 16.00 6.67% $ 20.00 33.33%
Supervisor Pickup $ 18.00 $ 19.00 5.56% $ 23.00 27.78%
Field Billable Hourly Rates ST Rate OT Rate ST Rate OT Rate ST Rate OT Rate ST Rate OT Rate
Foreman $ 67.80 $ 90.10 $69.30 $92.10 2.21% $ 83.00 $ 110.50 22.42% 22.64%
Operator CAT 245/365 (or equiv) $ 52.35 $ 72.05 $54.40 $73.20 3.92% $ 65.50 $ 88.00 25.12% 22.14%
Operator Regular $ 43.15 $ 59.15 $44.80 $60.00 3.82% $ 54.00 $ 72.00 25.14% 21.72%
Laborer $ 35.75 $ 48.70 $35.90 $48.90 0.42% $ 43.00 $ 59.00 20.28% 21.15%
Pipelayer $ 38.80 $ 53.10 $40.55 $54.25 4.51% $ 49.00 $ 65.00 26.29% 22.41%
CDL Driver $ 39.35 $ 53.90 $43.10 $57.80 9.53% $ 52.00 $ 69.50 32.15% 28.94%
General Equipment Rates
Excavators ‐ CAT 302 (Mini) $ 41.00 $43.00 4.88% $ 52.00 26.83%
Excavators ‐ CAT 310 $ 60.00 $63.00 5.00% $ 76.00 26.67%
Excavators ‐ CAT 320 $ 69.00 $73.00 5.80% $ 88.00 27.54%
Excavators ‐ CAT 325, 333s $ 118.00 $124.00 5.08% $ 149.00 26.27%
Excavators ‐ CAT 345 $ 204.00 $215.00 5.39% $ 258.00 26.47%
Excavators ‐ CAT 365 $ 258.00 $270.00 4.65% $ 324.00 25.58%
Skidsteers $ 47.00 $50.00 6.38% $ 60.00 27.66%
Loaders ‐ 925 (2.5‐3CY) $ 57.00 $60.00 5.26% $ 72.00 26.32%
Loaders ‐ 938 (3‐4CY) $ 68.00 $72.00 5.88% $ 86.50 27.21%
Loaders ‐ 950 (4‐6CY) $ 76.00 $80.00 5.26% $ 96.00 26.32%
Backhoes 420 $ 39.00 $41.00 5.13% $ 49.00 25.64%
Compactors 323 $ 38.00 $40.00 5.26% $ 48.00 26.32%
Compactors 433 $ 58.00 $61.00 5.17% $ 73.00 25.86%
Compactors 563 $ 68.00 $72.00 5.88% $ 86.50 27.21%
Ford F150 $ 15.00 $16.00 6.67% $ 20.00 33.33%
Ford F250 $ 18.00 $19.00 5.56% $ 23.00 27.78%
Ford F350 $ 18.00 $19.00 5.56% $ 23.00 27.78%
25 KW Generator $ 15.00 $16.00 6.67% $ 20.00 33.33%
36 KW Generator $ 18.00 $19.00 5.56% $ 23.00 27.78%
56 KW Generator $ 22.00 $23.00 4.55% $ 28.00 27.27%
185 CFM Air Compressor $ 30.00 $32.00 6.67% $ 39.00 30.00%
Lowboy Trailer $ 25.00 $26.00 4.00% $ 31.00 24.00%
Flatbed Trailer $ 14.00 $15.00 7.14% $ 18.00 28.57%
Tool Trailer/Connex Box $ 10.00 $10.00 0.00% $ 12.00 20.00%
Side Dump Trailer $ 29.00 $30.00 3.45% $ 36.00 24.14%
Boom Truck $ 43.00 $45.00 4.65% $ 54.00 25.58%
Water Truck $ 25.00 $26.00 4.00% $ 31.00 24.00%
Truck Tractor $ 38.00 $40.00 5.26% $ 48.00 26.32%
Average Rate Increase Average Rate Increase
5.11% 26.23%
Over 2 years Over 5 Years
5.25%
Page 12 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
ATTACHMENT C
WORK ORDER SCHEDULE OF SERVICES
Page 13 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
ID Task Name Duration Start Finish Predecessors
1 2019 WATER SYSTEM IMPROVEMENTS ‐ RR BORES 149 days Fri 1/4/19 Tue 8/6/19
2 Overall Design 116 days Fri 1/4/19 Tue 6/18/19
3 Meetings for Hickory Street (Sharp Pt deleted) 88 days Fri 1/4/19 Tue 5/7/19
4 Kick‐off Meeting, 1/4/19 1 day Fri 1/4/19 Fri 1/4/19
5 Design Team Meeting #1 ‐ 1/18/19 1 day Fri 1/18/19 Fri 1/18/19
6 Design Team Meeting #2 ‐ 2/4/19 1 day Fri 2/1/19 Fri 2/1/19
7 Design Team Meeting #3 ‐ 2/21/19 1 day Fri 2/15/19 Fri 2/15/19
8 Design Team Meeting #4 ‐ 3/11/19 1 day Fri 3/1/19 Fri 3/1/19
9 Design Team Meeting #5 ‐ 3/25/19 1 day Fri 3/15/19 Fri 3/15/19
10 Design Team Meeting #6 ‐ 4/8/19 1 day Fri 4/12/19 Fri 4/12/19
11 Design Team Meeting #7 ‐ 4/16/19 1 day Tue 4/16/19 Tue 4/16/19
12 Final Design Team Meeting #8 ‐ 5/7/19 1 day Tue 5/7/19 Tue 5/7/19
13 Sharp Point Drive 1 day Wed 1/16/19 Wed 1/16/19
14 Test Pits / Geotech in Field 1 day Wed 1/16/19 Wed 1/16/19
15 Hickory Street Design & Permits 108 days Wed 1/16/19 Tue 6/18/19
16 Design / Field Work 73 days Wed 1/16/19 Fri 4/26/19
17 Test Pits / Geotech in Field 1 day Wed 1/16/19 Wed 1/16/19
18 Potholing existing utilities on proposed bore alignment 3 days Tue 1/22/19 Thu 1/24/19
19 Determine Casing Size & Depth / Profile / Prep RR Permit 20 days Thu 1/17/19 Wed 2/13/19 17
20 WL Design (tunnel & open cut components) ‐ 30%/60% 30 days Fri 1/25/19 Thu 3/7/19 18
21 WL Design (tunnel & open cut components) ‐ 90% (Ready for UP Permit) 25 days Fri 3/8/19 Thu 4/11/19 20
22 WL Design (tunnel & open cut components) ‐ 100% (Ready for pricing) 11 days Fri 4/12/19 Fri 4/26/19 21
2019 WATER SYSTEM IMPROVEMENTS - RR BORES
Overall Design
Meetings for Hickory Street (Sharp Pt deleted)
Kick-off Meeting, 1/4/19
Design Team Meeting #1 - 1/18/19
Design Team Meeting #2 - 2/4/19
Design Team Meeting #3 - 2/21/19
Design Team Meeting #4 - 3/11/19
Design Team Meeting #5 - 3/25/19
Design Team Meeting #6 - 4/8/19
Design Team Meeting #7 - 4/16/19
Final Design Team Meeting #8 - 5/7/19
Sharp Point Drive
Test Pits / Geotech in Field
Hickory Street Design & Permits
Design / Field Work
Test Pits / Geotech in Field
Potholing existing utilities on proposed bore alignment
Determine Casing Size & Depth / Profile / Prep RR Permit
WL Design (tunnel & open cut components) - 30%/60%
WL Design (tunnel & open cut components) - 90% (Ready for UP Permit)
WL Design (tunnel & open cut components) - 100% (Ready for pricing)
30 6 132027 3 101724 3 10172431 7 142128 5 121926 2 9 162330 7 142128 4 111825 1 8 152229 6 132027 3 101724 1 8 152229 5 121926
Jan '19 Feb '19 Mar '19 Apr '19 May '19 Jun '19 Jul '19 Aug '19 Sep '19 Oct '19 Nov '19 Dec '19 Jan '20
Task
Split
Progress
Milestone
Summary
Project Summary
External Tasks
External Milestone
Deadline
2019 Water System Improvements
Railroad Bores @ Sharp Point Drive & Hickory Street
UPDATED: MAY 9, 2019
Page 1
ID Task Name Duration Start Finish Predecessors
23 Specification Development (complete with 100% dwgs) 30 days Wed 3/20/19 Tue 4/30/19
24 Lithos ‐ Tunnel Specs 30 days Wed 3/20/19 Tue 4/30/19 22FF+2 days
25 Merrick ‐ Remaining Specs 30 days Wed 3/20/19 Tue 4/30/19 22FF+2 days
26 Permitting 16 days Fri 4/12/19 Fri 5/3/19
27 Submit Union Pacific Railroad ROE & Crossing Permit 1 day Fri 4/12/19 Fri 4/12/19 21
28 UPRR Permit Approval (assume 15 days) 15 days Mon 4/15/19 Fri 5/3/19 27
29 Construction Cost Estimates 25 days Mon 4/29/19 Tue 6/4/19
30 Construction Cost Estimate Development by BTC (following 90% dwgs) 9 days Mon 4/29/19 Thu 5/9/19 22
31 Independent Cost Estimate (ICE) Kick Off Meeting (DATE TBD) 1 day Tue 5/14/19 Tue 5/14/19 30FS+2 days
32 Independent Estimate (assume they need 2 weeks) 10 days Wed 5/15/19 Thu 5/30/19 31
33 ICE Reconciliation 1 day Tue 6/4/19 Tue 6/4/19 32FS+2 days
34 Fort Collins Work Orders 10 days Wed 6/5/19 Tue 6/18/19
35 Hickory Street Work Order to BTC 10 days Wed 6/5/19 Tue 6/18/19 33
36 Early Construction Activities 10 days Wed 6/5/19 Tue 6/18/19
37 Submittals & Material Procurement 10 days Wed 6/5/19 Tue 6/18/19
38 Hickory Street 10 days Wed 6/5/19 Tue 6/18/19
39 Submittals 10 days Wed 6/5/19 Tue 6/18/19 35SS
40 Procure Long Lead Items ‐ Casing 10 days Wed 6/5/19 Tue 6/18/19 35SS
41 Construction Duration 33 days Wed 6/19/19 Tue 8/6/19
42 Hickory Street (GBM Auger Bore ‐ 140LF) 33 days Wed 6/19/19 Tue 8/6/19
43 Mobilization (Earliest Potential Start Date) 2 days Wed 6/19/19 Thu 6/20/19 40
44 Dig Launch Pit (44FT x 12FT) 3 days Thu 6/20/19 Mon 6/24/19 43SS+1 day
Specification Development (complete with 100% dwgs)
Lithos - Tunnel Specs
Merrick - Remaining Specs
Permitting
Submit Union Pacific Railroad ROE & Crossing Permit
UPRR Permit Approval (assume 15 days)
Construction Cost Estimates
Construction Cost Estimate Development by BTC (following 90% dwgs)
Independent Cost Estimate (ICE) Kick Off Meeting (DATE TBD)
Independent Estimate (assume they need 2 weeks)
ICE Reconciliation
Fort Collins Work Orders
Hickory Street Work Order to BTC
Early Construction Activities
Submittals & Material Procurement
Hickory Street
Submittals
Procure Long Lead Items - Casing
Construction Duration
Construction Duration
Hickory Street (GBM Auger Bore - 140LF)
Hickory Street (GBM Auger Bore - 140LF)
Mobilization (Earliest Potential Start Date)
Dig Launch Pit (44FT x 12FT)
30 6 132027 3 101724 3 10172431 7 142128 5 121926 2 9 162330 7 142128 4 111825 1 8 152229 6 132027 3 101724 1 8 152229 5 121926
Jan '19 Feb '19 Mar '19 Apr '19 May '19 Jun '19 Jul '19 Aug '19 Sep '19 Oct '19 Nov '19 Dec '19 Jan '20
Task
Split
Progress
Milestone
Summary
Project Summary
External Tasks
External Milestone
Deadline
2019 Water System Improvements
Railroad Bores @ Sharp Point Drive & Hickory Street
ID Task Name Duration Start Finish Predecessors
45 Dig Receive Pit (12FT x 8FT) 1 day Tue 6/25/19 Tue 6/25/19 44
46 Setup for GBM Pilot Tube, Install 4" Pilot Tube 3 days Wed 6/26/19 Fri 6/28/19 45
47 Setup for 24" Auger Bore 2 days Mon 7/1/19 Tue 7/2/19 46
48 Install 140LF of Casing with GBM‐Auger Bore Method (30LF/DAY) 5 days Wed 7/3/19 Thu 7/11/19 47
49 Teardown Bore & Prep for carrier pipe 2 days Fri 7/12/19 Mon 7/15/19 48
50 Skid Carrier Pipe Through Casing 2 days Tue 7/16/19 Wed 7/17/19 49
51 Teardown Tunnel Equipment, Install Open Cut components on East Side 3 days Thu 7/18/19 Mon 7/22/19 50
52 Fort Collins Tie‐In Work on West side 4 days Tue 7/23/19 Fri 7/26/19 51
53 Disinfect New Line / Load Line / Pressure Test 3 days Mon 7/29/19 Wed 7/31/19 52
54 Backfill Bore & Receive Pits 2 days Thu 8/1/19 Fri 8/2/19 53
55 Demobe & Site Restoration 2 days Mon 8/5/19 Tue 8/6/19 54
56 Final Completion of Hickory Street WL 0 days Tue 8/6/19 Tue 8/6/19 55
Dig Receive Pit (12FT x 8FT)
Setup for GBM Pilot Tube, Install 4" Pilot Tube
Setup for 24" Auger Bore
Install 140LF of Casing with GBM-Auger Bore Method (30LF/DAY)
Teardown Bore & Prep for carrier pipe
Skid Carrier Pipe Through Casing
Teardown Tunnel Equipment, Install Open Cut components on East
Fort Collins Tie-In Work on West side
Disinfect New Line / Load Line / Pressure Test
Backfill Bore & Receive Pits
Demobe & Site Restoration
Final Completion of Hickory Street WL
30 6 132027 3 101724 3 10172431 7 142128 5 121926 2 9 162330 7 142128 4 111825 1 8 152229 6 132027 3 101724 1 8 152229 5 121926
Jan '19 Feb '19 Mar '19 Apr '19 May '19 Jun '19 Jul '19 Aug '19 Sep '19 Oct '19 Nov '19 Dec '19 Jan '20
Task
Split
Progress
Milestone
Summary
Project Summary
External Tasks
External Milestone
Deadline
2019 Water System Improvements
Railroad Bores @ Sharp Point Drive & Hickory Street
UPDATED: MAY 9, 2019
Page 3
Project: 2019 WATER SYS IMPROV, R
Date: Thu 5/9/19
Page 16 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Utilities Work Order Form Official Purchasing Form
Last updated 10/2017
ATTACHMENT D
CERTIFICATE OF INSURANCE
CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents.
Page 17 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
PHONE FAX
(A/C, No, Ext): (A/C, No):
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXP
TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $
OTHER: $
COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
BT Construction, et. al
Policy #DTCO4H983410PHX
COMMERCIAL GENERAL LIABILITY
10/1/18 - 10/1/19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Section II) is amended to
include any person or organization that you agree in a
"written contract requiring insurance" to include as an
additional insured on this Coverage Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and
b) If, and only to the extent that, the injury or damage
is caused by acts or omissions of you or your
subcontractor in the performance of "your
work" to which the "written contract requiring
insurance" applies. The person or organization
does not qualify as an additional insured with
respect to the independent acts or omissions of
such person or organization.
2. The insurance provided to the additional insured by
this endorsement is limited as follows:
a) In the event that the Limits of Insurance of this
Coverage Part shown in the Declarations exceed
the limits of liability required by the "written
contract requiring insurance", the insurance
provided to the additional insured shall be limited
to the limits of liability required by that "written
contract requiring insurance". This endorsement
shall not increase the limits of insurance described
in Section III - Limits Of Insurance.
b) The insurance provided to the additional insured
does not apply to "bodily injury", "property
damage" or "personal injury" arising out of the
rendering of, or failure to render, any professional
architectural, engineering or surveying services,
including:
i. The preparing, approving, or failing to prepare or
approve, maps, shop drawings, opinions,
reports, surveys, field orders or change orders,
or the preparing, approving, or failing to prepare
or approve, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional insured
does not apply to "bodily injury" or "property
damage" caused by "your work" and included in
the "products-completed operations hazard"
unless the "written contract requiring insurance"
specifically requires you to provide such coverage
for that additional insured, and then the insurance
provided to the additional insured applies only to
such "bodily injury" or "property damage" that
occurs before the end of the period of time for
which the "written contract requiring insurance"
requires you to provide such coverage or the end
of the policy period, whichever is earlier.
i. How, when and where the "occurrence" or
offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
i. Immediately record the specifics of the
claim or "suit" and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
soon as practicable.
c) The additional insured must immediately send
us copies of all legal papers received in
connection with the claim or "suit", cooperate
with us in the investigation or settlement of the
claim or defense against the "suit", and
otherwise comply with all policy conditions.
d) The additional insured must tender the defense
and indemnity of any claim or "suit" to
any provider of "other insurance" which would
cover the additional insured for a loss we cover
under this endorsement. However, this condition
does not affect whether the insurance provided
to the additional insured by this endorsement is
primary to "other insurance" available to the
additional insured which covers that person or
organization as a named insured as described
in paragraph 3. above.
5. The following definition is added to SECTION V.
- DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional insured
on this Coverage Part, provided that the "bodily
injury" and "property damage" occurs and the
"personal injury" is caused by an offense
committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or agreement
is in effect; and
c. Before the end of the policy period.
Miscellaneous Attachment: M514419 Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
2005 The St. Paul Travelers Companies, Inc.
CD D2 46 08 05
Miscellaneous Attachment: M514419 Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the
following: COMMERCIAL GENERAL LIABILITY
COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. Aircraft Chartered With Pilot
B. Damage To Premises Rented To You
C. Increased Supplementary Payments
D. Incidental Medical Malpractice
E. Who Is An Insured - Newly Acquired Or Formed
Organizations
F. Who Is An Insured - Broadened Named Insured -
Unnamed Subsidiaries
G. Blanket Additional Insured - Owners, Managers Or
Lessors Of Premises
PROVISIONS
A. AIRCRAFT CHARTERED WITH PILOT
The following is added to Exclusion g., Aircraft,
Auto Or Watercraft, in Paragraph 2. of SECTION
I - COVERAGES - COVERAGE A BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY:
This exclusion does not apply to an aircraft that
is:
(a) Chartered with a pilot to any insured;
(b) Not owned by any insured; and
(c) Not being used to carry any person or property
for a charge.
B. DAMAGE TO PREMISES RENTED TO YOU
1. The first paragraph of the exceptions in Ex-
clusion j., Damage To Property, in Paragraph
2. of SECTION I - COVERAGES -COVERAGE
A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY is deleted.
2. The following replaces the last paragraph of
Paragraph 2., Exclusions, of SECTION I
-COVERAGES - COVERAGE A. BODILY
H.Blanket Additional Insured - Lessors Of Leased
Equipment
I. Blanket Additional Insured - States Or Political
Subdivisions - Permits
J. Knowledge And Notice Of Occurrence Or Offense
K. Unintentional Omission
L. Blanket Waiver Of Subrogation
M.Amended Bodily Injury Definition
N.Contractual Liability - Railroads
INJURY AND PROPERTY DAMAGE LI-
ABILITY:
Exclusions c. and g. through n. do not apply
to "premises damage". Exclusion f.(1)(a)
does not apply to "premises damage" caused
by:
a. Fire;
b. Explosion;
COMMERCIAL GENERAL LIABILITY
3. The following replaces Paragraph 6. of SECTION
III - LIMITS OF INSURANCE:
Subject to 5. above, the Damage To Premises
Rented To You Limit is the most we will pay
under Coverage A for damages because of
"premises damage" to any one premises. The
Damage To Premises Rented To You Limit will
apply to all "property damage" proximately
caused by the same "occurrence", whether such
damage results from: fire; explosion; lightning;
smoke resulting from such fire, explosion, or
lightning; or water; or any combination of any of
these causes.
The Damage To Premises Rented To You Limit
will be:
a. The amount shown for the Damage To
Premises Rented To You Limit on the
Declarations of this Coverage Part; or
b. $300,000 if no amount is shown for the
Damage To Premises Rented To You Limit
on the Declarations of this Coverage Part.
4. The following replaces Paragraph a. of the
definition of "insured contract" in the
DEFINITIONS Section:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person or
organization for "premises damage" is not
an "insured contract";
5. The following is added to the DEFINITIONS
Section:
"Premises damage" means "property damage" to:
a. Any premises while rented to you or
temporarily occupied by you with permission
of the owner; or
b. The contents of any premises while such
premises is rented to you, if you rent such
premises for a period of seven or fewer
consecutive days.
6. The following replaces Paragraph 4.b.(1)(b) of
SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS:
(b) That is insurance for "premises damage"; or
7. Paragraph 4.b.(1)(c) of SECTION IV
-COMMERCIAL GENERAL LIABILITY CON-
DITIONS is deleted.
Page 2 of 6
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
C. INCREASED SUPPLEMENTARY PAYMENTS
1. The following replaces Paragraph 1.b. of
SUPPLEMENTARY PAYMENTS - COVER-
AGES A AND B of SECTION I - COVER-
AGE:
b. Up to $2,500 for the cost of bail bonds
required because of accidents or traffic
law violations arising out of the use of
any vehicle to which the Bodily Injury
Liability Coverage applies. We do not
have to furnish these bonds.
2. The following replaces Paragraph 1.d. of
SUPPLEMENTARY PAYMENTS - COVER-
AGES A AND B of SECTION I - COVER-
AGES:
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit", including actual loss of earnings up
to $500 a day because of time off from
work.
D. INCIDENTAL MEDICAL MALPRACTICE
1. The following is added to the definition of
"occurrence" in the DEFINITIONS Section:
"Occurrence" also means an act or omission
committed in providing or failing to provide
"incidental medical services", first aid or
"Good Samaritan services" to a person.
2. The following is added to Paragraph 2.a.(1)
of SECTION II - WHO IS AN INSURED:
Paragraph (1)(d) above does not apply to
"bodily injury" arising out of providing or
failing to provide:
(I) "Incidental medical services" by any of
your "employees" who is a nurse
practitioner, registered nurse, licensed
practical nurse, nurse assistant,
emergency medical technician or
paramedic; or
(ii) First aid or "Good Samaritan services" by
any of your "employees" or "volunteer
workers", other than an employed or vol-
unteer doctor. Any such "employees" or
"volunteer workers" providing or failing to
provide first aid or "Good Samaritan ser-
vices" during their work hours for you will
be deemed to be acting within the scope
of their employment by you or performing
duties related to the conduct of your busi-
ness.
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
COMMERCIAL GENERAL LIABILITY
3. The following is added to Paragraph 5. of
SECTION III - LIMITS OF INSURANCE:
For the purposes of determining the applicable
Each Occurrence Limit, all related acts or
omissions committed in providing or failing to
provide "incidental medical services", first aid
or "Good Samaritan services" to any one per-
son will be deemed to be one "occurrence".
4. The following exclusion is added to Paragraph 2.,
Exclusions, of SECTION I - COVERAGES -
COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY:
Sale Of Pharmaceuticals
"Bodily injury" or "property damage" arising out
of the willful violation of a penal statute or
ordinance relating to the sale of pharmaceuti-
cals committed by, or with the knowledge or
consent of, the insured.
5. The following is added to the DEFINITIONS
Section:
"Incidental medical services" means:
a. Medical, surgical, dental, laboratory, x-ray
or nursing service or treatment, advice or
instruction, or the related furnishing of food
or beverages; or
b. The furnishing or dispensing of drugs or
medical, dental, or surgical supplies or
appliances.
"Good Samaritan services" means any emer-
gency medical services for which no compen-
sation is demanded or received.
6. The following is added to Paragraph 4.b., Ex-
cess Insurance, of SECTION IV - COM-
MERCIAL GENERAL LIABILITY CONDI-
TIONS:
The insurance is excess over any valid and
collectible other insurance available to the in-
sured, whether primary, excess, contingent
or on any other basis, that is available to any
of your "employees" or "volunteer workers"
for "bodily injury" that arises out of providing
or failing to provide "incidental medical ser-
vices", first aid or "Good Samaritan services"
to any person to the extent not subject to
Paragraph 2.a.(1) of Section II - Who Is An
Insured.
E. WHO IS AN INSURED - NEWLY ACQUIRED OR
FORMED ORGANIZATIONS
The following replaces Paragraph 4. of SECTION II
- WHO IS AN INSURED:
Page 3 of 6
4. Any organization you newly acquire or form,
other than a partnership, joint venture or limited
liability company, of which you are the sole
owner or in which you maintain the majority
ownership interest, will qualify as a Named
Insured if there is no other insurance which
provides similar coverage to that organization.
However:
COMMERCIAL GENERAL LIABILITY
G. BLANKET ADDITIONAL INSURED - OWNERS,
MANAGERS OR LESSORS OF PREMISES
The following is added to SECTION II - WHO IS AN
INSURED:
Any person or organization that is a premises
owner, manager or lessor and that you have
agreed in a written contract or agreement to include
as an additional insured on this Coverage Part is an
insured, but only with respect to liability for "bodily
injury", "property damage", "personal injury" or
"advertising injury" that:
a. Is "bodily injury" or "property damage" that
occurs, or is "personal injury" or "advertising
injury" caused by an offense that is committed,
subsequent to the execution of that contract or
agreement; and
b. Arises out of the ownership, maintenance or
use of that part of any premises leased to
you.
The insurance provided to such premises owner,
manager or lessor is subject to the following pro-
visions:
a. The limits of insurance provided to such
premises owner, manager or lessor will be
the minimum limits which you agreed to pro-
vide in the written contract or agreement, or
the limits shown on the Declarations, which-
ever are less.
b. The insurance provided to such premises owner,
manager or lessor does not apply to:
(1) Any "bodily injury" or "property damage"
that occurs, or "personal injury" or "adver-
tising injury" caused by an offense that is
committed, after you cease to be a tenant
in that premises; or
(2) Structural alterations, new construction or
demolition operations performed by or on
behalf of such premises owner, lessor or
manager.
c. The insurance provided to such premises
owner, manager or lessor is excess over any
valid and collectible other insurance available
to such premises owner, manager or lessor,
whether primary, excess, contingent or on
any other basis, unless you have agreed in
the written contract or agreement that this in-
surance must be primary to, or non-
contributory with, such other insurance, in
which case this insurance will be primary to,
and non-contributory with, such other insur-
ance.
Page 4 of 6
H. BLANKET ADDITIONAL INSURED - LESSORS
OF LEASED EQUIPMENT
The following is added to SECTION II - WHO IS AN
INSURED:
Any person or organization that is an equipment
lessor and that you have agreed in a written con-
tract or agreement to include as an insured on this
COMMERCIAL GENERAL LIABILITY
by any ordinance, law or building code to
include as an additional insured on this
Coverage Part is an insured, but only with
respect to liability for "bodily injury", "property
damage", "personal injury" or "advertising injury"
arising out of such operations.
The insurance provided to such state or political
subdivision does not apply to:
a. Any "bodily injury," "property damage," "per-
sonal injury" or "advertising injury" arising
out of operations performed for that state or
political subdivision; or
b. Any "bodily injury" or "property damage" in-
cluded in the "products-completed
operations hazard".
J. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
The following is added to Paragraph 2., Duties
In The Event of Occurrence, Offense, Claim
or Suit, of SECTION IV - COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS:
e. The following provisions apply to Paragraph
a. above, but only for the purposes of the in-
surance provided under this Coverage Part
to you or any insured listed in Paragraph 1.
or 2. of Section II - Who Is An Insured:
(1) Notice to us of such "occurrence" or of-
fense must be given as soon as practica-
ble only after the "occurrence" or
offense is known by you (if you are an
individual), any of your partners or
members who is an individual (if you are
a partnership or joint venture), any of
your managers who is an individual (if
you are a limited liability company), any
of your "executive officers" or directors
(if you are an organization other than a
partnership, joint venture or limited
liability company) or any "employee"
authorized by you to give notice of an
"occurrence" or offense.
(2) If you are a partnership, joint venture or
limited liability company, and none of
your partners, joint venture members or
managers are individuals, notice to us of
such "occurrence" or offense must be
given as soon as practicable only after
the "occurrence" or offense is known by:
(a) Any individual who is:
(I) A partner or member of any part-
nership or joint venture;
(ii)A manager of any limited liability
company; or
(ii) An executive officer or director of
any other organization;
that is your partner, joint venture
member or manager; or
(b) Any "employee" authorized by such
partnership, joint venture, limited li-
If the insured has agreed in a contract or agreement
to waive that insured's right of recovery against any
person or organization, we waive our right of
recovery against such person or organization, but
only for payments we make because of:
a. "Bodily injury" or "property damage" that occurs; or
b. "Personal injury" or "advertising injury"
caused by an offense that is committed;
subsequent to the execution of that contract or
agreement.
M. AMENDED BODILY INJURY DEFINITION
The following replaces the definition of "bodily injury"
in the DEFINITIONS Section:
3. "Bodily injury" means bodily injury, mental
anguish, mental injury, shock, fright, disability,
humiliation, sickness or disease sustained by a
person, including death resulting from any of
these at any time.
N. CONTRACTUAL LIABILITY - RAILROADS
1. The following replaces Paragraph c. of the
definition of "insured contract" in the DEFINI-
TIONS Section:
c. Any easement or license agreement;
2. Paragraph f.(1) of the definition of "insured
contract" in the DEFINITIONS Section is deleted.
CG D3 16 11 11 Page 6 of 6
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for
any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited
by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that
coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only.
Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your
policy carefully to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED
B. BLANKET ADDITIONAL INSURED
C. EMPLOYEE HIRED AUTO
D. EMPLOYEES AS INSURED
E. SUPPLEMENTARY PAYMENTS -
INCREASED LIMITS
F. HIRED AUTO - LIMITED WORLDWIDE
COVERAGE - INDEMNITY BASIS
G. WAIVER OF DEDUCTIBLE - GLASS
H. HIRED AUTO PHYSICAL DAMAGE - LOSS
OF USE - INCREASED LIMIT
I. PHYSICAL DAMAGE - TRANSPORTATION
EXPENSES - INCREASED LIMIT
J. PERSONAL EFFECTS
K. AIRBAGS
L. NOTICE AND KNOWLEDGE OF ACCIDENT
OR LOSS
M. BLANKET WAIVER OF SUBROGATION
N. UNINTENTIONAL ERRORS OR OMISSIONS
PROVISIONS
A. BROAD FORM NAMED INSURED
The following is added to Paragraph A.1., Who Is An
Insured, of SECTION II - LIABILITY
COVERAGE:
Any organization you newly acquire or form during
the policy period over which you maintain 50% or
more ownership interest and that is not separately
insured for Business Auto Coverage. Coverage
under this provision is afforded only until the 180th
day after you acquire or form the organization or
the end of the policy period, whichever is earlier.
B. BLANKET ADDITIONAL INSURED
The following is added to Paragraph c. in A.1., Who
Is An Insured, of Section II - Liability
Coverage:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that is signed and
executed by you before the "bodily injury" or "property
damage" occurs and that is in effect during the policy
period, to be named as an additional insured is an
"insured" for Liability Coverage, but only for damages to
which this insurance applies and only to the extent that
person or organization qualifies as an "insured" under
the Who Is An Insured provision contained in Section II.
C. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A.1., Who
Is An Insured, of SECTION II - LI-
ABILITY COVERAGE:
2. The following replaces Paragraph b. in B.5.,
Other Insurance, of SECTION IV - BUSINESS
AUTO CONDITIONS:
b. For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
"autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
an "employee's" name, with your
permission, while performing duties
related to the conduct of your
business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
D. EMPLOYEES AS INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II - COVERED AUTOS
LIABILITY COVERAGE
Any "employee" of yours is an "insured" while using
a covered "auto" you don't own, hire or borrow in
your business or your personal affairs.
E. SUPPLEMENTARY PAYMENTS - INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2), of
SECTION II - COVERED AUTOS LIABILITY
COVERAGE:
(2) Up to $3,000 for cost of bail bonds (in-
cluding bonds for related traffic law viola-
tions) required because of an "accident"
we cover. We do not have to furnish these
bonds.
The following replaces Paragraph A.2.a.(4), of
SECTION II - COVERED AUTOS
LIABILITY COVERAGE:
(4) All reasonable expenses incurred by the
"insured" at our request, including actual
loss of earnings up to $500 a day because
of time off from work.
F. HIRED AUTO - LIMITED WORLDWIDE COVERAGE
- INDEMNITY BASIS
The following replaces Subparagraph (5) in Para-
graph B.7., Policy Period, Coverage Territory, of
SECTION IV - BUSINESS AUTO CONDITIONS:
5. Anywhere in the world, except any country or
jurisdiction while any trade sanction, embargo, or
similar regulation imposed by the United States of
America applies to and prohibits the transaction of
business with or within such country or jurisdiction, for
Covered Autos Liability Coverage for any covered "auto"
that you lease, hire, rent or borrow without a driver for a
period of 30 days or less and that is not an "auto" you
lease, hire, rent or borrow from any of your "employees",
partners (if you are a partnership), members (if you are a
limited liability company) or members of their households.
(a) With respect to any claim made or "suit" brought
outside the United States of America, the territories
and possessions of the United States of America,
PAGE 2 OF 4
(b) This insurance is excess over any valid and
collectible other insurance available to the
"insured" whether primary, excess contingent
or on any other basis.
(c) This insurance is not a substitute for re-
quired or compulsory insurance in any
country outside the United States, its ter-
ritories and possessions, Puerto Rico and
Canada.
You agree to maintain all required or
compulsory insurance in any such country
up to the minimum limits required by local
law. Your failure to comply with compulsory
insurance requirements will not invalidate
the coverage afforded by this policy, but we
will only be liable to the same extent we
would have been liable had you complied
with the compulsory insurance requirements.
(d) It is understood that we are not an admitted
or authorized insurer outside the United
States of America, its territories and
possessions, Puerto Rico and Canada. We
assume no responsibility for the furnishing of
certificates of insurance, or for compliance in
any way with the laws of other countries
relating to insurance.
G. WAIVER OF DEDUCTIBLE - GLASS
The following is added to Paragraph D., Deductible,
of SECTION III - PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered "auto" will apply to glass
damage if the glass is repaired rather than replaced.
H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE
- INCREASED LIMIT
The following replaces the last sentence of
Paragraph A.4.b., Loss Of Use Expenses, of SEC-
TION III - PHYSICAL DAMAGE COVERAGE:
However, the most we will pay for any expenses for
loss of use is $65 per day, to a maximum of $750 for
any one "accident".
I. PHYSICAL DAMAGE - TRANSPORTATION
EXPENSES - INCREASED LIMIT
The following replaces the first sentence in Paragraph
A.4.a., Transportation Expenses, of SECTION III -
PHYSICAL DAMAGE COVERAGE:
We will pay up to $50 per day to a maximum of $1,500
for temporary transportation expense incurred by you
because of the total theft of a covered "auto" of the
private passenger type.
J. PERSONAL PROPERTY
The following is added to Paragraph A.4., Coverage
Extensions, of SECTION III - PHYSICAL DAMAGE
COVERAGE:
Personal Property
We will pay up to $400 for "loss" to wearing apparel
and other personal property which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto".
This coverage applies only in the event of a total theft
(b) A partner (if you are a partnership);
(c) A member (if you are a limited liability com-
pany);
(d) An executive officer, director or insurance
manager (if you are a corporation or other or-
ganization); or
(e) Any "employee" authorized by you to give no-
tice of the "accident" or "loss".
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us, of
SECTION IV - BUSINESS AUTO CONDITIONS:
5. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have against
any person or organization to the ex-
tent required of you by a written contract signed
and executed prior to any "accident" or "loss",
provided that the "accident" or "loss" arises out of
operations contemplated by such contract. The
waiver applies only to the person or organization
designated in such contract.
N. UNINTENTIONAL ERRORS OR OMISSIONS
The following is added to Paragraph B.2., Concealment,
Misrepresentation, Or Fraud, of SECTION IV -
BUSINESS AUTO CONDITIONS:
The unintentional omission of, or unintentional error in,
any information given by you shall not prejudice your
rights under this insurance. However this provision
does not affect our right to collect additional premium or
exercise our right of cancellation or non-renewal.
PAGE 4 OF 4
CA T3 53 02 15
Miscellaneous Attachment: M514424
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
TRAVELERS
ONE TOWER SQUARE
HARTFORD, CT 06183
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00)-01
POLICY NUMBER: UB-6J84757A-18-26-G
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
DESIGNATED ORGANIZATION:
Any Person or Organization for which the insured has agreed by written contract executed prior to loss to furnish this
waiver.
Miscellaneous Attachment: M514415 Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
of your covered "auto".
No deductibles apply to this Personal Property
coverage.
K. AIRBAGS
The following is added to Paragraph B.3., Exclusions,
of SECTION III - PHYSICAL DAMAGE COVERAGE:
Exclusion 3.a. does not apply to "loss" to one or more
airbags in a covered "auto" you own that inflate due to
a cause other than a cause of "loss" set forth in
Paragraphs A.1.b. and A.1.c., but only:
a. If that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any warranty;
and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1;000 for any one
"loss".
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
The following is added to Paragraph A.2.a., of SECTION
IV - BUSINESS AUTO CONDITIONS:
Your duty to give us or our authorized representative
prompt notice of the "accident" or "loss" applies only
when the "accident" or "loss" is known to:
(a) You (if you are an individual)
PAGE 3 OF 4
Miscellaneous Attachment: M514424
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Puerto Rico and Canada:
(i) You must arrange to defend the "insured"
against, and investigate or settle any such
claim or "suit" and keep us advised of all pro-
ceedings and actions.
(ii) Neither you nor any other involved
"insured" will make any settlement without our
consent.
(iii) We may, at our discretion, participate in
defending the "insured" against, or in the
settlement of, any claim or "suit".
(iv) We will reimburse the "insured" for sums
that the "insured" legally must pay as
damages because of "bodily injury" or
"property damage" to which this insurance
applies, that the "insured" pays with our
consent, but only up to the limit described in
Paragraph C., Limit Of Insurance, of
SECTION II - COVERED AUTOS LIABILITY
COVERAGE.
(v) We will reimburse the "insured" for the
reasonable expenses incurred with our
consent for your investigation of such claims
and your defense of the "insured" against any
such "suit", but only up to and included within
the limit described in Paragraph C., Limits Of
Insurance, of SECTION II - COVERED
AUTOS LIABILITY COVERAGE, and not in
addition to such limit. Our duty to make such
payments ends when we have used up the
applicable limit of insurance in payments for
damages, settlements or defense expenses.
Miscellaneous Attachment: M514424
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
contract or agreement in that "employee's" name,
with your permission, while performing duties
related to the conduct of your business.
PAGE 1 OF 4
CA T3 53 02 15
Miscellaneous Attachment: M514424
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
ability company or other
organization to give notice of an
"occurrence" or offense.
(3) Notice to us of such "occurrence" or of an
offense will be deemed to be given as
soon as practicable if it is given in good
faith as soon as practicable to your work-
ers' compensation insurer. This applies
only if you subsequently give notice to
us of the "occurrence" or offense as
soon as practicable after any of the
persons described in Paragraphs e. (1)
or (2) above discovers that the
"occurrence" or offense may result in
sums to which the insurance provided
under this Coverage Part may apply.
However, if this Coverage Part includes an en-
dorsement that provides limited coverage for
"bodily injury" or "property damage" or pollution
costs arising out of a discharge, release or es-
cape of "pollutants" which contains a
requirement that the discharge, release or
escape of "pollutants" must be reported to us
within a specific number of days after its abrupt
commencement, this Paragraph e. does not
affect that requirement.
K. UNINTENTIONAL OMISSION
The following is added to Paragraph 6.,
Representations, of SECTION IV -
COMMERCIAL GENERAL LIABILITY
CONDITIONS:
The unintentional omission of, or unintentional
error in, any information provided by you which
we relied upon in issuing this policy will not preju-
dice your rights under this insurance. However,
this provision does not affect our right to collect
additional premium or to exercise our rights of
cancellation or nonrenewal in accordance with
applicable insurance laws or regulations.
L. BLANKET WAIVER OF SUBROGATION
The following is added to Paragraph 8.,
Transfer Of Rights Of Recovery Against
Others To Us, of SECTION IV - COMMERCIAL
GENERAL LIABILITY CONDITIONS:
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Coverage Part is an insured, but only with respect
to liability for "bodily injury", "property damage",
"personal injury" or "advertising injury" that:
a. Is "bodily injury" or "property damage" that
occurs, or is "personal injury" or "advertising
injury" caused by an offense that is committed,
subsequent to the execution of that contract or
agreement; and
b. Is caused, in whole or in part, by your acts or
omissions in the maintenance, operation or
use of equipment leased to you by such
equipment lessor.
The insurance provided to such equipment lessor is
subject to the following provisions:
a. The limits of insurance provided to such
equipment lessor will be the minimum limits
which you agreed to provide in the written
contract or agreement, or the limits shown on
the Declarations, whichever are less.
b. The insurance provided to such equipment
lessor does not apply to any "bodily injury" or
"property damage" that occurs, or "personal
injury" or "advertising injury" caused by an of-
fense that is committed, after the equipment
lease expires.
c. The insurance provided to such equipment
lessor is excess over any valid and collectible
other insurance available to such equipment
lessor, whether primary, excess, contingent or
on any other basis, unless you have agreed in
the written contract or agreement that this
insurance must be primary to, or
non-contributory with, such other insurance, in
which case this insurance will be primary to,
and non-contributory with, such other in-
surance.
I. BLANKET ADDITIONAL INSURED - STATES OR
POLITICAL SUBDIVISIONS - PERMITS
The following is added to SECTION II - WHO IS AN
INSURED:
Any state or political subdivision that has issued a
permit in connection with operations performed by
you or on your behalf and that you are required
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
a. Coverage under this provision is afforded only:
(1) Until the 180th day after you acquire or
form the organization or the end of the
policy period, whichever is earlier, if you
do not report such organization in writing
to us within 180 days after you acquire or
form it; or
(2) Until the end of the policy period, when
that date is later than 180 days after you
acquire or form such organization, if you
report such organization in writing to us
within 180 days after you acquire or form
it, and we agree in writing that it will con-
tinue to be a Named Insured until the end
of the policy period;
b. Coverage A does not apply to "bodily injury" or
"property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to "personal injury"
or "advertising injury" arising out of an
offense committed before you acquired or
formed the organization.
F. WHO IS AN INSURED - BROADENED NAMED
INSURED - UNNAMED SUBSIDIARIES
The following is added to SECTION II - WHO IS AN
INSURED:
Any of your subsidiaries, other than a partnership,
joint venture or limited liability company, that is not
shown as a Named Insured in the Declarations is a
Named Insured if you maintain an ownership
interest of more than 50% in such subsidiary on the
first day of the policy period.
No such subsidiary is an insured for "bodily
injury" or "property damage" that occurred, or
"personal injury" or "advertising injury" caused by
an offense committed after the date, if any,
during the policy period, that you no longer
maintain an ownership interest of more than 50%
in such subsidiary.
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
c. Lightning;
d. Smoke resulting from such fire, explosion,
or lightning; or
e. Water;
unless Exclusion f. of Section I - Coverage A -
Bodily Injury And Property Damage Liability is
replaced by another endorsement to this
Coverage Part that has Exclusion - All Pollu-
tion Injury Or Damage or Total Pollution Ex-
clusion in its title.
A separate limit of insurance applies to
"premises damage" as described in Paragraph
6. of SECTION III - LIMITS OF INSURANCE.
Miscellaneous Attachment: M514430
Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
3. The insurance provided to the additional insured by
this endorsement is excess over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that is
available to the additional insured for a loss we cover
under this endorsement. However, if the "written
contract requiring insurance" specifically requires that
this insurance apply on a primary basis or a primary
and non-contributory basis, this insurance is primary
to "other insurance" available to the additional insured
which covers that person or organization as a named
insured for such loss, and we will not share with that
"other insurance". But the insurance provided to the
additional insured by this endorsement still is excess
over any valid and collectible "other insurance",
whether primary, excess, contingent or on any other
basis, that is available to the additional insured when
that person or organization is an additional insured
under such "other insurance".
4. As a condition of coverage provided to the additional
insured by this endorsement:
a) The additional insured must give us written notice
as soon as practicable of an "occurrence" or an
offense which may result in a claim. To the extent
possible, such notice should include:
2005 The St. Paul Travelers Companies, Inc.
CG D2 46 08 05
Miscellaneous Attachment: M514419 Master ID: 1312924, Certificate ID: 16077420
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 have ADDITIONAL INSURED provisions or 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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies
8110 E Union Avenue
Suite 700
Denver CO 80237
(303) 414-6000
BT Construction, Inc.
9885 Emporia Street
Henderson, CO 80640
BTCON01
The Charter Oak Fire Insurance Company 25615
The Phoenix Insurance Company 25623
Travelers Property Casualty Co of America 25674
X
X
1,000,000
300,000
5,000
1,000,000
2,000,000
2,000,000
X
X X
1,000,000
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
X X 10,000,000
10,000,000
XXXXXXX
N
X
1,000,000
1,000,000
1,000,000
B DT8104H983410COF 10/1/2018 10/1/2019
A DTCO4H983410PHX 10/1/2018 10/1/2019
C CUP-8J518965-18-26 10/1/2018 10/1/2019
C UB-6J84757A-18-26-G 10/1/2018 10/1/2019
10/1/2019
1312924
Y N
Y N
Y N
N
5/9/2019
16077420
16077420 XXXXXXX
City of Fort Collins
Financial Services
Purchasing Division
215 N. Mason St. 2nd Floor, PO Box 80522
Fort Collins CO 80522
RE: 8106 Utility Infrastructure Construction Services. City of Fort Collins is included as additional insured with respects to General Liability, Automobile
Liability, and Excess Liability as required by written contract.
X X
See Attachments
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
UPDATED: MAY 9, 2019
Page 2
Project: 2019 WATER SYS IMPROV, R
Date: Thu 5/9/19
Page 15 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4
Project: 2019 WATER SYS IMPROV, R
Date: Thu 5/9/19
Page 14 of 17
DocuSign Envelope ID: 73836488-1E52-4148-A0AA-BB5354C3DFC4