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101359 EVERGREEN TENNIS COURTS INC - CONTRACT - AGREEMENT MISC - EVERGREEN TENNIS COURTS INC
Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 1 of 14 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 EVERGREEN TENNIS COURTS INC. 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 for Miscellaneous Tennis Court Services. 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. 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 the Agreement, make changes within the general scope of the particular services assigned and the Service Provider agrees to perform such changed services. 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 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 November 1, 2015 and shall continue DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 2 of 14 in full force and effect until October 31, 2016, unless sooner terminated as herein provided. 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: Evergreen Tennis Courts Inc Attn: George Stahlin 2332 Fountain Drive Loveland, CO 80538 City of Fort Collins Attn: Jill Wuertz 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, with markups, stated within the Bid Schedule Proposal Form, attached hereto as Exhibit "B", consisting of two (2) pages, and incorporated herein by this reference. Payment shall be made by the City only 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 DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 3 of 14 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 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 DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 4 of 14 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 "D", 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 Director of Purchasing and Risk Management, 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. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 5 of 14 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 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. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 6 of 14 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. Performance Bond. For any Work Order greater than $100,000.00, Service Provider shall obtain 100% Performance Bonds in accordance with Exhibit “C”, consisting of two (2) pages, attached hereto and incorporated herein. Performance Bond shall be submitted along with Work Order form. 23. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit E - Confidentiality, consisting of one (1) page, attached hereto and incorporated herein by this reference. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 7 of 14 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul Purchasing Director DATE: ATTEST: City Clerk APPROVED AS TO FORM: Senior Assistant City Attorney EVERGREEN TENNIS COURTS INC By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA George Stahlin President 11/4/2015 11/10/2015 Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 8 of 14 EXHIBIT A WORK ORDER FORM PURSUANT TO AN AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND EVERGREEN TENNIS COURTS INC AGREEMENT DATED: November 1, 2015 Work Order Number: Purchase Order Number: Project Title: Commencement Date: 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 Services Agreement between the parties. In the event of a conflict between or ambiguity in the terms of the Services Agreement and this Work Order (including the attached forms) the Services Agreement shall control. The attached forms consisting of ___ (_) pages are hereby accepted and incorporated herein, by this reference, and Notice to Proceed is hereby given. SERVICE PROVIDER By:_______________________________ Date:_____________________________ CITY OF FORT COLLINS By:_________________________________ Project Manager Date: ______________________________ By: _______________________________ Gerry Paul Purchasing Director (over $60,000.00) Date: ____________________________ DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 9 of 14 EXHIBIT B COMPENSATION DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 10 of 14 DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 11 of 14 EXHIBIT C PERFORMANCE BOND Bond No. KNOW ALL MEN BY THESE PRESENTS: that Evergreen Tennis Courts, Inc 2332 Fountain Dr., Loveland, CO 80538 (an Individual), (a Partnership), (a Corporation), hereinafter referred to as the "Principal" and (Firm) (Address) hereinafter referred to as "the Surety", are held and firmly bound unto City of Fort Collins, 300 LaPorte Ave, Fort Collins, Colorado 80522 a (Municipal Corporation) hereinafter referred to as the "OWNER", in the penal sum of ($ ) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, successors and assigns, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION are such that whereas the Principal entered into a certain Agreement with the OWNER, dated the 1st day of November, 2015, a copy of which is hereto attached and made a part hereof, for the performance of The City of Fort Collins Work Order, titled , Work Order Number , dated the day of , , a copy of which is hereto attached and made a part hereof. NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the undertakings, covenants, terms, conditions and agreements of said Work Order and Agreement during the original term thereof, and any extensions thereof which may be granted by the OWNER, with or without Notice to the Surety and during the life of the guaranty period, and if the Principal shall satisfy all claims and demands incurred under such Work Order and Agreement, and shall fully indemnify and save harmless the OWNER from all cost and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all outlay and expense which the OWNER may incur in making good any default, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED, FURTHER, that the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Work Order and Agreement or to the Work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligation on this bond; and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Work Order and Agreement or to the Work or to the Specifications. PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. PROVIDED, FURTHER, that the Surety Company must be authorized to transact business in the State of Colorado and be acceptable to the OWNER. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 12 of 14 IN WITNESS WHEREOF, this instrument is executed in three (3) counterparts, each one of which shall be deemed an original, this _____ day of ___________, _____. IN PRESENCE OF: Principal (Title) (Title) (Corporate Seal) (Address) IN PRESENCE OF: Other Partners By: By: IN PRESENCE OF: Surety By: (Address) NOTE: Date of Bond must not be prior to date of Agreement. If CONTRACTOR is Partnership, all partners should execute Bond. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 13 of 14 EXHIBIT D 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: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA No new insurance required Service Agreement – Work Order Type Miscellaneous Tennis Court Services Page 14 of 14 EXHIBIT E 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: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 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). PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA IN 71 65 03 10 IN 71 65 03 10 Page 1 of 2 IMPORTANT INSURANCE INFORMATION Please read this Notice carefully. No coverage is provided by this notice nor can it be construed to replace any provision of your policy. You should read your policy and review your declarations page for complete information on the coverages you are provided. If there is any conflict between the policy and this notice, the provisions of the policy shall prevail. BUSINESS AUTO EXTENSION ENDORSEMENT FORM Our Business Auto Extension Endorsement Form has been included as a part of your policy. This endorsement serves three purposes: • Add coverages for which no premium charge is made • Combine multiple exclusions which are typically added with separate endorsement forms on a single form. These apply to special exposures where it is the industry position to never provide coverage for them on a Business Auto Policy. • Clarify policy language Here is a summary of the provisions included in the form with a comparison to the base coverage form CA0001. Category CA0001 Business Auto Coverage Form AC0102 Business Auto Extension Endorsement ADDED COVERAGES Changes for Trailers and Farm Equipment Liability coverage for trailers with a load capacity of 2,000 pounds or less. Liability coverage for trailers designed to be towed by a car, pickup, panel truck, or van if not used for business purposes, except farming or ranching, and for farm wagons or farm implements while being towed by a covered auto. Changes for Additional Newly Acquired Vehicles Symbol 7 provides coverage for newly acquired autos only if we cover all autos you own for that coverage or it replaces an auto you previously owned that had that coverage and you tell us within 30 days. Symbol 7 includes newly acquired autos if we already cover at least one auto you own for that coverage or it replaces an auto you previously owned that had that coverage and you tell us within 30 days after you acquire it. The most we will pay for Physical Damage Coverage is $100,000 per auto. Blanket Additional Insured While coverage is automatically provided by the coverage form, an endorsement needs to be added to include the name of the additional insured party. Any person or organization which you have agreed to name as an additional insured in a written contract other than a contract for the lease or rental of a vehicle is an "insured" for Liability Coverage. Accidental Airbag Discharge Coverage Not provided in CA0001. The mechanical breakdown exclusion does IN 71 65 03 10 Page 2 of 2 IN 71 65 03 10 Category CA0001 Business Auto Coverage Form AC0102 Business Auto Extension Endorsement Unintentional Failure to Disclose Hazards Coverage is void if you or any insured intentionally conceal or misrepresent a material fact at any time. Unintentional failure to disclose any hazards existing at the inception date of your policy we will not affect coverage. Autos Hired or Rented by Employees A separate endorsement is added to clarify that vehicles rented to employees are covered. Vehicles rented to employees are covered autos on this policy. Emergency Lockout – Private Passenger Vehicles Not addressed in CA0001 Coverage for up to $50 for reasonable expense incurred for the services of a locksmith to gain entry into your covered private passenger auto. CLARIFIED COVERAGES Expected or Intended Injury Exclusion Excludes bodily injury or property damage expected or intended from the standpoint of the insured. Clarification that coverage is excluded even if the resulting bodily injury or property damage is of a different kind, quality or degree than initially expected or intended; or is sustained by a different person, entity, real property, or personal property than that initially expected or intended. Motor Home Contents Coverage An exclusion endorsement should be added if coverage is not desired for motor home contents. Exclusion automatically applies unless Miscellaneous Personal Property Coverage endorsement AC0086 is added to the policy. Physical Damage Limit of Insurance Repair or replacement with other property of like kind or quality. Clarification that the cost of repairing or replacing may be based on an estimate which includes parts furnished by the original equipment manufacturer or other sources including non-original equipment manufacturers. IN 52 23 03 10 IN 52 23 03 10 Page 1 of 2 IMPORTANT INSURANCE INFORMATION Please read this Notice carefully. No coverage is provided by this notice nor can it be construed to replace any provision of your policy. You should read your policy and review your declarations page for complete information on the coverages you are provided. If there is any conflict between the policy and this notice, the provisions of the policy shall prevail. BUSINESS AUTO ADVANTAGE ENDORSEMENT • Our Business Auto Advantage Endorsement Form has been included as a part of your policy. This endorsement broadens your coverage in a number of areas. Here is a summary of the provisions included in the form with a comparison to the base coverage form CA0001 Category CA0001 Business Auto Coverage Form AC0101 Business Auto Advantage Endorsement Newly Acquired or Formed Entities No automatic coverage for new entities. Coverage for newly acquired or formed entities for 180 days or until the end of the policy period, whichever is later. Temporary Substitute Autos – Physical Damage Coverage for temporary substitutes provided for Liability. Coverage for temporary substitutes provided for both Liability and Physical Damage. Employees As Insureds An employee is not considered an insured while driving a vehicle he or she owns unless endorsement CA9933 is added to the policy which provides excess coverage. Equivalent coverage to CA9933 – employee provided excess coverage while driving a vehicle he or she owns. Supplementary Payments – Bail Bonds Up to $2,000 limit. Up to $2,500 limit. Supplementary Payments – Loss of Earnings Up to $250 per day. Up to $500 per day. Fellow Employee Coverage is excluded for bodily injury to a fellow employee. Fellow employee exclusion does not apply to an "insured" who occupies a position as an officer, manager, or supervisor. Personal Effects of Insured and Property of Others No coverage. Up to $250 of coverage for property of others in Care, Custody or Control. Up to $500 of coverage for your property that is lost or damaged as a result of a covered “loss”, with no deductible. IN 52 23 03 10 Page 2 of 2 IN 52 23 03 10 Category CA0001 Business Auto Coverage Form AC0101 Business Auto Advantage Endorsement Auto Loan or Lease Coverage For additional premium, coverage can be provided with endorsement AC2071. In the event of total loss which is covered under Comprehensive, Specified Causes of Loss, or Collision, we will also pay any unpaid amount due on the loan or lease plus additional miscellaneous expenses. Rental Reimbursement Coverage For additional premium, coverage can be provided by endorsement CA9923. For a vehicle which is covered for Physical Damage Coverage we will pay for rental reimbursement expenses with a limit of $75 per day for a maximum of 30 days unless coverage is provided by endorsement form CA9923. Extended Transportation Expense Coverage provided for up to $20 per day to a maximum of $600 for total theft of private passenger type autos if Comprehensive or Specified Causes of Loss are provided. Coverage provided for up to $50 per day to a maximum of $1,000 for total theft of private passenger type autos if Comprehensive or Specified Causes of Loss are provided. Extra Expense – Stolen Autos No coverage provided. Up to $5,000 for the expense of returning a stolen covered “auto” to you if Comprehensive or Specified Causes of Loss Coverage are provided. New Vehicle Replacement Cost Coverage is provided on an actual cash value basis. In the event of a total loss, replacement cost (no depreciation) applies to a private passenger type vehicle or a vehicle with a gross vehicle weight of 20,000 pounds or less which is less than one year old. Blanket Waiver of Subrogation No person or organization can do anything to impair our rights of subrogation after accident or loss. We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to an accident. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Hired Auto Physical Damage For an additional premium, coverage can be provided for leased or rented vehicles. Coverage is provided for leased, hired, rented or borrowed vehicles with no limit if hired auto Liability Coverage is provided. The deductible applied will be equal to the largest deductible applicable to any owned auto. Towing Coverage For additional premium, coverage can be provided for up to $50 for private passenger type autos. Coverage is provided for $100 for private passenger type and for $250 for other than private passenger type if vehicle has Comprehensive or Specified Causes of Loss Coverage and Collision Coverages. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA Physical Damage Limit of Insurance – Advertising Wraps Repair or replacement with other property of like kind or quality. Valuation of wraps is in addition to the value of the vehicle. Liberalization Applies to revisions that broaden coverage under the policy without additional premium during the policy period Applies to revisions that broaden coverage under the policy without additional premium within 60 days prior to or during the policy period COMBINED EXCLUSION OF COVERAGE FOR SPECIAL EXPOSURES Damage to Named Insured’s Property Not addressed Coverage is excluded for damage to another Named Insured's property. Abuse or Molestation Not addressed Exclusion of the actual or threatened abuse or molestation. Explosives An exclusion endorsement is added if the exposure to making, selling, or transporting explosives exists. Exclusion automatically applies without the need to add a separate endorsement. Rolling Stores (Products Exclusion) An exclusion endorsement is added if the insured sells products from vehicles. Exclusion automatically applies without the need to add a separate endorsement. Wrong Delivery of Liquid Products An exclusion endorsement is added if the insured delivers liquid products. Exclusion automatically applies without the need to add a separate endorsement. Professional Services An exclusion endorsement is added if the insured provides any medical or professional services. Exclusion automatically applies without the need to add a separate endorsement. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA not apply to the accidental discharge of an airbag. Glass Repair – Waiver of Deductible Not addressed in CA0001. No deductible applies if glass is repaired rather than replaced. Amended Duties in Event of Accident, Claim, Suit, or Loss (Notice of Occurrence) You must give us prompt notice of an accident or loss. The requirement that you must notify us of an accident, claim, suit, or loss applies only when it is known to a sole proprietor, partner, executive offer, member of a limited liability company or a designated individual. DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD EVERTEN-01 NROYBAL 11/3/2015 PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 (970) 635-9400 (970) 635-9401 info@mypfsinsurance.com Allied Insurance Group 19100 Evergreen Tennis Courts Inc George Stahlin 2332 Fountain Dr Loveland, CO 80538 Pinnacol Assurance Co 41190 A X 1,000,000 X ACPGLAO3016695720 07/01/2015 07/01/2016 100,000 X Blkt AI 5,000 X Blkt WOS 1,000,000 2,000,000 X 2,000,000 1,000,000 A ACPBA3016695720 07/01/2015 07/01/2016 X X X $500 Comp X X 1,000,000 A ACPCAA3016695720 07/01/2015 07/01/2016 1,000,000 X X B 4149372 07/01/2015 07/01/2016 1,000,000 1,000,000 1,000,000 A Property Section ACP3006695720 07/01/2015 07/01/2016 Ded 1,000 If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability and designated insured under automobile liability (except hired and non-owned automobile). City of Fort Collins Purchasing Department PO Box 580 Fort Collins, CO 80522 DocuSign Envelope ID: 2AEBD06F-449C-41F4-AD9B-ADB3673C3AAA