HomeMy WebLinkAboutSEASONAL SOUPS & COMMON LINK - CONTRACT - RFP - 7632 OUTDOOR CONCESSIONAIRE - DOWNTOWN TRANSIT CEN (2)Concession Agreement Page 1 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
CONCESSION AGREEMENT
THIS AGREEMENT is made and entered into this day of May 30, 2014, by and between THE
CITY OF FORT COLLINS, COLORADO, a Municipal Corporation (City), and SEASONAL SOUPS,
LLC (Concessionaire).
WITNESSETH
WHEREAS, the City agrees to grant to the Concessionaire and the Concessionaire accepts
from the City a concession for outdoor vending at the Downtown Transit Center (DTC) located
at 250 N. Mason Street, Fort Collins, CO 80524.
NOW THEREFORE, in consideration of the mutual covenants and obligations herein
expressed, the parties agree as follows:
Section 1. Contract Documents
The contract documents consist of this Agreement and Exhibits A, B and C,
a t t ached hereto and incorporated herein by this reference.
Section 2. Terms of the Agreement
A. This Agreement shall be effective from June 1, 2014 until May 31, 2015, unless sooner
terminated as herein provided. The City may, at its option, renew the Agreement for
additional one (1) year terms, to a maximum of four (4) additional one (1) year
terms.
B. In the event that the concession location can not be used because of improvements
being made at the concession location, this Agreement may be suspended on
t h i r t y ( 30) days’ notice to the Concessionaire. The suspension shall continue until
the improvements are completed or it is determined that the location can no longer be
used as a concession site.
Section 3. Concession Operations
The City hereby grants Concessionaire a concession for the use of the Downtown Transit
Center concession area as defined in Exhibit "A", consisting of one (1) page, attached and
incorporated herein by reference, for outdoor vending. The Concessionaire shall have the
right to operate an outdoor food vending concession within this area in accordance with the
Agreement.
A. Independent Contractor: The services to be performed by the Concessionaire are
those of an independent contractor and not as an employee of the City. The City shall
not be responsible for withholding any portion of Concessionaire's compensation
hereunder for the payment of FICA, Worker's Compensation or otherwise.
B. Records: The Concessionaire shall keep adequate and proper business records
of all expenses and receipts of the concession operations. At the request of the City, all
such business records shall be made open and available for inspection and audit by
the City of Fort Collins Treasury Division.
C. Licenses: The Concessionaire shall obtain and pay for all licenses needed for the
operation of the concession including, but not necessarily limited to, a County Health
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 2 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
Department Food Services establishment inspection and City and State sales tax
licenses. Any such licenses held specifically by the Concessionaire in connection with
this Agreement shall be surrendered by the Concessionaire at the time of termination of
this Agreement.
D. Laws, Rules & Regulations : The operation of the concession granted under this
Agreement shall, at all times, conform with all applicable Federal, State, and local laws
and with all applicable rules and regulations adopted by the City or any of its Boards or
Departments .
E. Insurance/Indemnity: The Concessionaire shall indemnify, save and hold
harmless the City from all claims and losses, including costs and reasonable attorney's
fees arising directly or indirectly out of the Concessionaire's use of the concession area or
operation of the concession. The Service Provider shall maintain, during the life of this
Agreement, such commercial general liability and automobile liability insurance as will
provide coverage for damage claims of personal injury, including accidental death, as well
as for claims for property damage, which may arise directly or indirectly from the
performance of work under this Agreement. The amount of insurance for each coverage,
Commercial General and Vehicle, shall not be less than $500,000 combined single limits
for bodily injury and property damage, naming the City as an additional insured under
this Agreement of the type and with the limits specified within Exhibit "B", consisting
of one (1) page, attached and incorporated herein by reference. The Concessionaire,
before commencing services hereunder, shall deliver to the City's Director of
Purchasing and Risk Management, P.O. Box 580, Fort Collins, CO 80522, one (1) copy
of a certificate evidencing the insurance coverage required from an insurance company
acceptable to the City.
F. Signage: All signs on the concession truck must be approved by the City
Representative. Signs may be displayed in or on the truck only unless additional signage
is approved by the City Representative.
G. Mobile Food Truck: The mobile food truck may not exceed the size of eleven (11)
foot wide and thirty-five (35) foot long. Truck width shall not extend beyond one (1) foot of
the forward and side curbs. The design and appearance of the mobile food truck must
conform to the specifications described in Concessionaire's proposal, unless otherwise
agreed to in writing by the parties before the mobile food truck may be used at the
concession area. The City reserves the right to approve any modifications, changes, or
alternative mobile food truck. The mobile food truck is subject to inspection by the City.
The mobile food truck must be maintained and repaired to the City's satisfaction. The
mobile food truck must be removed from the site when not in use.
H. Restrictions: Equipment such as tables, chairs, benches and displays not attached
to the truck may not be used except for items and equipment authorized, in writing, by the
City Representative. Merchandise must be restricted to the mobile food truck. A tarp or
other protective medium must be placed to protect underlying surface. Mobile food truck
must be located in approved location site and cannot impede vehicular or pedestrian flow.
I. Cleanliness: Concessionaire shall keep the concession area clean of all trash
within a one- hundred (100) foot radius of site. Food Concessionaires must use a tarp
under the serving area, to minimize grease deposits and spillage.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 3 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
Concessionaire shall pay the City Twenty Dollars ($20.00) per month cleaning fee for
power washing of the site granted. The Cleaning fee is subject to change during term of
Agreement based on frequency required with at least thirty (30) days’ notice to the
Concessionaire.
City fees associated with the concession operation must be filed by their due date. No
assessment fees, penalties or interest will be waived by the City.
J. Power Source: Portable generators will be permitted if contained within the
designated concession area. Use of a power generator must not violate the noise
regulations contained in the City’s Noise Control Ordinance (Chapter 20, Article II) of
the City Code. For more information, visit www.colocode.com/fcmunihtml.html.
K. Stock: The Concessionaire shall maintain an adequate stock of supplies on hand
for all occasions in order to supply to the needs of parties desiring to patronize the
concession area.
L. Hours: The Concessionaire must keep the concession area open for business as
agreed to in this contract. Beginning from the contract start date and ending thirty-one (31)
days from that date, the Concessionaire shall submit, verbally or in writing, the days and
hours of operation for approval by the City Representative. The Concessionaire shall
notify, verbally or in writing, the City Representative of any changes to operating days and
hours during this period, subject to approval by the City Representative. After conclusion
of the one month period, the ongoing days and hours will be determined through
negotiation between the Concessionaire and the City Representative. The agreed upon
days and hours will be reflected in an amended contract. Any adjustments to the ongoing
days and hours shall be requested in writing and are subject to approval by the City
Representative.
Concessionaire is not required to operate on days when Transfort is not operating
transit services out of the Downtown Transit Center.
Inclement Weather: The Concessionaire shall not be required to operate the
concession when it is raining, snowing, hailing, and abnormally windy or when the air
temperature is below 50 degrees Fahrenheit.
M. Product: The products authorized are as described in Concessionaire's proposal
and agreed to by the City Representative. The City Representative will not pre-
authorize new products but does reserve the right to review any new products that may
be added. This is to ensure that the new products meet the same quality as those
proposed in the original Request for Proposal.
Smoking instruments, tobacco and tobacco products, gum and alcohol will not be sold.
The City recommends the Concessionaire incorporate the Dietary Guidelines for Americans,
as outlined on www.health.gov/dietaryguidelines. The Dietary Guidelines encourage
Americans to focus on eating a healthy diet, one that focuses on foods and beverages that
help achieve and maintain a healthy weight, promote health and prevent disease.
N. Customer Service: Concessionaire is required to uphold high standards of
customer service by addressing customer complaints in a prompt and courteous manner.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 4 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
Concessionaire will also provide contact information for the City, updated as needed.
The personal conduct of the Concessionaire has a direct impact on the quality of
performance. Unacceptable personal conduct/behavior by the Concessionaire may result in
immediate or early termination of the Agreement.
Section 4. General Conditions
A. The Concessionaire shall neither assign any of the rights nor delegate any of the
duties under the provisions of this Agreement without having first obtained the written
permission of the City. The Concessionaire shall not sublet any portion of the concession
area or allow any other person to take possession of any portion of the concession area
without prior written consent of the City. Any such assignment or subletting without the
City’s prior written consent shall be deemed null and void and of no effect.
B. This Agreement may not be enlarged, modified or altered except in writing, signed
by the parties as an amendment hereto.
C. No waiver of any breach of this Agreement shall be held or construed to be a
waiver of any subsequent breach thereof.
D. It is expressly understood and agreed by and between the parties hereto that in the
performance of the terms and conditions of this Agreement, time is of the essence.
E. The location assigned is not transferable to another vendor or
Concessionaire.
F. Fixtures and Improvements:
1. The Concessionaire agrees that all auxiliary equipment needed to operate the
Concession shall be installed at its expense. Prior to making any and all
improvements on said premises, the Concessionaire agrees to obtain the
approval of the appropriate City Department and shall supervise the construction
of said improvements.
2. Upon the termination of this Agreement the Concessionaire shall remove any
fixtures or improvements made by it to the concession area. However, the
concession area must be restored to as good a condition as the premises were in
at the time the Concessionaire took possession thereof.
G. This Agreement shall be binding upon and inure to the benefit of the heirs,
successors, and assigns of the parties hereto.
H. If either party must resort to legal action to enforce the terms of this Agreement, the
prevailing party shall be awarded its costs and reasonable attorney's fees.
I. Any notice required or desired to be given under this Agreement will be considered
delivered to the other party upon hand delivery or upon its deposit in the United States
mail, postage prepaid, sent by registered mail, addressed to the other party at the
following addresses:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 5 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
City: Copy to: Concessionaire:
City of Fort Collins City of Fort Collins Seasonal Soups
Purchasing Division Transfort Attn: Angela Norman
P.O. Box 580 Attn: Timothy Wilder 1009 Knobcone Pl.
Fort Collins, CO 80522 P.O. Box 580 Loveland, CO 80538
Fort Collins, CO 80522
J. Notwithstanding the time periods contained herein, either party may terminate this
Agreement at any time without cause by providing written notice of termination to the other
party. Such notice shall be delivered at least fifteen (15) days prior to the termination date
contained in said notice unless otherwise agreed in writing by the parties. All notices
provided under this Agreement shall be effective when mailed, postage prepaid and sent
to the above addresses.
Section 5. Default
A. The Concessionaire shall be in default under the terms and conditions of this
Agreement, if the Concessionaire fails to cure the default within ten (10) days after written
notice setting forth the nature of the default is delivered to the Concessionaire.
B. In the event the default is not timely cured, the City may elect to (a) terminate this
Agreement and seek damages; (b) treat the Agreement as continuing and require specific
performance or (c) avail itself of any other remedy at law or equity.
Section 6. Prohibition Against Employing Illegal Aliens.
Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees
that:
A. As of the date of this Agreement:
1. Service Provider does not knowingly employ or contract with an illegal alien
who will perform work under this Agreement; and
2. Service Provider will participate in either the e-Verify program created in
Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th
Congress, as amended, administered by the United States Department of Homeland
Security (the "e-Verify Program") or the Department Program (the "Department
Program"), an employment verification program established pursuant to Section 8-17.5-
102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired
employees to perform work under this Agreement.
B. Service Provider shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement or knowingly enter into a contract with a
subcontractor that knowingly employs or contracts with an illegal alien to perform work
under this Agreement.
C. Service Provider is prohibited from using the e-Verify Program or Department
Program procedures to undertake pre-employment screening of job applicants while this
Agreement is being performed.
D. If Service Provider obtains actual knowledge that a subcontractor performing work
under this Agreement knowingly employs or contracts with an illegal alien, Service
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 6 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
Provider shall:
1. Notify such subcontractor and the City within three days that Service Provider
has actual knowledge that the subcontractor is employing or contracting with an
illegal alien; and
2. Terminate the subcontract with the subcontractor if within three (3) days of
receiving the notice required pursuant to this section the subcontractor does not
cease employing or contracting with the illegal alien; except that Service Provider
shall not terminate the contract with the subcontractor if during such three days the
subcontractor provides information to establish that the subcontractor has not
knowingly employed or contracted with an illegal alien.
E. Service Provider shall comply with any reasonable request by the Colorado
Department of Labor and Employment (the "Department") made in the course of an
investigation that the Department undertakes or is undertaking pursuant to the
authority established in Subsection 8-17 .5-102 (5), C.R.S.
F. If Service Provider violates any provision of this Agreement pertaining to the
duties imposed by Subsection 8-17 .5-102, C.R.S. the City may terminate this
Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual
and consequential damages to the City arising out of Service Provider's violation of
Subsection 8-17.5-102, C.R.S.
G. The City will notify the Office of the Secretary of State if Service Provider violates
this provision of this Agreement and the City terminates the Agreement for such breach.
Section 7. Special Provisions.
Special provisions or conditions relating to the services to be performed pursuant to this
Agreement are set forth in Exhibit "C", Affidavit Pursuant to C.R.S. 24-76.5-103, consisting
of one (1) page, attached hereto and incorporated herein by this reference.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 7 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
CITY OF FORT COLLINS, COLORADO
a municipal corporation
By:_______________________________
Gerry Paul
Director of Purchasing and Risk Management
Date:_____________________________
ATTEST:
_________________________________
City Clerk
APPROVED AS TO FORM:
________________________________
Assistant City Attorney
Seasonal Soups, LLC
By:_______________________________
__________________________________
PRINT NAME
__________________________________
TITLE
Date:_____________________________
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Owner
6/10/2014
Angela Norman
6/11/2014
Concession Agreement Page 8 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
EXHIBIT A
DOWNTOWN TRANSIT CENTER MOBILE VENDOR PARKING LOCATION
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Concession Agreement Page 9 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
EXHIBIT B
INSURANCE REQUIREMENTS
1. The Service Provider will provide, from insurance companies acceptable to the City, the
insurance coverage designated hereinafter and pay all costs. Before commencing work
under this bid, the Service Provider shall furnish the City with certificates of insurance
showing the type, amount, class of operations covered, effective dates and date of
expiration of policies, and containing substantially the following statement:
"The insurance evidenced by this Certificate will not be cancelled or materially
altered, except after ten (10) days written notice has been received by the City of
Fort Collins."
In case of the breach of any provision of the Insurance Requirements, the City, at its
option, may take out and maintain, at the expense of the Service Provider, such
insurance as the City may deem proper and may deduct the cost of such insurance from
any monies which may be due or become due the Service Provider under this
Agreement. The City, its officers, agents and employees shall be named as additional
insured on the Service Provider's general liability and automobile liability insurance
policies for any claims arising out of work performed under this Agreement.
2. Insurance coverage shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall
maintain during the life of this Agreement for all of the Service Provider's
employees engaged in work performed under this agreement:
1. Workers' Compensation insurance with statutory limits as required by
Colorado law.
2. Employer's Liability insurance with limits of $100,000 per accident,
$500,000 disease aggregate, and $100,000 disease each employee.
B. Commercial General & Vehicle Liability. The Service Provider shall maintain
during the life of this Agreement such commercial general liability and automobile
liability insurance as will provide coverage for damage claims of personal injury,
including accidental death, as well as for claims for property damage, which may
arise directly or indirectly from the performance of work under this Agreement.
Coverage for property damage shall be on a "broad form" basis. The amount of
insurance for each coverage, Commercial General and Vehicle, shall not be less
than $500,000 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: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
New insurance
Concession Agreement Page 10 of 10
7632 Outdoor Concessionaires – Downtown Transit Center
EXHIBIT C
AFFIDAVIT PURSUANT TO C.R.S. 24-76.5-103
I, __________________________________, swear or affirm under penalty of perjury
under the laws of the State of Colorado that (check one):
___ I am a United States citizen, or
___ I am a Permanent Resident of the United States, or
___ I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a
public benefit. I understand that state law requires me to provide proof that I am lawfully
present in the United States prior to receipt of this public benefit. I further acknowledge
that making a false, fictitious, or fraudulent statement or representation in this sworn
affidavit is punishable under the criminal laws of Colorado as perjury in the second
degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate
criminal offense each time a public benefit is fraudulently received.
___________________________ _______________
Signature Date
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
6/10/2014
X
Angela Norman
Insured Full Copy
482117 05-28-14
OLD TOWN INS INC
315 W.MAGNOLIA ST #7
FORT COLLINS, CO 80521
ANGELA NORMAN
1009 KNOBCONE PL
LOVELAND, CO 80538-1945
CUSTOMER NUMBER: RUN DATE:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338
05-28-14
001
OLD TOWN INS INC
Allstate Insurance Company
OLD TOWN INS INC
ANGELA NORMAN
(SEE NAMED INSURED ENDORSEMENT)
X $ 25.00
$ 25.00
SEE NEXT PAGE
DM CW 30 01 10 Allstate Insurance Company
Policy Number
THIS ENDORSEMENT CHANGES THE POLICY.
PLEASE READ IT CAREFULLY.
COMMON POLICY CHANGE ENDORSEMENT
Endorsement No.
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or
conditions of coverage unless at the sole request of the insured.
COVERAGE PART INFORMATION ---Coverage parts affected by this change as indicated by x below.
Commercial Property
Commercial General Liability
Commercial Crime
Commercial Inland Marine
The following item(s):
Insured’s Name Insured’s Mailing Address
Policy Number Company
Effective/Expiration Date Insured’s Legal Status/Business of Insured
Payment Plan Premium Determination
Additional Interested Parties Coverage Forms and Endorsements
Limits/Exposures Deductibles
Covered Property/Location Description Classification/Class Codes
Rates Underlying Exposure/Insurance
is (are) changed to read {See Additional Page(s) }
The above amendments result in a change in the premium as follows:
This premium does not include taxes and surcharges.
No Changes To be Adjusted at Audit
Additional Return
Tax and Surcharge Changes
Additional Return
Countersigned By:
AUTHORIZED AGENT
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338
05-28-14
001
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
THE FOLLOWING ADDITIONAL INTEREST (ADDITIONAL INSURED) HAS BEEN ADDED
TO THE POLICY:
CITY OF FORT COLLINS
250 N MASON ST
FORT COLLINS CO 80524-4407
ADDITIONAL INSURED HAS BEEN ADDED.
THE FOLLOWING FORM(S) HAS BEEN ADDED:
CG 20 26 07-04 ADDL INSD-DESIGNATED PERSON/ORGANIZATION
ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME
DM CW 30 01 10 Allstate Insurance Company
Policy Number
COMMON POLICY CHANGE ENDORSEMENT
Endorsement No.
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
POLICY CHANGES ENDORSEMENT DESCRIPTION (CONT’D)
REMOVAL PERMIT
If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Coverage Part:
If Covered Property is removed to a new location that is described on this Policy Change, you may extend this
insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in
the proportion that the value at each location bears to the value of all Covered Property being removed. This permit
applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the
previous location.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338
05-28-14
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
DM CW 30 (cont.)
THE NAMED INSURED ON FORM DM CW 30 IS AMENDED TO READ:
ANGELA NORMAN
DBA - SEASONAL SOUPS
DM CW 03 01 10 Allstate Insurance Company
Policy Number
SCHEDULE OF NAMED INSURED(S)
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338
05-28-14
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
COMMON POLICY FORMS AND ENDORSEMENTS
DM CW 30 01-10 COMMON POLICY CHANGE ENDORSEMENT
DM CW 03 01-10 SCHEDULE OF NAMED INSURED(S)
DM CW 12 01-10 SCHEDULE OF FORMS AND ENDORSEMENTS
GENERAL LIABILITY FORMS AND ENDORSEMENTS
DL CW 30 01-10 SCHEDULE OF GENERAL LIABILITY CHANGES
CG 20 26 07-04 ADDL INSD-DESIGNATED PERSON/ORGANIZATION
DM CW 12 01 10
DM CW 12 01 10 Allstate Insurance Company
Policy Number
SCHEDULE OF FORMS AND ENDORSEMENTS
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338 01-02-2014
OLD TOWN INS INC 05-28-14
1009 KNOBCONE PL
01-02-2015
01-02-2014
LOVELAND, CO 80538-1945
ANGELA NORMAN
Certificate Holder
0
$ 2,000,000
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 100,000
$ 5,000
CITY OF FORT COLLINS
250 N MASON ST
FORT COLLINS, CO 80524-4407
CERTIFICATE OF INSURANCE - COMMERCIAL
CI CW 02 01 10
ALLSTATE INSURANCE COMPANY - NORTHBROOK, IL
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.
INTERESTED PARTY TYPE:
Description of Operation:
CERTIFICATE HOLDER NAMED INSURED
Name and Address of Party to Whom this Certificate is Issued Name and Address of Insured
Location Address (if different than above)
This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated below,
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.
TYPE OF INSURANCE AND LIMITS
Policy Number: Effective Date: Expiration Date:
COVERAGE SUMMARY
GENERAL LIABILITY AMOUNT
GENERAL AGGREGATE LIMIT (Other than Products -- Completed Operations)
PRODUCTS --COMPLETED OPERATIONS AGGREGATE LIMIT
PERSONAL AND ADVERTISING INJURY LIMIT
EACH OCCURRENCE LIMIT
PHYSICAL DAMAGE LIMIT ANY ONE LOSS
MEDICAL EXPENSE LIMIT ANY ONE PERSON
PROPERTY INSURANCE
POLICY TYPE
Amount
BUILDING Replacement Cost Actual Cash Value Deductible
CONTENTS Replacement Cost Actual Cash Value Deductible
Basic Form Wind Deductible %
Broad Form Exclude Wind YES NO
Special Form
ADDITIONAL COVERAGE’S:
MORTGAGE CLAUSE - The policy contains a Mortgage Clause in favor of:
Mortgagee
Address
CERTIFICATE PERIOD
THIS CERTIFICATE WILL REMAIN IN FORCE FROM THE INCEPTION OF THE POLICY UNTIL THE POLICY IS CANCELLED OR EXPIRES.
POLICY INCEPTION DATE: 12:01 AM 12:00 NOON
Standard Time at the location of the Insured premises.
PROVISIONS
This form is not the contract of insurance, but attests that a policy as identified above has been issued. The provisions of the policy shall prevail
Insured Full Copy
648132338
05-28-14
001
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
Additional Insured
ALL
49950
$ 25.00
Flat Charge
ADDED
DL CW 30 01 10 Allstate Insurance Company
Policy Number
Endorsement No.
SCHEDULE OF GENERAL LIABILITY CHANGES
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
CLASS CODE INFORMATION AFFECTED BY THIS CHANGE IS ADDED, DELETED OR CHANGED AS INDICATED.
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Insured Full Copy
648132338
CITY OF FORT COLLINS
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 07 04 ISO Properties, Inc., 2004 Page 1 of 1
ADDITIONAL INSURED --DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II --Who Is An Insured is amended to include
as an additional insured the person(s) or organiza-
tion(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 your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
482117 05-28-14
OLD TOWN INS INC
315 W.MAGNOLIA ST #7
FORT COLLINS, CO 80521
OLD TOWN INS INC
315 W.MAGNOLIA ST #7
FORT COLLINS, CO 80521
CUSTOMER NUMBER: RUN DATE:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
05-28-14
001
OLD TOWN INS INC
Allstate Insurance Company
OLD TOWN INS INC
ANGELA NORMAN
(SEE NAMED INSURED ENDORSEMENT)
X $ 25.00
$ 25.00
SEE NEXT PAGE
DM CW 30 01 10 Allstate Insurance Company
Policy Number
THIS ENDORSEMENT CHANGES THE POLICY.
PLEASE READ IT CAREFULLY.
COMMON POLICY CHANGE ENDORSEMENT
Endorsement No.
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or
conditions of coverage unless at the sole request of the insured.
COVERAGE PART INFORMATION ---Coverage parts affected by this change as indicated by x below.
Commercial Property
Commercial General Liability
Commercial Crime
Commercial Inland Marine
The following item(s):
Insured’s Name Insured’s Mailing Address
Policy Number Company
Effective/Expiration Date Insured’s Legal Status/Business of Insured
Payment Plan Premium Determination
Additional Interested Parties Coverage Forms and Endorsements
Limits/Exposures Deductibles
Covered Property/Location Description Classification/Class Codes
Rates Underlying Exposure/Insurance
is (are) changed to read {See Additional Page(s) }
The above amendments result in a change in the premium as follows:
This premium does not include taxes and surcharges.
No Changes To be Adjusted at Audit
Additional Return
Tax and Surcharge Changes
Additional Return
Countersigned By:
AUTHORIZED AGENT
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
05-28-14
001
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
THE FOLLOWING ADDITIONAL INTEREST (ADDITIONAL INSURED) HAS BEEN ADDED
TO THE POLICY:
CITY OF FORT COLLINS
250 N MASON ST
FORT COLLINS CO 80524-4407
ADDITIONAL INSURED HAS BEEN ADDED.
THE FOLLOWING FORM(S) HAS BEEN ADDED:
CG 20 26 07-04 ADDL INSD-DESIGNATED PERSON/ORGANIZATION
ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME
DM CW 30 01 10 Allstate Insurance Company
Policy Number
COMMON POLICY CHANGE ENDORSEMENT
Endorsement No.
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
POLICY CHANGES ENDORSEMENT DESCRIPTION (CONT’D)
REMOVAL PERMIT
If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Coverage Part:
If Covered Property is removed to a new location that is described on this Policy Change, you may extend this
insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in
the proportion that the value at each location bears to the value of all Covered Property being removed. This permit
applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the
previous location.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
05-28-14
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
DM CW 30 (cont.)
THE NAMED INSURED ON FORM DM CW 30 IS AMENDED TO READ:
ANGELA NORMAN
DBA - SEASONAL SOUPS
DM CW 03 01 10 Allstate Insurance Company
Policy Number
SCHEDULE OF NAMED INSURED(S)
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
05-28-14
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
COMMON POLICY FORMS AND ENDORSEMENTS
DM CW 30 01-10 COMMON POLICY CHANGE ENDORSEMENT
DM CW 03 01-10 SCHEDULE OF NAMED INSURED(S)
DM CW 12 01-10 SCHEDULE OF FORMS AND ENDORSEMENTS
GENERAL LIABILITY FORMS AND ENDORSEMENTS
DL CW 30 01-10 SCHEDULE OF GENERAL LIABILITY CHANGES
CG 20 26 07-04 ADDL INSD-DESIGNATED PERSON/ORGANIZATION
DM CW 12 01 10
DM CW 12 01 10 Allstate Insurance Company
Policy Number
SCHEDULE OF FORMS AND ENDORSEMENTS
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
05-28-14
001
OLD TOWN INS INC
ANGELA NORMAN
Allstate Insurance Company
Additional Insured
ALL
49950
$ 25.00
Flat Charge
ADDED
DL CW 30 01 10 Allstate Insurance Company
Policy Number
Endorsement No.
SCHEDULE OF GENERAL LIABILITY CHANGES
Named Insured Effective Date:
12:01 A.M., Standard Time
Agent Name
CLASS CODE INFORMATION AFFECTED BY THIS CHANGE IS ADDED, DELETED OR CHANGED AS INDICATED.
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
THE FOLLOWING CLASS CODE INFORMATION IS:
Code No. Premium Basis
Premises/Operations
Location Exposure Rate Premium
Products/Completed Operations
Rate Premium
Classification:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Agent Copy
648132338
CITY OF FORT COLLINS
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 07 04 ISO Properties, Inc., 2004 Page 1 of 1
ADDITIONAL INSURED --DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II --Who Is An Insured is amended to include
as an additional insured the person(s) or organiza-
tion(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 your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
482117 05-28-14
OLD TOWN INS INC
315 W.MAGNOLIA ST #7
FORT COLLINS, CO 80521
CITY OF FORT COLLINS
250 N MASON ST
FORT COLLINS, CO 80524-4407
CUSTOMER NUMBER: RUN DATE:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
648132338
CITY OF FORT COLLINS
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 07 04 ISO Properties, Inc., 2004 Page 1 of 1
ADDITIONAL INSURED --DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II --Who Is An Insured is amended to include
as an additional insured the person(s) or organiza-
tion(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 your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Certificate Copy
482117 06-10-14
OLD TOWN INS INC
315 W.MAGNOLIA ST #7
FORT COLLINS, CO 80521
CITY OF FORT COLLINS
250 N MASON ST
FORT COLLINS, CO 80524-4407
CUSTOMER NUMBER: RUN DATE:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
Certificate Copy
648122238
11-19-2013 11-19-2014
OLD TOWN INS INC
ANGELA NORMAN
1009 KNOBCONE PL
LOVELAND CO 80538-1945
CERTIFICATE HOLDER
CITY OF FORT COLLINS
X
$ 1,000,000
250 N MASON ST
FORT COLLINS, CO 80524-4407
CI CW A02 10 11
Includes copyrighted material of Insurance Services Office, Inc., with its permission
CI CW A02 10 11 Allstate Insurance Company Page 1 of 1
CERTIFICATE OF INSURANCE
This certificate is issued for informational purposes only. It certifies that the policies listed in this document have
been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify
coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions
of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard-
less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits
shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits.
Certificate Holder: Named Insured:
Automobile Liability
Insurer Name: Allstate Insurance Company
Policy Number:
1 --Any Auto 2 --Owned Autos Only 3 --Owned Priv. Pass. Autos Only
4 --Owned Autos Other Than Priv.
Pass. Autos Only
5 --Owned Autos Subject to No
Fault
6 --Owned Autos Subject to a Compulsory UM Law
7 --Specifically Described Autos 8 --Hired Autos Only 9 --Non-owned Autos Only
Policy Effective Date: Policy Expiration Date:
Limits Of Combined Single Limit (each accident)
Insurance:
BI Per Person BI Per Accident PD Per Accident
Description of Operations/Locations/Vehicles/Endorsements/Special Provisions
Interested Party Type:
THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER.
IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES)
MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE H OLDER WITH
ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT
INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT.
Producer:
Authorized Representative:
Date:
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696
in all respects.
IT IS AGREED THAT SHOULD THE INSURANCE PROTECTION EVIDENCED HEREIN TERMINATE, THE ISSUING COMPANY WILL
ENDEAVOR TO MAIL NOTICE OF SUCH TERMINATION WITHIN DAYS FOR THE FOLLOWING INTERESTED
PARTIES: MORTGAGEE, LIEN HOLDER, ADDITIONAL INSURED AND ADDITIONAL INTERESTED PARTY.
Authorized Representative Date
DocuSign Envelope ID: 0C441CEF-5B7D-4CD7-A1FF-6971998E7696