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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - NORTH RANGE BEHAVIORAL HEALTH (10)February 10, 2016 North Range Behavioral Health Attn: Larry Pottorff larry.pottorff@northrange.org 1300 North 17th Avenue Greeley, CO 80631 RE: Renewal, North Range Behavioral Health Substance Abuse Professional Services Agreement Dear Mr. Pottorff: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: 1) The term will be extended for one (1) additional year, January 1, 2016 through December 31, 2016. 2) The City of Fort Collins agrees to pay Ninety Seven Thousand Nine Hundred Sixty-Six Dollars ($97,966.00) for the 2016 renewal term. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance naming the City as an additional insured on General Liability and Automobile within the next fifteen days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non-renewal. Please contact Doug Clapp, CPPB, Senior Buyer at (970) 221-6776 if you have any questions regarding this matter. Sincerely, Gerry Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew this agreement by signing this letter and returning it to Purchasing Division within the next fifteen days.) GSP: jg Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing DocuSign Envelope ID: 19A9E4DC-780D-46BB-9820-9869582A7B3C 2/23/2016 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 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 Michael J Schmitt CIC NORTH12 OP ID: AL 02/09/2016 Michael J Schmitt CIC Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC 970-356-8030 970-356-8032 Philadelphia Insurance Co 23850 North Range Behavioral Health Pinnacol Assurance 1300 N 17th Avenue Greeley, CO 80631 Lloyds of London AX 1,000,000 X X PHPK1356673 07/01/2015 07/01/2016 1,000,000 X Professional Liab 20,000 X HIPAA Incl 1,000,000 3,000,000 X 3,000,000 Emp Ben. 1,000,000 1,000,000 AX X PHPK1356673 07/01/2015 07/01/2016 X X 2,000,000 A PHUB504760 07/01/2015 07/01/2016 2,000,000 X 10,000 X B 4044331 07/01/2015 07/01/2016 100,000 100,000 500,000 C Privacy UCS2669550.15 07/01/2015 07/01/2016 Each 1,000,000 Aggregate 1,000,000 The City of Fort Collins is listed as additional insured as pertains to the general and auto liability policies, per written contract. CITYFTC City of Fort Collins-Financial Services Purchasing Division 215 N Mason St. --2nd Floor PO Box 580 Fort Collins, CO 80522 DocuSign Envelope ID: 19A9E4DC-780D-46BB-9820-9869582A7B3C