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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - LIQUID CARBON DIOXIDENovember 18, 2019 Reliant Gases, LTD Attn: David Burdick 10817 West County Road 60 Midland, TX 79707 RE: Renewal, Liquid Carbon Dioxide- Reliant Gases LTD Dear Mr. Burdick: 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, January 10, 2020 through January 9, 2021. 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 Marisa Donegon, Buyer at (970) 416-4377 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew this agreement 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: B69C15A9-6FE4-452D-BFC2-FC3A42DE7D57 12/10/2019 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: RELIA8 1 1 Higginbotham Insurance Agency, Inc. Reliant Holdings, Ltd. **Complete name shown in description 10817 West County Road 60 Midland TX 79707 25 CERTIFICATE OF LIABILITY INSURANCE The General Liability and Automobile Liability policy has a blanket Primary & Non Contributory endorsement that affords that coverage to certificate holders only where there is a written contract between the Named Insured and the certificate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Excess liability is underlying the General Liability, Automobile Liability and the Employers Liability and follows form on the underlying for the additional insured. ** Supplemental Name ** Name Printed on DEC Page: Reliant Holdings, Ltd. Reliant Holdings, Ltd. Reliant Group, LLC Reliant Employment Group, LLC Reliant Dry Ice Group, LLC Reliant Transportation Group, LLC Reliant Manufacturing Group, LLC FLOCO2 Management Group, LLC Reliant Supply Group, LLC Reliant Distribution Group, LLC Reliant Processing Group, LLC Reliant Employment Services, LTD Reliant Dry Ice, Ltd. Reliant Transportation, Ltd. Reliant Manufacturing, Ltd. FLOCO2, Ltd. Reliant Gases, Ltd. Reliant Distribution, Ltd. Reliant Processing, Ltd. Reliant Metro Carbonation, LLC Reliant Lonestar Management, LLC Reliant Equipment Leasing, LLC Reliant Equipment Leasing II, LLC Reliant Dry Ice Pacific, LLC Reliant Exploration & Production , LLC RDS Leasing, LLC Reliant Atlantic Group, Ltd Reliant Atlantic Group, LLC Sandhill Group, LLC Vanderbug Rice Partnership RE: Liquid Carbon Dioxide DocuSign Envelope ID: B69C15A9-6FE4-452D-BFC2-FC3A42DE7D57 (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 12/5/2019 Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 76102 Janna Gonzalez, Certificate CSR 817-349-2384 817-347-6981 jgonzalez@higginbotham.net Great American Alliance Ins. Co. 26832 RELIA8 Gemini Insurance Company 10833 Reliant Holdings, Ltd. **Complete name shown in description 10817 West County Road 60 Midland TX 79707 XL Specialty Insurance Company 37885 Crum & Forster Specialty Ins. Co 44520 National Fire & Marine Ins Co 20079 1295758859 B X 1,000,000 X 100,000 X BI/PD Ded 50,000 5,000 1,000,000 2,000,000 X X VMGP003556 3/26/2019 3/26/2020 2,000,000 C 1,000,000 X AEC004954902 3/26/2019 3/26/2020 E X 5,000,000 X 42UMO30736801 3/26/2019 3/26/2020 5,000,000 X $10,000 A A X N WC111026503 WC185582303 3/26/2019 3/26/2019 3/26/2020 3/26/2020 X Alternate Employ 1,000,000 1,000,000 1,000,000 D Contractors Pollution Liability Off-Site CPL109973 3/26/2019 3/26/2020 Each Incident Policy Aggregate Deductible $5,000,000 $5,000,000 $10,000 *CPL109973-CFS- Crum & Forster Specialty Ins. Co- 03/26/2019-03/26/2020- Stand Alone Pollution Policy- Sudden & Accidental coverage- $1,000,000/Each Incident - $1,000,000/Aggregate - $10,000 deductible The General Liability and Automobile Liability policies include a blanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Liability, Automobile Liability and Workers' Compensation policy includes a blanket waiver of subrogation endorsement to the certificate holder when required by written contract. See Attached... City of Fort Collins P.O. Box 580 Fort Collins CO 80522 DocuSign Envelope ID: B69C15A9-6FE4-452D-BFC2-FC3A42DE7D57