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HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9192241Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 1 of 13 SERVICES AGREEMENT WORK ORDER TYPE THIS AGREEMENT made and entered into the day and year set forth below, by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and CSU EXTENSION LARIMER COUNTY CSU EXTENSION hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Services to be Performed. a. This Agreement shall constitute the basic agreement between the parties for services related to participation in the Colorado Department of Public Health and Environment’s Health Disparities Grant Program. The conditions set forth herein shall apply to all services performed by the Service Provider on behalf of the City and particularly described in Work Orders agreed upon in writing by the parties from time to time. Such Work Orders, a sample of which is attached hereto as Exhibit A, consisting of one (1) page and incorporated herein by this reference, shall include a description of the services to be performed, the location and time for performance, the amount of payment, any materials to be supplied by the City and any other special circumstances relating to the performance of services. A general scope of services is attached hereto as Exhibit C, consisting of one (1) page, and incorporated herein by this reference. The only services authorized under this Agreement are those which are performed after receipt of such Work Order, except in emergency circumstances where oral work requests may be issued. Oral requests for emergency actions will be confirmed by issuance of a written Work Order within two (2) working days. Irrespective of references in Exhibit A to certain named third parties, Service Provider shall be solely responsible for performance of all duties hereunder. b. The City may, at any time during the term of a particular Work Order and without invalidating such Work Order, make changes to the scope of the particular services. Such changes shall be agreed upon in writing by the parties by Change Order, a sample of which is attached hereto as Exhibit B, consisting of one (1) page and incorporated herein by this reference. 2. Changes in the Work. The City reserves the right to independently bid any services rather than issuing work to the Service Provider pursuant to this Agreement. Nothing within this Agreement shall obligate the City to have any particular service performed by the Service Provider. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated as specified by each written Work Order or oral DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 2 of 13 emergency service request. Oral emergency service requests will be acted upon without waiting for a written Work Order. Time is of the essence. 4. Contract Period. This Agreement shall commence December 1, 2019 and shall continue in full force and effect until June 30, 2020, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed one (1) additional one year period. Renewals and pricing changes shall be negotiated by and agreed to by both parties. Written notice of renewal shall be provided to the Service Provider and mailed no later than thirty (30) days prior to contract end. 5. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without is fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. 6. Early Termination by City/Notices. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be mailed at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following address: Service Provider: City: Copy to: CSU EXTENSION LARIMER COUNTY CSU EXTENSION Attn: Kerri Rollins 1525 Blue Spruce Dr. Fort Collins, CO 80524 City of Fort Collins Attn: Meaghan Overton PO Box 580 Fort Collins, CO 80522 City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the termination date, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 7. Contract Sum. This is an open-end indefinite quantity Agreement with no fixed price. The actual amount of work to be performed will be stated on the individual Work Orders. The City makes no guarantee as to the number of Work Orders that may be issued or the actual amount of services which will in fact be requested. 8. Payments. a. The City agrees to pay and the Service Provider agrees to accept as full payment for all work done and all materials furnished and for all costs and expenses incurred in performance of the work the sums set forth for the hourly labor rate and material costs, DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 3 of 13 with markups, stated within the Bid Schedule Proposal Form, attached hereto as Exhibit D, consisting of one (1) page, and incorporated herein by this reference. Payment shall be made by the City Net 30 days from the date of the invoice and upon acceptance of the work by the City and upon the Service Provider furnishing satisfactory evidence of payment of all wages, taxes, supplies and materials, and other costs incurred in connection with the performance of such work. 9. City Representative. The City's representative will be shown on the specific Work Order and shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the work requested. All requests concerning this Agreement shall be directed to the City Representative. 10. Independent Contractor. It is agreed that in the performance of any services hereunder, the Service Provider is an independent contractor responsible to the City only as to the results to be obtained in the particular work assignment and to the extent that the work shall be done in accordance with the terms, plans and specifications furnished by the City. 11. Subcontractors. Service Provider may not subcontract any of the Work set forth in the Exhibit A, Statement of Work without the prior written consent of the city, which shall not be unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of the City), then the following provisions shall apply: (a) the subcontractor must be a reputable, qualified firm with an established record of successful performance in its respective trade performing identical or substantially similar work, (b) the subcontractor will be required to comply with all applicable terms of this Agreement, (c) the subcontract will not create any contractual relationship between any such subcontractor and the City, nor will it obligate the City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor will be subject to inspection by the City to the same extent as the work of the Service Provider. 12. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the city. 13. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights under the Agreement or of any cause of action arising out of the performance of this Agreement. 14. Warranty. a. Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. b. Unless otherwise provided in the Agreement, all materials and equipment incorporated DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 4 of 13 into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. c. Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 15. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this Agreement, such party may be declared in default thereof. 16. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 17. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire Agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representative, successors and assigns of said parties. 18. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever, brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit E, consisting of one (1) page, attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder shall deliver to the City's Purchasing DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 5 of 13 Director, P. O. Box 580, Fort Collins, Colorado 80522 one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the city. 19. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 20. Law/Severability. This Agreement shall be governed in all respect by the laws of the State of Colorado. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction such holding shall not invalidate or render unenforceable any other provision of this Agreement. 21. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: a. As of the date of this Agreement: 1) Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2) Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the “e-Verify Program”) or the Department Program (the “Department Program”), an employment verification program established pursuant to Section 8- 17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Service Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. c. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. d. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Service Provider shall: 1) Notify such subcontractor and the City within three days that Service Provider has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2) Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 6 of 13 the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Service Provider shall comply with any reasonable request by the Colorado Department of Labor and Employment (the “Department”) made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. f. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider’s violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breach. 22. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit F - Confidentiality, consisting of one (1) page, attached hereto and incorporated herein by this reference. DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 7 of 13 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul Purchasing Director DATE: ATTEST: APPROVED AS TO FORM: CSU EXTENSION LARIMER COUNTY CSU EXTENSION By: Printed: Title: Date: DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Director, Larimer County CSU Extension Kerri Rollins 12/17/2019 Assistant City Attorney ll 12/17/2019 City Clerk Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 8 of 13 EXHIBIT A WORK ORDER FORM PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND CSU EXTENSION LARIMER COUNTY CSU EXTENSION WORK ORDER NUMBER: PROJECT TITLE: ORIGINAL BID/RFP NUMBER & NAME: MASTER AGREEMENT EFFECTIVE DATE: Original Contract Date WORK ORDER COMMENCEMENT DATE: WORK ORDER COMPLETION DATE: MAXIMUM FEE: (time and reimbursable direct costs): PROJECT DESCRIPTION/SCOPE OF SERVICES: 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 ( ) page(s) 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: Date: Name, Title ACCEPTANCE: Date: Name, Project Manager REVIEWED: Date: Name, Buyer or Senior Buyer ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 9 of 13 EXHIBIT B CHANGE ORDER NO. PROJECT TITLE: SERVICE PROVIDER: Company Name WORK ORDER NUMBER: PO NUMBER: DESCRIPTION: 1. Reason for Change: Why is the change required? 2. Description of Change: Provide details of the changes to the Work 3. Change in Work Order Price: 4. Change in Work Order Time: ORIGINAL WORK ORDER PRICE $ .00 TOTAL APPROVED CHANGE ORDER .00 TOTAL PENDING CHANGE ORDER .00 TOTAL THIS CHANGE ORDER .00 TOTAL % OF THIS CHANGE ORDER % TOTAL C.O.% OF ORIGINAL WORK ORDER % ADJUSTED WORK ORDER COST $ .00 SERVICE PROVIDER: Date: Name, Title ACCEPTANCE: Date: Name, Project Manager REVIEWED: Date: Name, Buyer or Senior Buyer ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 10 of 13 EXHIBIT C GENERAL SCOPE OF SERVICES Scope: Participation in Colorado Department of Public Health and Environment grant core team, recruitment and engagement of Family Leadership Training Institute (FLTI) alumni and other key stakeholders in grant-related activities, and implementation of an English/Spanish (language justice model) 20-week cohort of the FLTI Civic Leadership Program. Background: The Family Leadership Training Institute (FLTI) is a named partner on a collaborative grant that has been awarded to the City of Fort Collins by the Colorado Department of Public Health and Environment (CDPHE) Health Disparities Grant Program (HDGP). The grant program requires cross-sector partnerships with letters of collaboration from each named grant partner as part of the grant application process. Because this supplier is one of those named partners, the City's effective use of the grant funding requires their participation as outlined in the grant application. FLTI has committed to participating in the grant project and providing the following services:  Recruiting for and facilitating a 20 week cohort of the Family Leadership Training Institute (FLTI) Civic Leadership program  Providing the FLTI curriculum in English and Spanish, using a language justice model and bilingual facilitators  Participating in the core project management team for the grant  Recruiting and engaging FLTI alumni and other key stakeholders in grant-related activities This is a separate, but integrated, scope of services that is fully coordinated and aligned with the deliverables and objectives of the CDPHE grant. DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 11 of 13 EXHIBIT D BID SCHEDULE Provision of services in accordance with the below rate structure: o Site Coordinator: $28/hr o Co-coordinator: $21/hr DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 12 of 13 EXHIBIT E INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: “The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins.” In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider 's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this Agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 Official Purchasing Document Last updated 10/2017 Service Agreement – Work Order Type SS 2019 – Larimer County – Family Leadership Training Institute Page 13 of 13 EXHIBIT F CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Service Provider hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Service Provider has agreed to perform, the Service Provider hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Service Provider agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Service Provider shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Service Provider shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Service Provider understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Service Provider shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Service Provider ceases to perform services for the City, or the City so requests for any reason, the Service Provider shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Service Provider understands and agrees that the City’s remedies at law for a breach of the Service Provider’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law. DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 EXHIBIT A WORK ORDER FORM PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND CSU EXTENSION LARIMER COUNTY CSU EXTENSION WORK ORDER NUMBER: 1 PROJECT TITLE: Health Disparities Grant Program ORIGINAL BID/RFP NUMBER & NAME: N/A – FLTI Sole Source MASTER AGREEMENT EFFECTIVE DATE: December 1, 2019 WORK ORDER COMMENCEMENT DATE: December 1, 2019 WORK ORDER COMPLETION DATE: June 30, 2020 MAXIMUM FEE: (time and reimbursable direct costs): $46,350 PROJECT DESCRIPTION/SCOPE OF SERVICES: See attached cost spreadsheet 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 two (2) page(s) 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: Date: Name, Title ACCEPTANCE: Date: Name, Project Manager REVIEWED: Date: Name, Buyer or Senior Buyer ACCEPTANCE: Date: Gerry Paul, Purchasing Director (if greater than $60,000) Work Order 1 SS 2019 - Larimer County - Family Leadership Training Institute Page 1 of 3 DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 12/17/2019 12/17/2019 12/17/2019 Month Staff time Description of Staff time Staff Cost Facilitator Payments Recruiment Hard Cost Training Cost FLTI Meals cost FLTI Transportation FLTI Supplies for FLTI Cohort Total November 2019 310 280-Site Coordinator and 30 - Co-Coordinator 1. 1- Attend Core team meetings -work on Stake holder Analysis - recruitment 3.2 Recruitment and preparation for the FLTI 2020 Cohort 3.3-3.4 Recruitment of FLTI Alumni and underrepresented populations 8470 $0.00 $400.00 $677.00 $0.00 $0.00 $253.00 $9,800.00 December 2019 120 100 - Site Coordinator and 20 - Co-Coordinator 1. 1- Attend Core team meetings -work on Stake holder Analysis - recruitment 3.2 Recruitment and preparation for the FLTI 2020 Cohort 3.3-3.4 Recruitment of FLTI Alumni and underrepresented populations 3220 $200.00 $600.00 $4,020.00 January 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $2,200.00 $100.00 $700.00 $50.00 $6,830.00 Month Staff time Description of Staff time Staff Cost Facilitator Payments Recruiment Hard Cost Training Cost FLTI Meals cost FLTI Transportation FLTI Supplies for FLTI Cohort Total June 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC- graduation and Post surveys. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $2,200.00 $100.00 $300.00 $200.00 $6,580.00 Total $34,370.00 $6,600.00 $1,200.00 $677.00 $2,200.00 $0.00 $1,303.00 $46,350.00 SUBTOTAL $46,350.00 ADVANCES $0.00 TOTAL $46,350.00 Work Order 1 Page 2 of 2 SS 2019 - Larimer County - Family Leadership Training Institute Page 3 of 3 DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 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 12/16/2019 Arthur J. Gallagher Risk Management Services, Inc. 6300 South Syracuse Way, Suite 700 Centennial CO 80111 Nathan Kathol 303-889-2548 720-200-5127 Nathan_Kathol@ajg.com Argonaut Insurance Company 19801 Safety National Casualty Corporation 15105 Larimer County, Colorado 200 W. Oak Street Suite 4000 Fort Collins CO 80522 1066881852 A X 1,000,000 X 2,000,000 X Y 290201904 5/15/2019 5/15/2020 A Included X In 290201904 5/15/2019 5/15/2020 Above B SP4060404 5/15/2019 5/15/2021 X 1,000,000 1,000,000 1,000,000 A Public Officials Wrongful Act Includs Professsional Liability 290201904 5/15/2019 5/15/2020 Each Occurrence Aggregate $1,000,000 $1,000,000 RE: Training classes for CDPHE Grant Certificate Holder is an Additional Insured as respects General Liability and Auto Liability policies, pursuant to and subject to the policy's terms, definitions, conditions and exclusions. City of Fort Collins, Risk Management PO Box 580 Fort Collins CO 80522-0580 USA DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4 February 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $100.00 $300.00 $50.00 $4,230.00 March 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $100.00 $300.00 $50.00 $4,230.00 April 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $2,200.00 $100.00 $300.00 $50.00 $6,430.00 May of 2020 140 120 - Site Coordinator and 20 - Co-Coordinator 3.2 conduct a 20-week language justice cohort of the FLTI civic leadership curriculum hosted at TFC. 3.3 & 3.4 recruit for resident panels 4.4 & 4.5 - continue to wotrk with core team on impact. 3780 $100.00 $300.00 $50.00 $4,230.00 Work Order 1 SS 2019 - Larimer County - Family Leadership Training Institute Page 2 of 3 DocuSign Envelope ID: 1593F95F-F0AC-4605-8865-61FD44A53EE4