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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8115 ENGINEERING SERVICES FOR WATER RECLAMATION & BIOSOLIDS FACILITY DESIGN & CONSTRUCTION (11)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 CAROLLO ENGINEERS, INC. WORK ORDER NUMBER: UC-WRF-2019-14 PROJECT TITLE: U ORIGINAL BID/RFP NUMBER & NAME: U8115, Engineering Services for Water Reclamation and Biosolids Facility Design and Construction Services MASTER AGREEMENT EFFECTIVE DATE: USeptember 21, 2015 ARCHITECT/ENGINEER: UCarollo Engineers, Inc OWNER’S REPRESENTATIVE: UJason Graham WORK ORDER COMMENCEMENT DATE: UOctober 1, 2019 WORK ORDER COMPLETION DATE: UNovember 30, 2019 MAXIMUM FEE: (time and reimbursable direct costs): U$25,216.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: UAnalysis existing influent data, evaluate existing influent monitoring configuration consider alternatives, provide conceptual design and cost evaluation for new monitoring station. See the 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 UthreeU (3) 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: Carollo Engineers, Inc. By: Date: Name: Title: Page 1 of 8 DWRF Influent Monitoring Analysis and Concept Design DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Vice President October 17, 2019 Jason Garside 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: Jason Graham, Director, Water Reclamation & Biosolids Division REQUISTION ENTERED Date: REVIEWED: Date: Pat Johnson, Senior Buyer APPROVED AS TO FORM: Date: Name,City Attorney's Title (if greater than $1,000,000) ACCEPTANCE: Date: Carol Webb, Deputy Director, Water Resources & Treatment Operations 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) Page 2 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F October 22, 2019 Michele Warren 10/22/2019 Administrative Assistant October 17, 2019 October 22, 2019 October 24, 2019 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES Page 3 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F pg. 1 Scope of Work – DWRF Influent Monitoring Analysis and Concept Design DRAFT (9-18-19) The City of Fort Collins (City) intends to implement a modification to the influent water quality monitoring at the Drake Water Reclamation Facility (DWRF) in support of collecting representative influent composite samples for influent quality characterization required for permit compliance reporting, process monitoring and operational decision making. The current influent monitoring location and/or composite sampler setup configuration is believed to result in unrepresentative, erroneous results, specifically resulting in an overestimation of biological oxygen demand (BOD) influent concentrations. BOD influent monitoring results suggest that the DWRF is approaching its BOD design capacity. If influent sampling results are indeed not representative, this could unjustifiably alert the Colorado Department of Public Health & Environment (CDPHE) to request action by the City to unnecessarily expand its treatment capacity. The City requires an analysis be performed to evaluate the existing influent monitoring location and sample collection configuration, consider alternative monitoring locations/configurations, and provide a conceptual design and cost estimate to implement the recommended improvements either by plant staff or through a future capital improvements project. It is anticipated that this scope of work will proceed beginning October 1, 2019 and is required to be completed by November 30, 2019. Scope of Work The scope of work for this Work Order is divided into the following tasks and subtasks: Task 1 - Project Coordination Task 1.1 - Project Coordination and Meetings Perform project initiation activities. Prepare for and facilitate the following meetings: 1. UKick off Meeting:U A two (2) hour project kick-off meeting including site walkthrough. 2. UFirst Coordination Meeting:U A two (2) hour coordination meeting with plant staff to review and assess current and alternative sampling locations and/or configurations. 3. UFinal Coordination Meeting.U A two (2) hour coordination meeting with plant staff to review and discuss final recommendations. Assume two (2) hours for preparation for each meeting and one (1) hour for development of meeting minutes. Task 1.2 - Progress Reporting Invoices will be submitted monthly by Consultant's Project Manager to City's Project Manager in accordance with City payment protocols. Each invoice will be submitted with a progress report detailing the work executed during the invoice period and work remaining. UTask 1 DeliverablesU:  Meeting Agenda, Presentation Materials and Minutes.  Monthly Progress Report and Invoices. Page 4 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F pg. 2 Task 2 – Engineering Analysis and Recommendation Task 2.1 – Engineering Opinion Consultant will prepare an engineering opinion that substantiates whether BOD and other influent parameters analyzed in the DWRF influent composite sample are accurate or overestimated. The following information will be utilized to prepare this opinion: 1. Daily historical influent flows and concentrations of the DWRF and Mulberry WRF (2014 to September 2019). 2. Biowin modeling and influent load mass balance analyses performed in association with the 2017Master Plan Update analysis. 3. Analysis of typical per capita wastewater constituent loads in the City's service area, other similar Colorado communities and industry wide averages. The Draft of the Engineering Opinion will be discussed at the First Coordination Meeting. Task 2.2 Engineering Analysis Consultant will review existing monitoring configuration to determine opinion on possible cause(s) of erroneous measurement results. Consultant to review and discuss investigative work previously undertaken by plant staff in identifying and testing potential solutions for modifying existing influent sample configuration and assessing alternative sampling locations. Consultant to discuss previously investigated solutions with plant staff. Consultant to review existing drawings for potential alternative monitoring locations and consider influent sampling configurations successfully utilized at other treatment facilities. Consultant will identify potential options for modifying existing monitoring configuration and alternative locations/configurations, and identify pros/cons of each option for consideration by City. Decision on preferred option will be requested at the Second Coordination Meeting. UTask 2 DeliverablesU:  Draft and Final Engineering Opinion Memorandum. Page 5 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER COST DETAIL Page 6 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F DRAFT - 9/18/19 DWRF INFLUENT MONITIORING AND CONCEPT DESIGN LABOR HOURS AND ENGINEERING FEE Senior Professional Project Manager (JG) Process Engineer (TRW) Professional (BC) Senior Technician Technician Document Processing/Clerical Billing Rate $253 $234 $221 $186 $0 $0 $0 $177 $125 $111 Task 1 - Project Coordination 0 28 24 0 0 0 0 0 0 0 52 $11,856 $0 $200 $624 $12,680 Task 1.1 - Project Coordination and Meetings 0 24 24 0 0 0 0 0 0 0 48 $10,920 $0 $200 $576 $11,696 Task 1.2 - Progress Reporting 0 4 0 0 0 0 0 0 0 0 4 $936 $0 $0 $48 $984 Task 2 - Engineering Analysis 0 16 28 8 0 0 0 0 0 4 56 $11,864 $0 $0 $672 $12,536 Task 2.1 - Engineering Opinion Memorandum 0 4 16 8 0 0 0 0 0 4 32 $6,404 $0 $0 $384 $6,788 Task 2.2 - Engineering Analysis 0 12 12 0 0 0 0 0 0 0 24 $5,460 $0 $0 $288 $5,748 PROJECT TOTALS - TASKS 1-2 0 44 52 8 0 0 0 0 0 4 108 $23,720 $0 $200 $1,296 $25,216 LABOR HOURS PROJECT COSTS Total Direct Labor Hours Total Labor Cost Subs Other Direct Costs (ODCs) PECE TOTAL COST Page 7 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F 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 8 of 8 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Subject: Date: No. of Pages: Phone: Sender: URL: MAIL Certificate of Insurance DOCUMENT Delivery by ecertsonline™ THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BY TELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonline™ Insurance Visions, Inc. All rights reserved. Risk Strategies Company 2040 Main Street, Suite 450 Irvine, CA 92614 949-242-9240 www.risk-strategies.com 7/2/2019 City of Fort Collins P.O. Box 580 Fort Collins CO 80522 Sandi Moreno 10 Cert No. 49775283 - Certificate of Liability: Carollo Engineers, Inc. - Professional Liability Renewal DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F 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? Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement CNA75079XX (1-15) Policy No: Page 1 of 2 Endorsement No: Effective Date: Insured Name: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization’s liability for: A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured’s ongoing operations as specified in such written contract; or 2. bodily injury or property damage caused in whole or in part by your work and included in the products-completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance Carollo Engineers, Inc. 6050490317 12/31/2018 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 2 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement CNA75079XX (1-15) Policy No: Page 2 of 2 Endorsement No: Effective Date: Insured Name: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. is required by written contract to be primary and non-contributory, this insurance will be primary and non- contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Carollo Engineers, Inc. 6050490317 12/31/2018 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 3 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization Blanket where required by written contract. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured’s ongoing operations or your work included in the products-completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Policy No: Endorsement No: Effective Date: Insured Name: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 7/2/2019 Carollo Engineers, Inc. 6050490317 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 4 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F CNA68021XX (2-13) Policy No: Page 1 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. Carollo Engineers, Inc. 6050490317 12/31/2018 City of Fort Collins P.O. Box 580 Fort Collins CO 80522 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 5 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Named Insured: Policy Number: Effective Date: ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Persons Or Organizations ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED UNDER A WRITTEN CONTRACT OR AGREEMENT. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II – LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non- contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA 71527XX (Ed. 10/12) Carollo Engineers, Inc. 6050490267 12/31/2018 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 6 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F CNA68021XX (2-13) Policy No: Page 1 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS It is understood and agreed that: If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. Carollo Engineers, Inc. City of Fort Collins P.O. Box 580 Fort Collins CO 80522 6050490267 12/31/2018 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 7 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F Carollo Engineers, Inc. 6050490270 12/31/2018 12/31/2018 6050490298 American Casualty Company of Reading, PA Valley Forge Insurance Company 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 8 of 9 Workers Compensation DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F PROFESSIONAL LIABILITY AND POLLUTION For All the Commitments you Make INCIDENT LIABILITY INSURANCE POLICY INSURED: Policy Effective Endorsement Number NOTICE ENDORSEMENT – CANCELLATION OR NON-RENEWAL We agree with you that your Policy is amended to include the following additional provisions. 1. Your Policy will not be: XX Cancelled by us until we provide at least: 10 days prior written notice if we cancel your Policy for Non-payment of Premium; 30 days prior written notice if we cancel your Policy for The following reasons: Any reason other than non-payment of premium. ___ Non-renewed by us until at least ___ days prior written notice is given to the person or entity named in 2. below. 2. Person or Entity: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy and expires concurrently with said Policy unless another effective date is shown above. By Authorized Representative __James F. Willging_____________________ (No signature is required if issued with the Policy or if it is effective on the Policy Effective Date) James F. Willging Countersigned by Authorized Representative 256423 (Ed. 10/05) Carollo Engineers, Inc. AEH288354410 7/4/2019 City of Fort Collins P.O. Box 580 Fort Collins CO 80522 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 9 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F (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 7/2/2019 Risk Strategies Company 2040 Main Street, Suite 450 Irvine, CA 92614 949-242-9240 www.risk-strategies.com CA DOI License No. 0F06675 Michael Christian Risk Strategies Company syoung@risk-strategies.com Carollo Engineers, Inc. 2700 Ygnacio Valley Road, #300 Walnut Creek CA 94598 49775283 ✓ ✓ Construction Services. Carollo Project #: 10103A.00. City of Fort Collins, its officers, agents and employees are included as additional insured as City of Fort Collins P.O. Box 580 Fort Collins CO 80522 Projects as on file with the insured including but not limited to: 8115 Engineering Services for Water Reclamation and Biosolids Facility Design & additional insureds with respects to General & Auto Liability. $1,000,000 $1,000,000 $25,000 $1,000,000 $2,000,000 $2,000,000 $1,000,000 Ded: Comp/Collision $1,000 $1,000,000 $1,000,000 $1,000,000 Each Claim: $1,000,000 Aggregate: $1,000,000 Deductible: $400,000 A ✓ 6050490317 12/31/2018 12/31/2019 ✓ ✓ Deductible $0 ✓ E 6050490267 12/31/2018 12/31/2019 ✓ ✓ ✓ B 6050490270 12/31/2018 12/31/2019 ✓ ✓ C 6050490298 12/31/2018 12/31/2019 N Deductible: $0 D Professional Liability AEH288354410 7/4/2019 7/4/2020 Unlimited Prior Acts Continental Insurance Company 35289 American Casualty Company of Reading, PA 20427 Valley Forge Insurance Company 20508 Continental Casualty Company 20443 National Fire Insurance Co of Hartford 20478 49775283 | *18-19 GL-AL-UL-WC 19-20 PL ($1M/$1M) | Sandi Moreno | 7/2/2019 4:36:11 AM (PDT) | Page 1 of 9 DocuSign Envelope ID: 139F9FD7-ABE2-435D-B9AC-2D7AD726B77F