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HomeMy WebLinkAboutTHE FAMILY CARE CONNECTION INC - CONTRACT - SOLE SOURCE - THE FAMILY CARE CONNECTIONOfficial Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 1 of 13 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 THE FAMILY CARE CONNECTION, INC, 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 four (4) pages and incorporated herein by this reference. 2. Contract Period. This Agreement shall commence January 1, 2023, and shall continue in full force and effect until December 31, 2023, unless sooner terminated as herein provided. 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 ten (10) 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 ten (10) 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 immediately when emailed or three (3) business days from the date of the notice when mailed to the following addresses: Service Provider: City: Copy to: The Family Care Connection, Inc. Attn: Terry Stroh 6386 Pumpkin Ridge Drive, Unit 2 Windsor, CO 80550 familycareconnection@gmail.com City of Fort Collins Attn: Kelley Vodden PO Box 580 Fort Collins, CO 80522 kvodden@fcgov.com City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 purchasing@fcgov.com 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. Service Provider shall submit a final invoice within ten (10) days of the effective date of termination. Undisputed invoices shall be paid Net DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 2 of 13 30 days of the date of the invoice. Such payment shall be the Service Provider's sole right and remedy for such termination. 5. Compensation. The City shall pay the Service Provider for the performance of this Contract, subject to additions and deletions provided herein, as per the attached Exhibit B, consisting of one (1) page and incorporated herein by this reference. Invoices shall be emailed to invoices@fcgov.com with a copy to the Project Manager. The cost of the work completed shall be paid to the Service Provider following the submittal of a correct itemized invoice by the Service Provider. The City is exempt from sales and use tax. The City’s Certificate of Exemption license number is 09804502. A copy of the license is available upon written request. The City pays invoices on Net 30 days from the date of the invoice. 6. Appropriation. To the extent this Agreement or any provision in it constitutes a multiple fiscal year debt or financial obligation of the City, it shall be subject to annual appropriation by City Council as required in Article V, Section 8(b) of the City Charter, City Code Section 8 -186, and Article X, Section 20 of the Colorado Constitution. The City shall have no obligation to continue this Agreement in any fiscal year for which no such supporting appropriation has been made. 7. 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. 8. 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. 9. 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. Irrespective of any subcontractors named in Exhibit A, Service Provider shall be solely responsible for performance of all duties hereunder. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 3 of 13 10. 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. 11. 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. 12. Warranty. 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. 13. 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. 14. 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 themselves 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. 15. Entire Agreement; Binding Effect; Order of Precedence; Authority to Execute. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties regarding this transaction 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. Covenants or representations not contained in this Agreement shall not be binding on the parties. In the event of a conflict between terms of the Agreement and any exhibit or attachment, the terms of the Agreement shall prevail. Each person executing this Agreement affirms that they have the necessary authority to sign on behalf of their respective party and to bind such party to the terms of this Agreement. 16. 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 DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 4 of 13 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. 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, purchasing@fcgov.com or 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. 17. Law/Severability. The laws of the State of Colorado shall govern the construction, interpretation, execution, and enforcement of this Agreement. The Parties further agree that Larimer County District Court is the proper venue for all disputes. If the City subsequently agrees in writing that the matter may be heard in federal court, venue will be in Denver District Court. 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 Unlawful Discrimination. The City, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 US.C. §§ 2000d to 2000d-4) and the Regulations, affirmatively ensures that for all contracts entered into with the City, disadvantaged business enterprises are afforded a full and fair opportunity to bid on the contract and are not to be discriminated against on the grounds of race, color, or national origin in consideration for an award. The City strictly prohibits unlawful discrimination based on an individual’s gender (regardless of gender identity or gender expression), race, color, religion, creed, national origin, ancestry, age 40 years or older, marital status, disability, sexual orientation, genetic information, or other characteristics protected by law. For the purpose of this policy “sexual orientation” means a person’s actual or perceived orientation toward heterosexuality, homosexuality, and bisexuality. The City also strictly prohibits unlawful harassment in the workplace, including sexual harassment. Further, the City strictly prohibits unlawful retaliation against a person who engages in protected activity. Protected activity includes an employee complaining that he or she has been discriminated against in violation of the above policy or participating in an employment discrimination proceeding. The City requires its vendors to comply with the City’s policy for equal employment opportunity and to prohibit unlawful discrimination, harassment and retaliation. This requirement applies to all third-party vendors and their subcontractors at every tier. 19. Governmental Immunity Act. No term or condition of this Agreement shall be construed or interpreted as a waiver, express or implied, of any of the notices, requirements, immunities, rights, benefits, protections, limitations of liability, and other provisions of the Colorado DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 5 of 13 Governmental Immunity Act, C.R.S. § 24-10-101 et seq. and under any other applicable law. 20. Colorado Open Records Act. The City is subject to Sec. 24-72-201 et seq. of the Colorado Revised Statute (CORA). This Agreement is subject to public disclosure in whole pursuant to CORA. 21. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit D - Confidentiality, consisting of one (1) page, attached hereto, and incorporated herein by this reference. [Signature Page Follows] DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 6 of 13 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul, Purchasing Director Date: ATTEST: APPROVED AS TO FORM: THE FAMILY CARE CONNECTION, INC. By: Printed: Title: Date: DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Terry Stroh President 12/23/2022 Assistant City Attorney 1/9/2023 City Clerk Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 7 of 13 EXHIBIT A SCOPE OF SERVICES I. SERVICE PROVIDER OBLIGATIONS. Service Provider agrees to provide the following services under this agreement: A. Provide in-home child and adult/senior non-medical care to City Employees according to City program guidelines as specified in Section IV below. 1. Care will be available 24 hours per day, 365 days per year; 2. Care is provided for well or mildly ill individuals; 3. Care is non-medical. 4. Service Provider reserves the right to refuse service or to require an Employee to return home in the event Service Provider determines the needs of the situation exceed the boundaries of non-medical care; B. Provide monthly billing and utilization reports to City. C. Service Provider has guidelines which Employees and City must abide by regarding use of Service Provider’s service including:  A four (4) hour minimum payment for utilization of service in any given day;  If Employee cancels pre-scheduled care after 8:00 PM the night before care is scheduled, City shall be responsible for full payment, including Employee co-pay, for four (4) hours of service, except as specified in Subsection 3 below;  If Employee cancels care within two (2) hours of pre-scheduled care start time, City shall be responsible for full payment, including Employee co-pay, for the total time scheduled;  If Employee uses service on a given day but terminates service earlier than the agreed upon end time for that day, City and Employee shall be responsible for full payment, including Employee co-pay, for the remaining scheduled hours for that day;  Service Provider will bill City for time and one-half its regular hourly rate for services provided on December 24 after 5 PM, December 25, December 31 after 5 PM, January 1, July 4, Thanksgiving Day and Easter Sunday;  Pre-scheduled care during the local school district’s Spring Break and Winter Holiday may not be canceled within ten (10) days of the start of service. If cancellation takes place with less than ten (10) days advance notice, City shall be responsible for full payment, including Employee co-pay, for the time scheduled if Service Provider cannot place the scheduled caregiver in another job. Service Provider shall undertake reasonable efforts to re-schedule said caregiver;  Service Provider provides service on a first-come, first-served basis. Reasonable effort is made to provide service to every Employee that needs service. Service Provider and City acknowledge that there may occasionally be times when service may not be available due to lack of available caregivers;  Service Provider shall orally communicate applicable guidelines to Employee at the time Employee contacts Service Provider to schedule care; DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 8 of 13 D. Service Provider and City agree that all Employee co-pays and mileage reimbursements shall be paid by Employee to caregiver at the conclusion of each day’s service. E. Assist in communication of program to Employees of City as requested by City. Service Provider agrees to provide information and brochures about its services to City’s Human Resources Department to assist with communicating the service to Employees. F. Maintain records regarding each Employee’s hourly usage and terminate service at the allotted hourly limit (as pre-determined by City and defined in Section IV below). Service Provider shall notify each Employee when she/he has used 75% of her/his allotted hourly time for the year. G. Refer only qualified caregivers to City Employees:  Caregivers shall be at least 18 years of age.  Caregivers shall be CPR and First Aid trained.  Service Provider shall conduct background checks on caregivers including: criminal history, driving record check, social security number and name verification, sex offender database check, reference, employment and education verification. Service Provider agrees to inform City of any changes in this process. Service Provider shall complete, upon execution of this agreement, sex offender database checks on all current caregivers and provide the results to the Project Manager by no later than January 31, 2023. Sex Offender Database check results must be provided to the Project Manager for any caregiver hired thereafter prior to the caregiver providing any services under this Agreement;  Caregivers shall have experience in age-appropriate caregiving. H. Service Provider will respond to any complaints from any source concerning its activities or the activities of its caregivers under this agreement. Service Provider shall notify City within two (2) business days shall provide a written response to City within seven (7) days of receiving a complaint from any source. Service Provider shall undertake reasonable and timely efforts to resolve complaints. II. LEGAL OBLIGATIONS. Service Provider agrees to the following: A. Service Provider agrees that, in performing its obligations under this agreement, it will comply with all applicable local, state, and federal laws, rules and regulations. III. CITY OBLIGATIONS. City agrees to the following: A. City will periodically provide to Service Provider a list of City’s eligible Employees including new hires and terminations. B. City will pay the applicable hourly rate less Employee co-pay for all billed hours. City agrees to pay Service Provider within 30 days of receipt of monthly invoice from Service Provider. C. City is responsible for communicating information about the back-up, in-home care program to its Employees. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 9 of 13 IV. CITY PROGRAM GUIDELINES. City Employees using services under this agreement are subject to the following: A. Employees are allowed up to 100 hours of care to be provided in their home each calendar year defined as January 1 to December 31. B. If both parents are employed by City, the number of care hours are considered to be available per household and shall not exceed 100 hours combined for both parents. C. The Employee co-pay is Seven Dollars ($7.00) per hour of care received and is to be paid to Service Provider and given to Service Provider’s caregiver at the conclusion of each day of service. D. No more than five consecutive days of care are allowed unless due to extenuating circumstances approved in advance by the City’s Human Resources Department. E. The need for care must be work-related. Back-up, in-home service is specifically intended to allow City Employees the opportunity to report to work and minimize absenteeism. Employees cannot use this service for non-work-related reasons. Employees may use this service for any of the following so long as the coverage is needed due to the Employee’s or her/his spouse’s work schedule:  Employee’s regular caregiver (including a spouse) is ill;  Employee’s regular caregiver is closed due to vacation, staff enrichment, or snow days;  Employee’s child or adult/elderly family member is mildly ill;  Employee’s household has a gap between regular child care arrangements;  Employee’s children’s school is closed due to a Service Provider, conference or vacation day; Coverage of care for any other reason not listed above that allows an Employee to attend work will be evaluated on a case-by-case basis by the City’s Human Resources Department prior to the service being rendered and eligibility for coverage will be determined at the sole discretion of the City. F. An Employee’s child(ren) and adult/elderly family members qualify for care as long as they live with the Employee and/or the Employee is the primary caregiver. This may include an Employee’s children, stepchildren, foster children, grandchildren and other legal dependents. V. CONFIDENTIALITY. A. Service Provider acknowledges that in the course of this agreement it may receive information from City that is not publicly available regarding City and Employees. Service Provider agrees to protect the confidentiality of this information. Service Provider will not publish communication materials using City’s name without City approval. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 10 of 13 B. City agrees to protect, to the extent legally permissible, information received from Service Provider clearly identified as confidential. City will not publish communication materials using Service Provider’s name without Service Provider approval. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 11 of 13 EXHIBIT B COMPENSATION The following pricing shall remain fixed for the term of this Agreement. The total hourly rate to be paid to the Service Provider Thirty-seven Dollars ($37). Payment is to be divided into 2 parts as follows:  $30 /hour shall be paid to the Service Provider by the City for each hour of care provided to an Employee.  $7/hour shall be paid to the Service Provider by the Employee for each hour of care provided upon conclusion of the care day. Effective January 1, 2023, no Employees, regardless of their role for the City, will be exempt from the $7/hour co-pay. Invoices for the City portion shall be emailed to invoices@fcgov.com with a copy to the Project Manager. The cost of the work completed shall be paid to the Service Provider following the submittal of a correct itemized invoice by the Service Provider showing the date, number of hours worked, and Employee name. The City pays Net 30 days. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 12 of 13 EXHIBIT C INSURANCE REQUIREMENTS 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. 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. Insurance certificates should show the certificate holder as follows: City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 The City, its officers, agents and employees shall be named as additional insureds on the Service Provider 's general liability insurance policy by marking the appropriate box or adding a statement to this effect on the certificate, for any claims arising out of work performed under this Agreement. 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. Workers' Compensation & Employer’s Liability insurance shall conform with statutory limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee, or as required by Colorado law. B. General Liability. The Service Provider shall maintain during the life of this Agreement such General Liability 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 General Liability, 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: B18DA161-6884-4744-AC71-2925D2529EEC Official Purchasing Document Last updated 7/19/2022 Services Agreement SS 2022 – The Family Care Connection Page 13 of 13 EXHIBIT D CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Service Provider hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Service Provider has agreed to perform, the Service Provider hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Service Provider agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Service Provider shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Service Provider shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Service Provider understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Service Provider shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Service Provider ceases to perform services for the City, or the City so requests for any reason, the Service Provider shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Service Provider understands and agrees that the City’s remedies at law for a breach of the Service Provider’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law. DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC 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 2/11/2022 AssuredPartners Colorado 4582 S.Ulster St.,Suite 600 Denver CO 80237 303-863-7788 303-861-7502 APCO360@assuredptrco.com Scottsdale Insurance Company 41297 FAMICAR-02 Pinnacol Assurance 41190FamilyCareConnectionInc. 707 3rd St,Unit E1 Windsor CO 80550 872514870 A X 1,000,000 X 100,000 5,000 1,000,000 2,000,000 CPS7306426 2/14/2022 2/14/2023 2,000,000 B 4199096 2/1/2022 2/1/2023 100,000 100,000 500,000 City of Ft.Collins DocuSign Envelope ID: B18DA161-6884-4744-AC71-2925D2529EEC