Loading...
HomeMy WebLinkAbout529408 MCDONALD FARMS ENTERPRISES INC - CONTRACT - SOLE SOURCE - MCDONALD FARMS ENTERPRISES, INCDocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A Assistant City Attorney 9/15/2022 City Clerk DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/13/2022 Arthur J Galllagher Risk Management Services,Inc. 2618 E Broadway St Pearland TX 77581 Michael Schultz 281-485-7500 281-485-6933 Certrequests@ajg.com Crum &Forster Specialty Insurance Co 44520 WASTRES-04 Gemini Insurance Company 10833WasteResourceManagement,Inc See Additional Named Insureds in Description of Op 16350 Park Ten Place,Suite 215 Houston TX 77084 Navigators Specialty Insurance Company 36056 GuideOne National Insurance Company 14167 Old Republic Insurance Company 24147 139037966 A X 1,000,000 X 1,000,000 X Site Pollution 100,000 X Pollution Liab 1,000,000 2,000,000 X EPK-136418 7/30/2021 3/1/2023 2,000,000 E 1,000,000 X X X MWTB 315695 22 3/1/2022 3/1/2023 A X X 10,000,000EFX-118521 7/30/2021 3/1/2023 10,000,000 N/A E X N MWC 315694 22 3/1/2022 3/1/2023 1,000,000 1,000,000 1,000,000 B C D XS Auto XS Auto XS Auto GVE100252103 HO22EXCZ05W6HIC 560002145-02 3/1/2022 3/1/2022 3/1/2022 3/1/2023 3/1/2023 3/1/2023 3M XS of 2M 3M XS of 3M XS of 2M 3M XS of 5M $3,000,000 $3,000,000 $3,000,000 Policy:Contractor Pollution Liability Policy Number:EPK-136418 Policy Period:07/30/2021 –03/1/2023 Carrier:Crum &Forster Specialty Insurance Co. Limit:$1,000,000-including Third Party Pollution Liability and Onsite Cleanup. See Attached... City of Fort Collins Purchasing Division PO Box 580 Fort Collins CO 80522 DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A 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: WASTRES-04 1 1 Arthur J Galllagher Risk Management Services,Inc.Waste Resource Management,Inc See Additional Named Insureds in Description of Op 16350 Park Ten Place,Suite 215 Houston TX 77084 25 CERTIFICATE OF LIABILITY INSURANCE Policy:Directors &Officers Liability Policy Number:PCD1004111-01 Policy Period:07/30/2022 –03/1/2023 Carrier:Arch Insurance Company Limit:$5,000,000 Policy:Cyber Liability Policy Number:D96415849 Policy Period:08/29/2022 –08/29/2023 Carrier:ACE American Insurance company Limit:$3,000,000 All policies (except Workers Compensation EL)include a blanket automatic additional insured that confers additional insured status to the certificate holder when specifically required in a written contract with the name insured. All policies include a blanket waiver of subrogation endorsement when specifically required in a written contract with the named insured. All policies include Primary and Non-Contributory -Blanket when specifically required by written contract with the named insured. Alternate Employer Endorsement WC 00 03 01 A 30 days notice of cancellation applies on General Liability. Named Insured Schedule: WRM Holdings,LLC EEE Parent I EEE Parent II Evergreen Environmental Energy,Inc. Pipe Maintenance Services,Inc.dba Silver City Processing Kappa Products Corporation Downstream Environmental,LLC SW Intermediate Sub,LLC SouthWaste Employment,LLC SouthWaste Disposal LLC EarthAmerica,LLC Central Florida Disposal Interests,LLC Apex Industrial Processing,LLC,fka A Honey Wagon TAP,INC.dba TAP Environmental &TAP,Inc.dba Big K Environmental SouthWaste Service Inc. SOS Liquid Waste Haulers,Ltd.,Co. SOS Enviro Services,LLC Partners Dewatering International,LC McDonald Farms Enterprises Inc. DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A MWC 315694 22 03-01-2022 MWC 315694 2203-01-22 03-01-2022 DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A MWC 315694 22 MWC 315694 2203-01-22 03-01-2022 DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A MWC 315694 2203-01-22 DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A DocuSign Envelope ID: A84A9A3B-25DA-4212-8CB0-E48B6E4EA47A