Loading...
HomeMy WebLinkAboutCORRESPONDENCE - RFP - 7671 BENEFITS - LIFE, DISABILITY & FAMILY MEDICAL LEAVE ADMINISTRATION (3)December 22, 2015 Denver Voya Employee Benefits Attn: Todd Tyson Todd.Tyson@Voya.com 8055 East Tufts Ave, Suite 650 Denver, CO 80237 RE: Renewal, 7671 Benefits - Life, Disability & Family Medial Leave Administration Dear Mr. Tyson: 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. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance certificate naming the City as an additional insured for General and Automotive Liability within the next fifteen (15) 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 Jill Wilson, Buyer at (970) 221-6216 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew 7671 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: D506DE83-BB6A-4DC4-B02B-2E332231533C 3/9/2016 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Carrier: Illinois National Insurance Company� � Carrier: New Hampshire Insurance Company � � 2 2 Carrier: New Hampshire Insurance Company � Policy No. WC020765111 (NJ, PA)� Atlanta Carrier: New Hampshire Insurance Company � Policy No. WC020765110 (IL, KY,NC,NH,UT)� � Effective Date: 05/30/2015 - 05/30/2016� �� �� � Workers Compensation Continued:� Certificate of Liability Insurance �� J01525 Effective Date: 05/30/2015 - 05/30/2016� Policy No. WC020765108 (FL) � Effective Date: 05/30/2015 - 05/30/2016� Effective Date: 05/30/2015 - 05/30/2016� Policy No. WC020765112 (MA, ND, OH, WA, WI,WY) � � *MARSH USA, INC.� 230 Park Avenue� Voya Financial, Inc.� New York, NY 10169 � 25 � DocuSign Envelope ID: D506DE83-BB6A-4DC4-B02B-2E332231533C PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. B 2,000,000 05/30/2016 GL1721754 Ronald A. Santaniello X WC020765107 (CA) ATL-003938861-01 X 1,000,000 5,000,000 WC020765109 (AZ) X 19445 5,000,000 of Marsh USA Inc. ATLANTA, GA 30326 N 05/30/2015 X COMP/COLL $1,000 DED 2,000,000 Contractual Liab. Coverage 05/30/2015 05/30/2016 C 05/30/2016 CA3940556 (AOS) A 5,000,000 2,000,000 X *WC Continued on Attached* 23809 National Union Fire Insurance Co. of Pittsburgh, PA 1,000,000 X X 12/29/2015 05/30/2015 05/30/2015 City of Fort Collins is included as additional insured on the above general liability policy and auto liability policy, where required by written contract but only with respect to liability arising out of the operations of the named insured. Host Liquor is included X 05/30/2015 Fort Collins, CO 80524-4402 City of Fort Collins 10,000 X B B Granite State Insurance Co J01525-Voya-AMER-15-16 5,000 05/30/2016 2,000,000 BE11237337 05/30/2016 A CA3940557 (MA) 23841 250,000 1,000,000 X WC020765106 (AOS) TWO ALLIANCE CENTER *MARSH USA, INC. X 3560 LENOX ROAD, SUITE 2400 230 Park Avenue Voya Financial, Inc. New York, NY 10169 X X 05/30/2015 215 N. Mason St. FI 2 05/30/2015 A 05/30/2016 05/30/2016 New Hampshire Insurance Company DocuSign Envelope ID: D506DE83-BB6A-4DC4-B02B-2E332231533C