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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - SD MYERS INCSeptember 7, 2018 SD Meyers Inc Attn: Sindi Harrison 180 South Avenue Tallmadge, OH 44278 RE: Renewal, Misc. Agreement - Oil Sampling from Live Substation Transformers Dear Ms. Harrison: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: 1) The term will be extended for one (1) additional year, November 6, 2018 through November 5, 2019. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance certificate naming the City as an additional insured for General and Automotive Liability within the next fifteen (15) days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non-renewal. Please contact Pat Johnson, CPPB, Senior Buyer at (970) 221-6816 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew Miscellaneous Agreement - Oil Sampling from Live Substation Transformers by signing this letter and returning it to Purchasing Division within the next fifteen days.) GSP: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: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 9/28/2018 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 03 13 06 11 Page 1 of 1 © 2011, The Hartford NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Policy Policy Number Number 20UENZQ6852 Effective Effective 10/10/01/01/13 2012-to 10/10/01/01/14 2013 Policy Number 20UENZQ6852 Effective Effective 10/10/10/10/10/10/01/01/01/01/01/01/2016 2017 2014 2018 2015 2015 Expiration 10/01/2015 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 20UENZQ6852 Effecitve 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE S. D. Myers, Inc. Endorsement Number: 1 ECC-315-0712 Common Policy Conditions Endorsement This endorsement, effective 10/1/2012 attaches to and forms a part of Policy Number FEI-ECC-10317-00. This endorsement changes the Policy. Please read it carefully. In consideration of the premium charged, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that all coverage parts included in this policy are subject to the following conditions: A. CANCELLATION The named insured may cancel this policy by mailing to the Company written notice stating when thereafter such cancellation shall become effective. The Company may cancel this policy by mailing to the named insured, at the mailing address specified the Declarations, written notice stating when not less than thirty (30) days thereafter such cancellation shall become effective, except in the event of the named insured's nonpayment of premium, not less than ten (10) days advance notice of cancellation shall be given. The mailing of notice as aforesaid, shall be sufficient proof of either party's intent to cancel. The effective date of cancellation specified in such notice shall terminate this policy period. Delivery of such notice shall be equivalent to mailing. If the named insured cancels, the earned premium shall be computed in accordance with the customary short rate table. If the Company cancels, the earned premium shall be computed pro rata. The Company will tender any return premium subject to retaining a minimum earned premium equal to 25% of the amount specified in the Declarations. Premium adjustment may be made either at the time cancellation is effective or as soon as practicable thereafter, but tender of the unearned premium or return of this policy, shall not be conditions precedent to cancellation hereunder. B. CHANGES No provision of this policy may be amended, waived or otherwise changed, except by endorsement hereto. 10/01/13 ECC1031701 10/01/2014 ECC1031702 10/01/2015 FEI-ECC1031703 10/01/2016 FEI-ECC-10317-04 10/01/2017 FEIECC1031705 S. D. Myers LLC 2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 10/01/2016 FEI-FEIECC1031705 ECC-10317-04 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 10/01/2016 FEI-ECC-10317-04 10/01/2017 FEIECC1031705 FEEIECC1031705 S. D. Myers LLC 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 10/01/0216 FEI-ECC-10317-04 10/10/01/01/2016 2017 FEIECC1031705 S. D. Myers LLC 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE 10/01/2016 FEI-ECC-10317-04 10/01/2017 FEIECC1031705 S. D. Myers LLC 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE S. D. Myers, Inc. Endorsement Number: 15 ECC-548-0712 Automatic Primary and Non-Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 10/1/2012 attaches to and forms a part of Policy Number FEI-ECC-10317-00. This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of $Applied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. 10/01/13 ECC1031701 10/01/2014 ECC1031702 10/01/2015 FEI-ECC1031703 10/01/2016 FEI-ECC-10317-04 10/01/2017 FEIECC1031705 S. D. Myers LLC 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE S. D. Myers, Inc. Endorsement Number: 6 ECC-320-0712 Automatic Waiver of Subrogation Endorsement This endorsement, effective 10/1/2012 attaches to and forms a part of Policy Number FEI-ECC-10317-00. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. The Company waives any right of recovery it may have against the person or organization shown in the above Schedule because of payments the Company makes for injury or damage arising out of the insured’s work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement act to extend the policy period, change the scope of coverage or increase the Aggregate Limits of Insurance shown in the Declarations. 10/01/13 ECC1031701 10/01/2014 ECC1031702 10/01/2015 FEI-ECC1031703 10/10/01/01/2016 2015 FEI-ECC-10317-04 10/01/2017 FEIECC1031705 S. D. Myers LLC 10/01/2018 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT OTHER: PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X WC 1021025-02 7/1/2018 7/1/2019 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE (MM/DD/YYYY) 6/5/2018 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 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). PRODUCER UNITED STATES INSURANCE SERVICES, INC. 856 ELDRIDGE LANDING RD. LINTHICUM, MD 21090-2903 CONTACT JULIE PHILLIPS NAME: PHONE 614-728-0535 (A/C, No, Ext): FAX 1-800-671-2351 (A/C, No): E-MAIL BWCOTHERSTATESCOVERAGE@BWC.STATE.OH.US ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ZURICH AMERICAN INSURANCE COMPANY 16535 INSURED SD MYERS, LLC SD MYERS, INC GOOD PLACE HOLDING CO 180 SOUTH AVE TALLMADGE, OH 44278 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : City of Fort Collins PO Box 580 Fort Collins CO 80522 Waiver of subrogation applies for workers’ compensation and employer’s liability as required by written contract. Waiver of subrogation applies in favor of City of Fort Collins with respect to workers’ compensation policy, as required by written contract. PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 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: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 9/28/2018 J. Smith Lanier & Co.-Atlanta 11330 Lakefield Drive Bldg 1, Suite 100 Duluth GA 30097 Jessica Lamar 770-476-1770 770-476-3651 jlamar@jsmithlanier.com Admiral Insurance Company 24856 Twin City Fire Insurance Co. 29459 S.D. Myers LLC S.D. Myers Inc. 180 South Avenue Tallmadge OH 44278 168909280 A X 1,000,000 X 50,000 X 50,000 5,000 1,000,000 2,000,000 X Y Y FEIECC1031705 10/1/2018 10/1/2019 2,000,000 B 1,000,000 X X X 0 deductible Y Y 20UENZQ6852 10/1/2018 10/1/2019 A X 6,000,000 X Y FEIEXS1031805 6,000,000 10/1/2018 10/1/2019 A Cont Pollution Liability Professional Liability FEIECC1031705 10/1/2018 10/1/2019 $1,000,000 ea occ $1,000,000 ea occ $2,000,000 agg $2,000,000 agg Certificate Holder is named as additional insured as per written contract, but only with respects to the general liability and automobile Liability insurance and subject to the provisions and limitations of the policies. Waiver of Subrogation applies in favor of the certificate holder in regards to for automobile liability and general liability as required by written contract. Coverage is primary and non-contributory as required by written contract. No deductible applies to automobile liability. Excess liability coverage is follows form Excess is follow form. City of Fort Collins PO Box 580 Fort Collins CO 80522 DocuSign Envelope ID: 7AFFE4C3-BC9E-4285-AC67-0B9E2359F2CE