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HomeMy WebLinkAbout58568 HUEBER INDUSTRIES LLC - CONTRACT - AGREEMENT MISC - HUEBER INDUSTRIES LLCServices Agreement MISC 2017 – McMurry Bridge Project Page 1 of 19 SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and HUEBER INDUSTRIES LLC, hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of eleven (11) pages and incorporated herein by this reference. Irrespective of references in Exhibit A to certain named third parties, Service Provider shall be solely responsible for performance of all duties hereunder. 2. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within five (5) days following execution of this Agreement by all parties. Services shall be completed no later than October 6, 2017. Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 3. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. 4. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: Service Provider: City: Copy to: Hueber Industries LLC Attn: Paul Hueber 217 Racquette Drive, Unit 14 Fort Collins, CO 80524 City of Fort Collins Attn: Karen Manci PO Box 580 Fort Collins, CO 80522 City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 2 of 19 Provider's sole right and remedy for such termination. 5. Contract Sum. The City shall pay the Service Provider for the performance of this Contract, subject to additions and deletions provided herein, Sixty-Nine Thousand Eighty- Seven Dollars and Fourteen Cents ($69,087.14) as per the attached Exhibit "B", consisting of one (1) page, and incorporated herein by this reference. Upon execution of the Agreement by all parties, the City shall pay the Service Provider a deposit of twenty-five (25) percent of the contract sum. The balance of the contract sum shall be paid upon satisfactory completion of the assignment. 6. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 7. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 8. Subcontractors. Service Provider may not subcontract any of the Work set forth in the Exhibit A, Statement of Work without the prior written consent of the city, which shall not be unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of the City), then the following provisions shall apply: (a) the subcontractor must be a reputable, qualified firm with an established record of successful performance in its respective trade performing identical or substantially similar work, (b) the subcontractor will be required to comply with all applicable terms of this Agreement, (c) the subcontract will not create any contractual relationship between any such subcontractor and the City, nor will it obligate the City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor will be subject to inspection by the City to the same extent as the work of the Service Provider. 9. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 10. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. 11. Warranty. DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 3 of 19 a. Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. b. Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. c. Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 12. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof. 13. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 14. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. 15. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 4 of 19 c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit C, consisting of one (1) page, attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Purchasing Director, P. O. Box 580, Fort Collins, Colorado 80522, one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. 16. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 17. Law/Severability. The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement. 18. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: a. As of the date of this Agreement: 1. Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2. Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the “e-Verify Program”) or the Department Program (the “Department Program”), an employment verification program established pursuant to Section 8-17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Service Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. c. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. d. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Service Provider shall: 1. Notify such subcontractor and the City within three days that Service Provider has DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 5 of 19 actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Service Provider shall comply with any reasonable request by the Colorado Department of Labor and Employment (the “Department”) made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. f. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider’s violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breach. DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 6 of 19 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul Purchasing Director DATE: ATTEST: APPROVED AS TO FORM: HUEBER INDUSTRIES LLC By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Owner Paul Hueber 8/29/2017 Assistant City Attorney 9/6/2017 Chief Deputy City Clerk Services Agreement MISC 2017 – McMurry Bridge Project Page 7 of 19 EXHIBIT A SCOPE OF WORK DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 8 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 9 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 10 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 11 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 12 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 13 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 14 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 15 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 16 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 17 of 19 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 18 of 19 EXHIBIT B COMPENSATION DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 Services Agreement MISC 2017 – McMurry Bridge Project Page 19 of 19 EXHIBIT C INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: “The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins.” In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider 's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 New insurance Form_SCTNID_CTGRY.XX10025241_OTHER <docindex><index>OTHER</index></docindex> Policy number: 01951421-4 Underwritten by: ARTISAN AND TRUCKERS CASUALTY CO Page 1 of 1 August 25, 2017 Progressive P.O. Box 94739 Cleveland, OH 44101 1-800-895-2886 Certificate of Insurance Certificate …………………………………………………………………………………………………………………………………………………………………………… Holder CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 Insured …………………………………………………………………………………………………………………………………………………………………………… Agent JOHN HUEBER 1016 PONDEROSA FORT COLLINS, CO 80521 PROG COMMERCIAL PO BOX 94739 CLEVELAND, OH 44101 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Effective Date: Policy Expiration Date: ……………………………………………………………………………………………………………………………………………………….. Nov 21, 2016 Nov 21, 2017 Insurance ……………………………………………………………………………………………………………………………………………………….coverage(s) Limits . BODILY ……………………………………………………………………………………………………………………………………………………….INJURY/PROPERTY DAMAGE $25,000/$50,000/$15,000 . UNINSURED/UNDERINSURED MOTORIST $25,000/$50,000 Description of Location/Vehicles/Special Items Scheduled ……………………………………………………………………………………………………………………………………………………….autos only . 1999 DODGE RAM WAGON B3500 2B5WB35Z4XK553507 Certificate number 23717NET421 Please be advised that the certificate holder will not be notified in the event of a mid-term cancellation. Form 5241 (10/02) DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 A X Pinnacol Assurance 41190 Pinnacol Assurance 7501 E Lowry Blvd Denver, CO 80230-7006 Hueber Industries LLC 217 Racquette Dr #14 Fort Collins, CO 80524 08/24/2017 4173749 05/01/2017 05/01/2018 100,000 100,000 500,000 1826434 City of Fort Collins Attn: Purchasing Department PO Box 580 Fort Collins , CO 80522 Y Pinnacol Assurance Unless otherwise stated in the policy provisions, coverage is in Colorado only. Excluded (If any) : John P Hueber DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) CERTIFICATE HOLDER COPY City of Fort Collins Attn: Purchasing Department PO Box 580 Fort Collins , CO 80522 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) AIL 10 67 08 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Includes copyrighted material of American Association of Insurance Services, Inc., with its permission. Contains copyrighted material of the National Council on Compensation Insurance, with its permission. AIL 10 67 08 11 Page 1 of 1 NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE PART COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY With respect to coverage provided by this endorsement, the provisions of the Coverage Part (Policy) apply unless modified by the endorsement. Cancellation The following is added under the Cancellation Condi- tion applicable to the Coverage Parts (Policy) listed above: If we cancel this policy for any reason other than non payment of premium, we will mail written notice of cancellation to the certificate holder(s) on file with the Company. Notice will be provided prior to the effec- tive date of cancellation. We will give the number of days notice as provided for in the Cancellation Condi- tion of this policy. The notice will state the effective date of cancellation. The policy period will end on that date. If you cancel this policy, or if we cancel for non pay- ment of premium, we will mail written notice of such cancellation to the certificate holder(s) on file with the Company. The notice will state the date the policy was cancelled. The notice will be mailed by first-class mail to the last known mailing address of the certificate holder(s) on file with the Company. Any notice of cancellation provided by this endorse- ment applies only to the certificate holder(s) with a certificate of insurance applicable to this policy’s period. Our failure to send notice of cancellation to the certifi- cate holder(s) will not amend, extend or alter the terms and conditions of this policy, including the can- cellation of this policy. If there is a conflict between any other policy cancella- tion provisions pertaining to the certificate holder(s) and this endorsement, the other policy provisions shall control. Nothing contained here varies, alters, or extends any provisions of the policy except as provided in this endorsement . DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: COUNTRY Mutual Insurance Company ACORD 25 ADDITIONAL INSURED(S): CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 20990 1 8/30/2017 1 AB9214220 CERTIFICATE OF LIABILITY INSURANCE HUEBER INDUSTRIES LLC 1016 PONDEROSA DR FORT COLLINS, CO 80521 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 AIL 10 67 08 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Includes copyrighted material of American Association of Insurance Services, Inc., with its permission. Contains copyrighted material of the National Council on Compensation Insurance, with its permission. AIL 10 67 08 11 Page 1 of 1 NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE PART COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY With respect to coverage provided by this endorsement, the provisions of the Coverage Part (Policy) apply unless modified by the endorsement. Cancellation The following is added under the Cancellation Condi- tion applicable to the Coverage Parts (Policy) listed above: If we cancel this policy for any reason other than non payment of premium, we will mail written notice of cancellation to the certificate holder(s) on file with the Company. Notice will be provided prior to the effec- tive date of cancellation. We will give the number of days notice as provided for in the Cancellation Condi- tion of this policy. The notice will state the effective date of cancellation. The policy period will end on that date. If you cancel this policy, or if we cancel for non pay- ment of premium, we will mail written notice of such cancellation to the certificate holder(s) on file with the Company. The notice will state the date the policy was cancelled. The notice will be mailed by first-class mail to the last known mailing address of the certificate holder(s) on file with the Company. Any notice of cancellation provided by this endorse- ment applies only to the certificate holder(s) with a certificate of insurance applicable to this policy’s period. Our failure to send notice of cancellation to the certifi- cate holder(s) will not amend, extend or alter the terms and conditions of this policy, including the can- cellation of this policy. If there is a conflict between any other policy cancella- tion provisions pertaining to the certificate holder(s) and this endorsement, the other policy provisions shall control. Nothing contained here varies, alters, or extends any provisions of the policy except as provided in this endorsement . DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RICH JOHNSON (04828) 4190 N GARFIELD AVE STE 1 LOVELAND, CO 80538-0000 970-667-9317 1,000,000 A 7/21/2018 5,000 2,000,000 RICHARD.JOHNSON@COUNTRYFINANCIAL.COM 970-282-7200 ✔ AB9214220 8/30/2017 100,000 2,000,000 5247007 JOB NAME: MCMURRAY BRIDGE PROJECT (CONTINUED) COUNTRY Mutual Insurance Company CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 ✔ ✔ RICH JOHNSON 7/21/2017 1,000,000 HUEBER INDUSTRIES LLC 1016 PONDEROSA DR FORT COLLINS, CO 80521 ✔ 20990 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23 PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RICH JOHNSON (04828) 4190 N GARFIELD AVE STE 1 LOVELAND, CO 80538-0000 970-667-9317 1,000,000 A 7/21/2018 5,000 2,000,000 RICHARD.JOHNSON@COUNTRYFINANCIAL.COM 970-282-7200 AB9214220 8/24/2017 100,000 2,000,000 5247007 COUNTRY Mutual Insurance Company CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 ✔ ✔ RICH JOHNSON 7/21/2017 1,000,000 HUEBER INDUSTRIES LLC 1016 PONDEROSA DR FORT COLLINS, CO 80521 ✔ 20990 DocuSign Envelope ID: F9DD0408-3E97-4ECC-9C03-151C06EFBA23