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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8827 CONSULTING ENGINEERING SERVICES WATER TREATMENT FACILITY DESIGN AND CONSTRUCTION FOR CAPITAL IMPROVEMENTSUtilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND HDR ENGINEERING, INC. WORK ORDER NUMBER: UHDR-WTFSS-032619 PROJECT TITLE: UWTF Process Engineering and Design ORIGINAL BID/RFP NUMBER & NAME: U8827 Consulting Engineering Services WTF Design and Construction for Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: UFebruary 20, 2019 ARCHITECT/ENGINEER: U HDR Engineering, Inc OWNER’S REPRESENTATIVE: USue Paquette WORK ORDER COMMENCEMENT DATE: UApril 1, 2019 WORK ORDER COMPLETION DATE: UDecember 31, 2019 MAXIMUM FEE: (time and reimbursable direct costs): U$60,000.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UServices shall include design and consulting input on WTF process and operational projects located at the Fort Collins Water Treatment Facility. See attached supporting documentations. Service Provider agrees to perform the services identified above and on the attached forms in accordance with the terms and conditions contained herein and in the Master Agreement between the parties. In the event of a conflict between or ambiguity in the terms of the Master Agreement and this Work Order (including the attached forms) the Master Agreement shall control. The attached forms consisting of UfourU (4) pages are hereby accepted and incorporated herein, by this reference, and Notice to Proceed is hereby given after all parties have signed this document. SERVICE PROVIDER: HDR Engineering, Inc. By: Date: Name: Title: Page 1 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Brad Martin Senior Vice President April 2, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 OWNER’S ACCEPTANCE & EXECUTION: This Work Order and the attached Contract Documents are hereby accepted and incorporated herein by this reference. ACCEPTANCE: Date: Sue Paquette, Civil Engineer III REVIEWED: Date: Marisa Donegon, Buyer II APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Mark Kempton, Director – Water Production Division ACCEPTANCE: Date: Owen Randall, Civil Engineering Director ACCEPTANCE: Date: Theresa Connor, Deputy Director – Water Engineering & Field Services ACCEPTANCE: Date: Carol Webb, Deputy Director – Water Resources & Treatment Operations ACCEPTANCE: Date: Kevin Gertig, Utilities Executive Director (if greater than $1,000,000) ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) ACCEPTANCE: Date: Darin Atteberry, City Manager (if greater than $1,000,000) ATTEST: Date: City Clerk Page 2 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 March 28, 2019 March 28, 2019 April 2, 2019 April 2, 2019 April 2, 2019 April 4, 2019 April 10, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES Page 3 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 WORK ORDER SCOPE OF SERVICES UScope of Services All work to be performed under this Work Order are subject to the terms of the Professional Service Agreement for RFP 8827 Consulting Engineering Services WTF Design and Construction Services for Capital Improvements (the “Agreement”). The Professional’s services for the project are detailed hereinafter. Project Objective: To provide treatment process consultation and design assistance to the City for various WTF Projects at the Water Treatment Facility (WTF) and related facilities. Task 1 – WTF Design and Process Engineering Project Assistance Professional will provide process engineering and design assistance for WTF capital projects for City staff when requested. Engineering assistance services are anticipated to include the following: Attendance at meetings when requested, post-treatment chemical assistance, water distribution modeling, regulatory review and assistance, treatment process consultation, and design support for Water Treatment Unit Processes replacement projects; submittal review of WTF replacement equipment; construction observations; cathodic protection and corrosion control design and field measurements, project meeting and scope development, project management, response to miscellaneous issues that may arise, and others services as request. Specific projects at the time of Work Order execution include: • Update of the Chlorine Risk Management Plan (RMP) for submission to the EPA by June 5, 2019 • Minor design assistance, CDPHE coordination, and submittal approval on the improvements for the Filter 7 underdrain system • Review and consultation regarding a potential new lime supplier for the Facility’s corrosion control program • Review of short circuiting of flows in the West Reservoir • Continued updating of the WTF’s Yard Piping ACAD Schematic Map • Update of the VA and ERP to comply with the new Water Infrastructure Act Professional will communicate scope and level of effort for requested assistance, as appropriate to WTF management. Professional’s Project Manager (PM) shall prepare, implement, monitor, and update the project execution plan throughout the project. Professional’s PM will prepare and submit to the WTF management, on a monthly basis, a brief cost and schedule status report. The report will include a narrative description of progress to-date, actual costs for each item, estimates of percent complete, and potential cost variances. Page 4 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Deliverables: The following deliverables will be prepared for this work order: • Design Documents (plans, specifications, calculations), including updating WTF schematic as needed, • Engineering Technical Memorandums, • Observation Reports, and • Monthly project cost and schedule status reports and invoices. Invoices will include the budget tracking spreadsheet form provided by City. (the consultant is responsible for tracking their contract, including completion date and need for change orders, plus.) Assumptions 1. This Work Order consists of a series of miscellaneous projects and tasks. Engineer will endeavor to complete individual projects and tasks as efficiently as possible and will keep the City’s Project Manager and WTF Production Manager informed of the budget expended per the notes above under Deliverables. 2. All services shall be performed in accordance with the Agreement Fee Schedule. Invoices shall include a detailed itemized cost break-down including the number of hours and hourly rates by job classification for Consultant and sub-consultants. Reimbursable expenses, as applicable will also be detailed. Page 5 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER COST DETAIL Page 6 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Senior Project Manager Senior Technical Advisor/ QC Senior Engineer II Project Engineer II Staff Engineer I Senior Electrical and Controls Engineer Senior CAD Designer CAD Designer Senior Project Accountant Clerical Assistant $ 230 $ 260 $ 210 $ 140 $ 110 $ 245 $ 175 $ 120 $ 125 $ 85 12 12 24 $ 4,260 $ 450 $ 4,710 $ 4,710 24 24 48 $ 10,560 $ 870 $ 11,430 $ 2,350 $ 13,780 16 12 56 54 12 40 4 194 $ 32,580 $ 1,350 $ 33,930 $ 5,000 $ 38,930 44 4 12 $ 2,320 $ 260 $ 2,580 $ 2,580 Sub-total 56 12 84 58 12 0 0 40 12 4 278 $ 49,720 $ 2,930 $ 52,650 $ 7,350 $ 59,650 56 12 84 58 12 0 0 40 12 4 278 $12,880 $3,120 $17,640 $8,120 $1,320 $0 $0 $4,800 $1,500 $340 $ 49,720 $ 2,930 $ 52,650 $ 7,350 WTF Design Assistance for the Fort Collins Utilities, 8827 Consulting Engineering Services WTF Design and Construction for Capital Improvements. HDR Engineering Merrick and Company Total Fee Hours Labor Total Expenses HDR Fee Task 1 – WTF Design and Process Engineering Project Assistance 1.1 Project Management Task Description TOTAL FEE (ROUNDED) $ 60,000 1.2 Project Coordination Meetings 1.3 Design and Process Assistance 1.4 Regulatory Review Assistance Hours Totals Page 7 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT C WORK ORDER SCHEDULE DETAIL Page 8 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 2019 April May June July August September October November December Project Notice to Proceed Project Construction Project Substantial Completion Project Final Acceptance Schedule for WTF Process Engineering and Design Page 9 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT D CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents. Page 10 of 10 DocuSign Envelope ID: 9E529942-0B32-45B6-A085-8957B28D2794 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-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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 AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: HDR Engineering, Inc. 1917 South 67th Street Omaha, NE 68106 Additional Insureds: The City, its officers, agents and employees 2 2 Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance SR ID: 17611958 BATCH: 1094436 CERT: W10336105 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F CG 25 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 Policy Number: TB2-641-444950-038 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): All locations owned by or rented to the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to operations at a single designated "loca- tion" shown in the Schedule above: 1. A separate Designated Location General Aggregate Limit applies to each designated "location", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damag- es because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Loca- tion General Aggregate Limit for that desig- nated "location". Such payments shall not re- duce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Location General Aggre- gate Limit for any other designated "location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Location General Aggre- gate Limit. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 04 05 09 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be at- tributed only to operations at a single designated "location" shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Location General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Location Gen- eral Aggregate Limit. D. For the purposes of this endorsement, the Defi- nitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Section III – Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2  Policy Number: TB2-641-444950-038 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All construction projects not located at premises owned, leased or rented by a Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III – Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F POLICY NUMBER: TB2-641-444950-038 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been p ut to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on b ehalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the POLICY NUMBER: TB2-641-444950-038 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization with whom you have agreed, through written contract, agreement or permit to provide additional insured coverage. Any location where you have agreed, through written contract, agreement or permit, to provide additional insured coverage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F POLICY NUMBER: TB2-641-444950-038 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization to whom or to which you are required to provide additional insured status in a written contract, agreement or permit except where such contract or agreement is prohibited. Any location where you have agreed, through written, contract, agreement or permit, to provide additional insured coverage for completed operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be br oader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F Policy Number TB2-641-444950-038 Issued by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT – SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: Where required by written contract. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on w hat basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV - Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit". LC 24 20 02 13 © 2013 Liberty Mutual Insurance. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F POLICY NUMBER: AS2-641-444950-048 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): As required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F AS2-641-444950-048 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F POLICY NUMBER: TB2-641-444950-038 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done un der a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F POLICY NUMBER: AS2-641-444950-048 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization for whom you perform work under a written contract of the contract requires you to obtain this agreement from us but only if the contract is executed prior to the injury or damage occurring. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a c ontract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Where required by contract or written agreement prior to loss. Issued by: For attachment to Policy No WA7-64D-444950-018 Effective Date 6/01/2018 Premium $ Issued to: WC 00 03 13 © 1983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1/1984 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F LIM 99 04 03 14 © 2014 Liberty Mutual Insurance. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Policy Number TB2-641-444950-038 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organization(s): Email Address or mailing address: Number Days Notice: As required by written contract or written agreement As required by written contract or written agreement 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F LIM 99 04 03 14 © 2014 Liberty Mutual Insurance. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Policy Number AS2-641-444950-048 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organization(s): Email Address or mailing address: Number Days Notice: Per Schedule on File 30 A. If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF MATERIAL CHANGE WC 99 20 15 Page 1 of 1 Ed. 09/01/2010 Copyright 2010 Liberty Mutual Group of Companies. All Rights Reserved We will not make changes that reduce the insurance afforded by this policy until written notice of such reduction has been delivered to those scheduled below at least 30 days before the effective date of the material change to the insurance afforded by this policy. Our failure to provide notice under this endorsement will not affect the validity of the changes except as it relates to the person or organization listed below. NAME As required by written contract or written agreement ADDRESS In no event will the notification be less than the minimum days required for notification by state statute. Notification will be provided to all parties in a manner as required by state statute, if any. This endorsement is executed by the Liberty Insurance Corporation Premium: Effective Date: 6/1/2018 Expiration Date: 6/1/2019 For attachment to Policy No: WA7-64D-444950-018 Countersigned by__________________________________________ Authorized Representative End. Serial No. DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 20 74 (Ed. 12-16) NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below by email as soon as practical after notifying the first Named Insured. B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) / Organization(s): As required by written contract 30 Days or written agreement All other terms and conditions of this policy remain unchanged. Issued by For attachment to Policy No. WA7-64D-444950-018 Effective Date 6/01/2018 Premium $ Issued to DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2  DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F (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 ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA HDR Engineering, Inc. 1917 South 67th Street Omaha, NE 68106 Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella/Excess Liability on a Primary, Non-contributory basis where required by written contract. Waiver of Subrogation applies on General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written contract. Umbrella/Excess policy is Follows Form over General Liability, Auto Liability and Employers Liability. Re: On-Call Drinking Water Engineering Services City of Fort Collins PO Box 580 Fort Collins, CO 80522 03/05/2019 1-877-945-7378 1-888-467-2378 certificates@willis.com Liberty Mutual Fire Insurance Company 23035 Liberty Insurance Corporation 42404 W10336105 A 2,000,000 1,000,000 Contractual Liability 10,000 2,000,000 4,000,000 4,000,000 Y Y TB2-641-444950-038 06/01/2018 06/01/2019 A 2,000,000 Y Y AS2-641-444950-048 06/01/2018 06/01/2019 B 5,000,000 Y Y TH7-641-444950-068 06/01/2018 06/01/2019 5,000,000 B WA7-64D-444950-018 Y 1,000,000 No 06/01/2018 06/01/2019 1,000,000 1,000,000 SR ID: 17611958 BATCH: 1094436 DocuSign Envelope ID: FD087CBB-9E529942-0B32-8697-45B6-4868-A085-B47A-8957B28D2794 C762D5920C8F Page 1 of 2