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Home My WebLink AboutCORRESPONDENCE - AGREEMENT MISC - NORTH RANGE BEHAVIORAL HEALTH PKA ISLAND GROVE REGIONAL TREATMENT CENTER (11)Administrative Services Purchasing Division City of Fort Collins December 12, 2003 B.J. Dean Island Grove Regional Treatment Center, Inc. 1140 M Street Greeley, CO 80631 Re: Inpatient Substance Abuse Detoxification RECEIVED DEC 15 2003 DEC 2 6 2003 The City of Fort Collins has elected to renew Inpatient Substance Abuse Detoxification for the City of Fort Collins with your firm. The term will be extended for one (1) additional year, January 1, 2004 through December 31, 2004. The City shall pay the Service provider for the performance of this contract, subject to additions and deletions provided within the above reference services agreement, the sum of Twenty -Two Thousand Nine Hundred Dollars ($22,900). If the renewal is acceptable to your firm, please sign this letter in the space provided and return along with a current copy of your insurance to the City of Fort Collins, Purchasing Division, before December 30, 2003. If delivered, please deliver to 215 North Mason Street, 2nd Floor, Fort Collins, CO 80524. If mailed, the mailing address is P.O. Box 580, Fort Collins, Colorado 80522-0580. If this renewal is not acceptable with your firm, please send us a written notice stating that you do not wish to renew the bid. If you have any questions regarding this renewal, please contact James B. O'Neill II, CPPO, FNIGP, Director of Purchasing and Risk Management, at 970-221- 6775. Sincerely, m B. O'Neill II, CPPO, FNIGP ctor of Purchasing and Risk Management Cc: Gary Perman, Police Lieutenant AV— 1211110-5 Signa a Date (Please indicate your desire to renew Bid #5669 by signing this letter and returning it with a current copy of insurance forms to Purchasing Division on or before December 30, 2003.) 215 North Mason Street • 2nd Floor • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 PRODUCER Ed Fundingsland Talbot Insurance Agency, Inc. 1601 28th Street Boulder, CO 80301 303-444-4443 fax303-449-7365 INSURED Island Grove Regional Treatment Center 1140 M Street Greeley CO 80631 kEE 1► ATE IMM/DD/YV) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY Pinnacol Assurance Company A COMPANY B COMPANY C COMPANY D 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. LTR TYPE OF INSURANCE POLICY NUMBER I DATE MMFDD/YY) POLICY EFECTIVE PDA EY(MM/DD/YYN I LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP IAnv one oersonl $ COMBINED SINGLE LIMIT $ BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ X INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL 4061756 10/01/2003 10/01/2004 X I T RYLIMIT OTH- ER EL EACH ACCIDENT 9 100,000 EL DISEASE - POLICY LIMIT $ 500, 000 EL DISEASE - EA EMPLOYEE $ 10 0 , 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS City of Fort Collins, Colorado, a municipal corp P. O. Box 580 300 LaPorte Ave. Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TOor THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTays notice f non-payment TO MAILSUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. @ds#2645140 ISLAG-1 AUTHORIZED REPRESENTATIVE ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDNYYY) 12/16/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 211 First Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Eaton, CO 80615 970 454-3381 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Black White & Associates Island Grove Regional Treatment Center Inc. INSURER B:INSURERC: 1140 M Street Greeley, CO 80631 INSURER D: INSURER E: l Uvcr%^"Ca 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE IMMIDD LIMITS A GENERAL LIABILITY CP7777649A 04/01/03 04/01/04 EACH OCCURRENCE $1 500 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Ex_]OCCUR DAMAGE TO RENTED a200 000 MED EXP (Any one person) $10 000 PERSONAL &ADV INJURY $1 500 000 GENERAL AGGREGATE s3000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3 00O 000 POLICY PRO LOC JECT A AUTOMOBILE LIABILITY ANY AUTO BA7777649A 04/01/03 04/01/04 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIREDAUTOS NON -OWNED AUTOS X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ a DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANV PROPRIETOR/PARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? tt yes, describe under E.L. DISEASE -EA EMPLOYE S E.L. DISEASE -POLICY LIMIT 1 $ SPECIAL PROVISIONS below A OTHER Professional LP7777649A 04/01/03 04/01/04 $1,000,000 Occurrence Liability $3,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Fort Collins, CO, A Municipal Corp. is listed as Additional Insured, as their interest may appear. City of Fort Collins, CO A Municipal Corp. PO Box 580 215 N. Mason Street Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE z—W - , ,I, & *QzDDyv41mc4zsU3 RXS O ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ^��^� �w %�.V.'Voj [ of z FUZU6943/1Y1242303