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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8073 ENGINEERING SERVICES FOR WATER, WASTEWATER, & STORMWATER FACILITIES CAPITAL IMPROVEMENTS PROJECTSUtilities Work Order Form Official Purchasing Form Last updated 10/2017 WORK ORDER PURSUANT TO A MASTER AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND ANDERSON CONSULTING ENGINEERS, INC. WORK ORDER NUMBER: 202003 PROJECT TITLE: Castlerock Storm Water Remediation Project ORIGINAL BID/RFP NUMBER & NAME: 8073, Engineering Services for Water, WW and Stormwater Facilities Capital Improvements MASTER AGREEMENT EFFECTIVE DATE: May 15, 2015 ARCHITECT/ENGINEER: Anderson Consulting Engineers OWNER’S REPRESENTATIVE: James Rose WORK ORDER COMMENCEMENT DATE: May 14, 2020 WORK ORDER COMPLETION DATE: January 30, 2021 MAXIMUM FEE: (time and reimbursable direct costs): $ 19,954.00 PROJECT DESCRIPTION/SCOPE OF SERVICES: Provide pre-construction and construction management services associated with the Castlerock Drive Sanitary Service and Sewer Line Improvement Project. 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 five (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: Anderson Consulting Engineers, Inc. By: Date: Name: Title: Page 1 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 Bradley Anderson Project Manager/Principal May 8, 2020 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: James Rose, Civil Engineer III REVIEWED: Date: Pat Johnston, Senior Buyer REQUISTION ENTERED BY: Date: ACCEPTANCE: Date: Matt Fater, Director, Civil Engineering ACCEPTANCE: Date: Andrew Gingerich, Interim Deputy Director, Water Engineering & Field Services ACCEPTANCE: Date: Theresa Connor, Interim 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: 7D810BDE-0340-4ECC-8979-633015F90092 Melissa Walker May 5, 2020 Coordinator, Finance May 5, 2020 May 6, 2020 May 12, 2020 May 8, 2020 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT A WORK ORDER SCOPE OF SERVICES Page 3 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 COFC2020.01_Castelrock Drive Sewer Improvements Project CM_SOW_04-29-2020 (002).docx April 28, 2020 Mr. James Rose Project Manager City of Fort Collins Utilities PO Box 580 Fort Collins, CO 80522-0580 Re: Scope of Work and Budget associated with Castlerock Drive Sanitary Service and Sewer Line Improvement Project Construction Services [ACE Project No. COFC2020.01B] Dear Jay: Enclosed is a copy of the Scope of Work and Budget proposed by Anderson Consulting Engineers, Inc. to provide pre-construction and construction management services associated with the Castlerock Drive Sanitary Service and Sewer Line Improvement Project. It is our understanding that construction of the project is anticipated to commence in July 2020 and conclude in October 2020, an assumed duration of 13 weeks. As indicated in the attached Scope of Work, we propose to complete the pre-construction and construction management services for a time-and-materials budget not to exceed $19,954. We appreciate the opportunity to continue to work with you on the construction phase of this project and look forward to discussing it with you following your review of the enclosed information. If you have any questions or comments concerning any aspect of this Scope of Work, Budget or Schedule, please do not hesitate to contact me. Sincerely, Bradley A. Anderson, P.E., CFM Vice President BAA/tlw Attachment A: Scope of Work Attachment B: Budget, ACE Fee Schedule Attachment C: Proposed Project Schedule Page 4 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 Attachment A. Scope of Work Page 1 of 3 April 28, 2020 COFC2020.01_Castelrock Drive Sewer Improvements Project CM_SOW_04-29-2020 (002).docx ATTACHMENT A. SCOPE OF WORK CASTLEROCK DRIVE SANITARY SERVICE AND PIPELINE IMPROVEMENT PROJECT PRE-CONSTRUCTION AND CONSTRUCTION MANAGEMENT SERVICES The purpose of this Scope of Work is to define the work effort by Anderson Consulting Engineers, Inc. (ACE) for pre-construction and construction management services associated with the Castlerock Drive Sanitary Service and Sewer Pipeline Improvement Project. Construction of the sanitary service and sewer pipeline improvements is expected to commence in July 2020 with an assumed maximum duration of approximately 13 weeks. As the consultant for this project, Anderson Consulting Engineers, Inc. (ACE) will provide the following construction management services: (a) pre-construction services, submittal review and responses to RFIs; (b) construction observation and inspection; (c) development of daily construction logs ; and (d) project close out and as-built construction drawings. This Scope of Work and associated Budget assumes that the construction contractor will obtain the services of a registered land surveyor to provide as-built survey information for critical project elements at no cost to ACE. In addition, it is also assumed that construction material testing (i.e., compaction, concrete, asphalt, etc.) will be obtained by the construction contractor or the City at no cost to ACE. Task 1. Pre-Construction Services, Submittal/Shop Drawing Review, Responses to RFIs This task includes time for the ACE to conduct the following: • Attend and participate in a pre-construction meeting with potential contractors; • Conduct pre-construction coordination with the City, Contractor, and third-party utility providers, as necessary; • Assist in the development of the Storm Water Management Plan (SWMP) and the procurement of pre-construction permits, as necessary; • Review and approve/reject Contractor submittals/shop drawings; • Maintain a submittal log; • Update the electronic project OneDrive site, as needed, with submittals/shop drawings and associated review comments/responses; and • Assist the City with the review and approval/rejection of contractor pay applications and change orders, as necessary. This task also includes time for ACE to internally prepare billing review reports/invoices and coordinate with City/contractor staff as needed. Page 5 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 Attachment A. Scope of Work Page 2 of 3 April 28, 2020 COFC2020.01_Castelrock Drive Sewer Improvements Project CM_SOW_04-29-2020 (002).docx Task 2. Construction Assistance/Resident Engineering Services Effort for this task involves providing resident engineering services during the construction phase of the project. For the purposes of this scope of work, construction is expected to commence on July 15th, 2020 and conclude October 15th, 2020 (a duration of approximately 13 weeks). Based on recent conversations with the City Project Manager, this task assumes that on-site construction observation/inspection services will be provided by ACE’s Project Engineer during the 13-week construction period of the project. The on-site services are intended to include the development of daily construction logs and documentation. Also included as part of this task is time for ACE’s Project Manager (Brian Smith) to conduct one site visit per week on an as-needed basis. Task 3. Project Close Out and Preparation of As-built Construction Drawings Following a determination of substantial completion of the project, ACE Staff will walk through the entire length of the project with representatives of the City of Fort Collins and the construction contractor. During this walk through a punch list will be prepared to document the additional work items that the contractor will need to address prior to the project being considered complete. The final construction drawings will be updated to reflect as-built information, as necessary. This task assumes that the construction contractor will obtain the services of a registered land surveyor to provide as-built survey information for critical project elements, that include, but are not limited to the following: • horizontal and vertical locations of new sanitary sewer services, and pipelines at junctions, manholes, and other critical locations; and • horizontal and vertical locations of utility services and third-party utilities crossing the new sanitary sewer pipelines. It is assumed that a pdf set of the draft as-built construction drawings will be distributed to the project team for review. Comments generated from the review will be incorporated into the final set of as-built construction drawings. It is further assumed that a total of two (2) full-sized (22” x 34”) paper, one (1) full-sized mylar, and five (5) half-sized (11” x 17”) paper final as-built construction sets will be provided to the City Staff for their use and distribution. Page 6 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 Utilities Work Order Form Official Purchasing Form Last updated 10/2017 ATTACHMENT B WORK ORDER COST DETAIL Page 7 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 Anderson Consulting Engineers, Inc. 2018 CITY OF FORT COLLINS FEE SCHEDULE Anderson Consulting Engineers, Inc. Civil • Water Resources • Environmental Labor Category Hourly Rate Senior Principal Engineer $190.00 Principal Engineer $180.00 Senior Project Manager $150.00 Project Manager $130.00 Senior Engineer/Scientist II $115.00 Senior Engineer I $105.00 Project Engineer II $99.00 Project Engineer I $90.00 Engineer $85.00 Senior GIS/CAD Technician $85.00 GIS/CAD Technician $80.00 Senior Project Assistant $74.00 Project Assistant $65.00 Other Directs Costs Airfare …..……........ @ cost In-house B&W Copies $0.10/copy Mileage ……..……… See Note below In-house Color Copies $1.00/copy Meals/Lodging ….. See Note below In-house B&W Plotter $5.00/plot In-house Color Plotter $10.00/plot Mileage and meals/lodging will be charged in accordance with Fort Collins Expense Guidelines (January 1, 2018). All other direct costs such as communications, equipment rental, materials, laboratory services, shipping and reproduction will be charged at cost. Page 8 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 ATTACHMENT B: BUDGET FOR THE CASTLEROCK DRIVE SANITARY SERVICE AND SEWER PIPELINE IMPROVEMENT PROJECT PRE-CONSTRUCTION AND CONSTRUCTION MANAGEMENT SERVICES PROJECT: Castlerock Drive Sanitary Service and Sewer PIpeline Project - CM Anderson Consulting Engineers, Inc. CLIENT: City of Fort Collins Utilities Direct Labor ODC's Totals Senior Project Project Project ACE PROJECT NO.: COFC2020.01B Principal Manager Engineer Assistant Other PREPARED BY: BAA Engineer I Direct DATE: 04/28/2020 $190/hr $130/hr $90/hr $74/hr Costs 190 130 90 74 Task/Description Hours Hours Hours Hours Cost Hours Cost 1. Pre-Construction Services, Submittal/Shop Drawing Review and Responses to RFIs 2 4 12 4 $150 22 $2,426 2. Construction Assistance/Resident Engineering Services 0 24 128 0 $200 152 $14,840 3. Project Close Out and Preparation of As-built Construction Drawings 2 6 12 2 $300 22 $2,688 TOTAL ACE PROJECT HOURS 4 34 152 6 196 TOTAL ACE BUDGET $760 $4,420 $13,680 $444 $650 $19,954 COFC2020.01B Castlerock Drive Sanitary Service and Sewer PIpeline Improvements Project CM Budget 04-29-2020.xlsx Page 9 of 10 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 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: 7D810BDE-0340-4ECC-8979-633015F90092 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/23/2020 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 be endorsed. If SUBROGATIONIS 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). PRODUCER USI INSURANCE SERVICES LLC/PHS 34343366 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251 CONTACT NAME: PHONE (A/C, No, Ext): (866) 467-8730 FAX (A/C, No): (888) 443-6112 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED ANDERSON CONSULTING ENGINEERS, INC. 375 E HORSETOOTH RD BLDG 5 FORT COLLINS CO 80525 INSURER A : Hartford Insurance Company of the Midwest 37478 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY) LIMITS COMMERCIAL GENERAL LIABILITY 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 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/23/2020 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 be endorsed. If SUBROGATIONIS 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). PRODUCER USI INSURANCE SERVICES LLC/PHS 34341438 The Hartford Business Service Center 3600 Wiseman Blvd San Antonio, TX 78251 CONTACT NAME: PHONE (A/C, No, Ext): (866) 467-8730 FAX (A/C, No): (888) 443-6112 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED ANDERSON CONSULTING ENGINEERS, INC. 375 E HORSETOOTH RD BLDG 5 FORT COLLINS CO 80525 INSURER A : Hartford Casualty Insurance Company 29424 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY) LIMITS A COMMERCIAL GENERAL LIABILITY X 34 SBW KC5665 12/28/2019 12/28/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 X General Liability MED EXP (Any one person) $10,000 ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC# : ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY USI INSURANCE SERVICES LLC/PHS NAMED INSURED ANDERSON CONSULTING ENGINEERS, INC. 375 E HORSETOOTH RD BLDG 5 FORT COLLINS CO 80525 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIC CODE EFFECTIVE DATE: SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE RE: RFP 8073 Engineering Services for Future Water, Wastewater & Stormwater facilities CIP. The City, its officers, agents and employees shall be named as additional insured per the Business Liability Coverage Form SS0008, and the Hired Auto and Non-Owned Auto Endorsement SS0438 attached to this Policy. Notice of cancellation will be provided in accordance with Form SS1223 attached to this policy. Notice of cancellation will be provided in accordance with Form WC990394 attached to this policy. DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 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 1/23/2020 Hall & Company 19660 10th Ave NE Poulsbo WA 98370 Jim Ledbetter 360-626-2019 360-598-3703 jledbetter@hallandcompany.com NAVIGATORS INSURANCE COMPANY 42307 739 Anderson Consulting Engineers Inc 375 E Horsetooth Rd, Bldg 5 Fort Collins CO 80525 687955225 A Professional Liab;Claims Made CM19DPL022684IV 2/11/2019 2/11/2020 Per Claim Aggregate $2,000,000 $3,000,000 Additional Insured Status is not available on Professional Liability Policy. Project: RFP 8073 Engineering Services for Future Water, Wastewater & Stormwater Facilities CIP City of Fort Collins PO Box 580 Fort Collins CO 80522-0580 DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PRO- JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY X 34 SBW KC5665 12/28/2019 12/28/2020 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS- MADE 34 SBW KC5665 12/28/2019 12/28/2020 EACH OCCURRENCE $8,000,000 AGGREGATE $8,000,000 DED X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT A EMPLOYMENT PRACTICES LIABILITY 34 SBW KC5665 12/28/2019 12/28/2020 Each Claim Limit Aggregate Limit $5,000 $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Please see Additional Remarks Schedule Acord Form 101 attached. CERTIFICATE HOLDER CANCELLATION City of Fort Collins PO BOX 580 FORT COLLINS CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS- MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A 34 WEG KD0066 01/01/2020 01/01/2021 X PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Notice of cancellation will be provided in accordance with Form WC990394 attached to this policy. CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 7D810BDE-0340-4ECC-8979-633015F90092