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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8073 ENGINEERING SERVICES FOR WATER, WASTEWATER & STORMWATER FACILITIES CAPITAL IMPROVEMENTS PROJECTS (3)Utilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND ICON ENGINEERING, INC. WORK ORDER NUMBER: UBLA-2019-04 PROJECT TITLE: UWest Vine Basin Floodplain Update - Phase 2 ORIGINAL BID/RFP NUMBER & NAME: U8073, Engineering Services for Water, WW and Stormwater Facilities Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: UMay 15, 2015 ARCHITECT/ENGINEER: UIcon Engineering, Inc. OWNER’S REPRESENTATIVE: UBeck Anderson WORK ORDER COMMENCEMENT DATE: UJuly 1, 2019 WORK ORDER COMPLETION DATE: UDecember 31, 2019 MAXIMUM FEE: (time and reimbursable direct costs): U$73,560.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UProject will update floodplain mapping for the West Vine Basin to reflect new hydrology. Scope of services for Phase 2 of the project include: Floodway determination, floodplain mapping, report production, web map development, comparison of mapped floodplain with regional hydrologic soil types, and 2-deminsional hydraulic analysis (rain-on-grid) to confirm flow paths and flooding extents identified in the 1-deminsional floodplain model. See attached supporting documentation. 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 UfiveU (5) 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: Icon Engineering, Inc. By: Date: Name: Title: Page 1 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB Craig Jacobson July 2, 2019 Principal 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: Beck Anderson, Civil Engineer III REVIEWED: Date: Pat Johnson, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Ken Sampley, Director, Civil Engineering ACCEPTANCE: Date: Theresa Connor, Deputy Director, Water Engineering & Field Services 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 (if greater than $1,000,000) Page 2 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB July 2, 2019 July 2, 2019 July 2, 2019 July 2, 2019 July 3, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES & COST DETAILS Page 3 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ICONENGINEERING, 7000 S. Yosemite Street, Suite 120, Centennial, INC. CO 80112 303.221.0802 | www.iconeng.com Planning | Design | Management Exhibit A Scope of Work West Vine Basin Floodplain Update – Phase 2 City of Fort Collins June 7, 2019 ICON Engineering, Inc. is pleased to provide this proposal for engineering services to complete the floodplain update for the West Vine Basin (Phase 2). Goals for this project are to update the floodplain mapping to reflect the changes in hydrology identified for the West Vine Basin in 2015. This work will also incorporate recent improvements made to the West Vine Central Flow Path, north of Vine Drive, in addition to current LiDAR topography. This scope is for the Phase 2 portion of the project, specifically: floodway determination, floodplain mapping, report production, and web map development. In addition, as requested by the City, as a project option, ICON will perform additional work related to validation of the floodplain results. First, a map will be prepared comparing the identified floodplain locations with regional hydrologic soil types. Second, a 2D analysis will be prepared for the basin reflecting a combination of rain-on- grid methods and direct hydrograph input to confirm flow paths and flooding extents currently identified. Our scope of work is outlined below. A fee spreadsheet has been provided for your review. Base Services – Phase 2: Task 1: Correspondence: Up to three (3) project meetings and up to three (3) periodic conference calls have been assumed for project correspondence. All other correspondence items will be made via phone calls and emails. Task 2: Floodway Analysis, Floodplain Delineation and Flood Profiles: Floodplains will be delineated for the 100-year flood event only. Floodplain and floodway delineations will be presented along with profile baselines, hydraulic cross-sections, base flood elevations (BFEs), and base map references on project workmaps. Flood profiles will be generated for the flood frequencies identified above. Page 4 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ICONENGINEERING, INC. Page 2 of 3 I:\Proposal\~2019\19-PRO-041_Fort Collins West Vine\ICON Scope of Service West Vine Hydraulics2.docx Task 3: Submittals and Reports: ICON will assemble a hydraulics report for the West Vine Basin Master Plan. This appendix will summarize the hydraulics background, data, methodology, and results from the study. Tables will be prepared documenting flood elevations and floodway data information. Technical backup information will be assembled in project appendices. Task 4: Review and Revisions: Time has been included to address comments from the City. It should be noted that a technical review was not completed by the City for the initial floodplain modeling. The entirety of the model will be reviewed by the City upon completion of the floodplain delineation and floodway identification. Review comments will address the aggregate of the floodplain modeling, floodplain delineation, and floodway modeling. Task 5: Project Webmap ICON will prepare a project webmap using a MapBox Open Source Platform to display the results of both the hydrology development and the hydraulic analysis. The web map will be available to assist in the review of the initial submittal and subsequently updated for the final project results. Optional Services: Hydraulic Modeling Verification: Optional services for the project include preparing a map comparing the identified floodplain locations with regionally published soil types. The purpose of this map is to serve as a validation tool, identify if the mapped floodplain is coincident with soil types known to be located within drainageway regions. Second, for a more detailed analysis, a 2D analysis will be prepared for the basin. This 2D model will be prepared using HEC-RAS 2D and will reflect rain- on-grid hydraulics to identify areas of potential flood risk. Similar to the hydrology, separate models will be prepared upstream, between, and downstream of each canal system. Downstream of each canal, spill flow hydrographs will also be added to the model to depict the spill flows from each canal location in the basin hydrology model. The results of the 2D models will be compared with the results of the existing 1D model to identify if the general flood limits are consistent. Should significant inconsistencies be discovered, additional hydraulic modeling may be required. This work will be done as a change to this original scope once the differences can be reviewed. Page 5 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ICONENGINEERING, INC. Page 3 of 3 I:\Proposal\~2019\19-PRO-041_Fort Collins West Vine\ICON Scope of Service West Vine Hydraulics2.docx Project Fees and Schedule: Project fees for this project are estimated at $60,500 for the base services and $13,060 for the optional services. $73,560 for all services proposed. We estimate that the base scope for this phase of the project can be completed in approximately 5-months’ time. Meeting this schedule will require an efficient review from the City. Additional time (approximately 1 month) will be needed should the City wish to pursue the optional services. Again, this schedule would assume that significant changes to the baseline hydraulic analysis would not be needed. Please note that a decision to pursue the optional services would need to be made prior to ICON beginning work on the initial project tasks. Thank you again for the opportunity to assist the City with this project. Please let us know if you have any questions or comments regarding this proposal. Sincerely, ICON Engineering, Inc. Craig D. Jacobson, PE, CFM Principal Page 6 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ICON ENGINEERING, INC. PROJECT ESTIMATING SHEET PROJECT NAME: West Vine Basin Floodplain Analysis CLIENT: CITY OF FORT COLLINS - Beck Anderson PREPARED BY: CDJ Principal Professional Professional Engineer GIS Admin GIS Survey Misc. CHECKED BY: JYM Engineer III Engineer I II Specialist Programmer Crew Direct DATE: 5/22/19 $176 $163 $140 $110 $94 $67 $105 $165 Costs Description Hours Hours Hours Hours Hours Hours Hours Hours TOTALS 1 Correspondence a. Project Meetings (3) 6 6 $200 $2,234 b. Conference Calls & Correspondence 44 $1,356 2 Floodway Analysis, Floodplain Delineation and Flood Profiles a. Floodway Analyses - Central Flow Path 3.0 15 6 $3,633 - Eastern Flow Path 2.0 10 4 $2,422 - Southeastern Flow Path 0.5 7 2 $1,449 - Southern Flow Path 3.0 15 6 $3,633 - Northern Flow Path 0.5 8 4 $1,832 - Northeastern Flow Path 0.5 7 2 $1,449 b. Project Workmaps 4 18 48 $15 $8,165 c. Flood Profiles 3 14 54 $15 $8,765 3 Submittals and Report Items a. Baseline Hydraulics Report 8 32 16 12 4 $50 $9,830 b. Floodplain and Floodway Data Tables c. Technical Appendix 4 Review and Revisions 4 16 12 8 4 $50 $5,702 5 Webmap a. Initial Review Map 24 48 $50 $7,922 b. Final Update 8 10 $48 $2,108 TOTAL BASE SERVICES - PHASE 2 39 152 32 106 126 8 0 0 428 $60,500 $6,776 $24,776 $4,480 $11,660 $11,844 $536 $0 $0 $428 $60,500 O.1 Optional Services a. Soil Comparison Map 2 6 $200 $1,090 b. 2D Model Preparation & Results 8 16 40 24 $98 $11,970 TOTAL OPTIONAL SERVICES - PHASE 2 8 18 40 0 30 0 0 0 298 $13,060 $1,408 $2,934 $5,600 $0 $2,820 $0 $0 $0 $298 $13,060 TOTAL ALL SERVICES - PHASE 2 47 2968 5680 0 2874 0 0 0 726 $73,560 $8,184 $27,710 $10,080 $11,660 $14,664 $536 $0 $0 $726 $73,560 Page 7 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER SCHEDULE DETAILS Page 8 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ID Task Mode Task Name Duration Start Finish 1 West Vine Hydraulics - Phase 1 2 3 Correspondence 90 days Mon 6/3/19 Fri 10/4/19 4 5 Floodway Analyses 65 days Mon 6/3/19 Fri 8/30/19 6 - Central Flow Path 10 days Mon 6/3/19 Fri 6/14/19 7 - Eastern Flow Path 10 days Mon 6/17/19Fri 6/28/19 8 - Southeastern Flow Path 5 days Mon 7/1/19 Fri 7/5/19 9 - Southern Flow Path 10 days Mon 7/8/19 Fri 7/19/19 10 - Northern Flow Path 5 days Mon 7/22/19Fri 7/26/19 11 - Northeastern Flow Path 5 days Mon 7/29/19Fri 8/2/19 12 - Project Workmaps 10 days Mon 8/5/19 Fri 8/16/19 13 - Flood Profiles 10 days Mon 8/19/19Fri 8/30/19 14 15 Submittals and Report Items 10 days Mon 9/2/19 Fri 9/13/19 16 - Appendix C - Baseline Hydraulics Report 10 days Mon 9/2/19 Fri 9/13/19 17 - Floodplain and Floodway Data Tables 10 days Mon 9/2/19 Fri 9/13/19 18 - Technical Appendix 5 days Mon 9/9/19 Fri 9/13/19 19 20 City Review 10 days Mon 9/16/19Fri 9/27/19 21 22 Review and Revisions 15 days Mon 9/30/19Fri 10/18/19 23 24 Webmaps 40 days Mon 8/26/19Fri 10/18/19 25 - Initial 15 days Mon 8/26/19Fri 9/13/19 26 - Final 5 days Mon 10/14/19Fri 10/18/19 27 28 Optional Services (time addition) 25 days Mon 10/21/19Fri 11/22/19 22 27 1 6 11 16 21 26 1 6 11 16 21 26 31 5 10 15 20 25 30 4 9 14 19 24 29 4 9 14 19 24 29 3 8 13 18 23 June 2019 July 2019 August 2019 September 2019 October 2019 November 2019 Task Split Milestone Summary Project Summary Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only External Tasks External Milestone Deadline Progress Manual Progress West Vine Hydraulics - Phase 1 Page 1 Project: schedule.mpp Date: Wed 5/22/19 Page 9 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT C CERTIFICATE OF INSURANCE CONTRACTOR shall submit Certificate of Insurance in compliance with the Contract Documents. Page 10 of 10 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE 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 PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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? (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) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 1/19/2019 Hall & Company 19660 10th Ave NE Poulsbo WA 98370 Jim Ledbetter 360-626-2019 360-598-3703 jledbetter@hallandcompany.com RLI INSURANCE COMPANY 13056 732 Icon Engineering Inc 7000 S Yosemite Street, Suite 120 Centennial CO 80112 300773389 A Professional Liab: Claims Made RDP0035085 1/30/2019 1/30/2020 Per Claim Aggregate $2,000,000 $2,000,000 Additional Insured Status is not available on Professional Liability Policy. Project: 8497 for Stormwater Consulting Engineering Services. City of Fort Collins 700 Wood Street Fort Collins CO 80521 DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB 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. 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 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 4/17/2019 (720) 212-2050 (303) 799-0156 22357 ICON Engineering Inc Douglas Williams 7000 S Yosemite St #120 Centennial, CO 80112 41190 A 2,000,000 X 34SBAPD8771 1/30/2019 1/30/2020 300,000 10,000 2,000,000 4,000,000 4,000,000 A 2,000,000 X 34SBAPD8771 1/30/2019 1/30/2020 A 2,000,000 34SBAPD8771 1/30/2019 1/30/2020 2,000,000 10,000 B 4077567 2/1/2019 2/1/2020 1,000,000 N 1,000,000 1,000,000 RE: 8497 Stormwater Consulting Engineering Services As required by written contract, The City, its officers, agents and employees shall be named as additional insureds on the General Liability and Automobile Liability insurance policies for any claims arising out of worked performed under this Agreement. City of Fort Collins 700 Wood Street Fort Collins, CO 80521 ICONENG-01 HANNAHA CCIG 5660 Greenwood Plaza Blvd. Suite 500 Greenwood Village, CO 80111 Beth Ficken BethF@thinkccig.com The Hartford Insurance Group Pinnacol Assurance X X X X X X X X X DocuSign Envelope ID: 0EB7E27F-91F9-4391-94A6-BA1BBEA21ACB