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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - ALARMSPECIALISTS INC March 25, 2022 LW Enterprises, Inc. dba Alarmspecialists, Inc. Attn: Larry Wells 6786 S. Revere Pkwy., Ste. 110 Centennial, CO 80112 RE: Contract Renewal, Miscellaneous Agreement 2020 Fire Panels - Alarmspecialists, Inc. Dear Mr. Wells: The City of Fort Collins wishes to extend the agreement term for the above captioned contract pursuant to the existing compensation rates, terms and conditions for one (1) additional year, May 28, 2022 through May 27, 2023. If the renewal is acceptable to your firm, please sign this letter in the space provided and attach a current copy of your insurance certificate naming the City as an additional insured on General Liability and Automobile Liability and including proof of Workers’ Compensation/ Employers’ Liability Insurance within the next fifteen days. If you wish to propose any changes to the existing agreement prior to renewal, please do not sign this renewal and provide details of your requested change for review and consideration. If you do not want to renew this contract, please provide written notification stating the reason for non-renewal. Please contact Jake Rector, Senior Buyer at (970) 221-6776 or jrector@fcgov.com if you have any questions regarding this matter. Sincerely, Gerry Paul Purchasing Director __________________________________________ ____________________________ Signature Date (Please indicate your desire to renew this agreement by signing this letter and returning it to Purchasing Division within the next fifteen days.) GP: kr Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD 3/25/2022 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) 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 RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT 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 E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below 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 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) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 2/25/2022 License # 0757776 (303) 252-3761 (866) 243-0727 10851 LW Enterprises, Inc. dba Alarmspecialists, Inc. 6786 S. Revere Parkway Suite 110 Centennial, CO 80112 10804 41190 A 1,000,000 X X 51GL002416-221 3/1/2022 3/1/2023 100,000 5,000 1,000,000 2,000,000 1,000,000 1,000,000B X X CPA 3184994 24 3/1/2022 3/1/2023 3,000,000A 51CC000750-221 3/1/2022 3/1/2023 3,000,000 10,000 C X 4089703 3/1/2022 3/1/2023 1,000,000 1,000,000 1,000,000 City of Fort Collins is included as additional insured under General Liability. City of Fort Collins PO Box 580 Fort Collins, CO 80522 LWENTER-01 PVIANZON HUB International Insurance Services (COL) 2000 S. Colorado Blvd Tower 2, Suite 150 Denver, CO 80222 Barb Arnold Barbara.arnold@hubinternational.com Everest Indemnity Insurance Company Continental Western Insurance Company Pinnacol Assurance Company X X X X X X X DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc.,2012 Page 1 of 2 ADDITIONAL INSURED –OWNERS, LESSEES ORCONTRACTORS–SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Blanket where required by written contract DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD Page 2 of 2 © Insurance Services Office, Inc.,2012 CG 20 10 04 13 C.With respect to the insurance afforded to these additional insureds,the following is added to Section III –Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc.,2012 Page 1 of 1 ADDITIONAL INSURED –OWNERS, LESSEES ORCONTRACTORS–COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III –Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Blanket where required by written contract DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                               DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                 DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                          DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                        DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                       DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                     DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                               DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com LW Enterprises Inc dba Alarmspecialis 6786 S Revere Parkway, Suite 110 Centennial, CO 80112 Hub International/BW 2000 S Colorado Blvd Tower 2, Suite 150 Denver, CO 80222 (970) 223-0924 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P HURDT - Underwriter 02/23/2022 17:36:00 4089703 59402897 359-B NCCI #: WC000313B Policy #: 4089703 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date:March 1, 2022 Expires on: March 1, 2023 Pinnacol Assurance has issued this endorsement February 23, 2022 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 To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) 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 RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT 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 E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below 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 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) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 2/25/2022 License # 0757776 (303) 252-3761 (866) 243-0727 10851 LW Enterprises, Inc. dba Alarmspecialists, Inc. 6786 S. Revere Parkway Suite 110 Centennial, CO 80112 10804 41190 A 1,000,000 X X 51GL002416-221 3/1/2022 3/1/2023 100,000 5,000 1,000,000 2,000,000 1,000,000 1,000,000B X X CPA 3184994 24 3/1/2022 3/1/2023 3,000,000A 51CC000750-221 3/1/2022 3/1/2023 3,000,000 10,000 C X 4089703 3/1/2022 3/1/2023 1,000,000 1,000,000 1,000,000 City of Fort Collins is included as additional insured under General Liability. City of Fort Collins PO Box 580 Fort Collins, CO 80522 LWENTER-01 PVIANZON HUB International Insurance Services (COL) 2000 S. Colorado Blvd Tower 2, Suite 150 Denver, CO 80222 Barb Arnold Barbara.arnold@hubinternational.com Everest Indemnity Insurance Company Continental Western Insurance Company Pinnacol Assurance Company X X X X X X X DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc.,2012 Page 1 of 2 ADDITIONAL INSURED –OWNERS, LESSEES ORCONTRACTORS–SCHEDULED PERSON ORORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Blanket where required by written contract DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD Page 2 of 2 © Insurance Services Office, Inc.,2012 CG 20 10 04 13 C.With respect to the insurance afforded to these additional insureds,the following is added to Section III –Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc.,2012 Page 1 of 1 ADDITIONAL INSURED –OWNERS, LESSEES ORCONTRACTORS–COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Section II –Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III –Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Blanket where required by written contract DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                               DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                 DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                          DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                        DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                       DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                                                     DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD                                                                               DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com LW Enterprises Inc dba Alarmspecialis 6786 S Revere Parkway, Suite 110 Centennial, CO 80112 Hub International/BW 2000 S Colorado Blvd Tower 2, Suite 150 Denver, CO 80222 (970) 223-0924 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P HURDT - Underwriter 02/23/2022 17:36:00 4089703 59402897 359-B NCCI #: WC000313B Policy #: 4089703 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date:March 1, 2022 Expires on: March 1, 2023 Pinnacol Assurance has issued this endorsement February 23, 2022 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 To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. DocuSign Envelope ID: 4A480149-83D9-4566-92EF-8CDC962934CD