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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - EMERGENCY RESPONDER TRAUMA COUNSELORS LLCSeptember 21, 2016 Emergency Responder Trauma Counselors, LLC ATTN: Joanne S. Rupert 19 Old Town Square Fort Collins, CO 80524 RE: Renewal - Emergency Responder Trauma Counselors, LLC Services Agreement Dear Ms. Rupert: The City of Fort Collins wishes to extend the agreement term for the above captioned contract per the existing terms and conditions and the following: 1. The term will be extended from September 22, 2016 through December 31, 2016. If the renewal is acceptable to your firm, please sign this letter in the space provided and attach a current copy of insurance naming the City and PFA as an additional insured for Professional Liability within the next five 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 Paul Purchasing Director __________________________________________ ________________ Signature Date (Please indicate your desire to renew by signing this letter and attaching insurance within the next five 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: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF 9/21/2016 HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY COVERAGE PART ENDORSEMENT G-121486-B (07/2001) Page 1 of 1 Additional Insured – Person or Entity In consideration of the premium paid, and subject to the Professional Liability limit of liability shown on the certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below (the “additional insured”) is an insured under this Coverage Part but only as respects its liability for your medical incidents and solely to the extent that: 1. a professional liability claim is made against you and the additional insured; and 2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co- defendants. In no event is there any coverage provided under this policy for a medical incident that is the direct liability of the additional insured. The City of Fort Collins Director of Purchase Dept. P.O. Box 580 Fort Collins, CO 80522 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. 1 POLICY NO. 419073969 ISSUED TO Joanne Rupert ENDORSEMENT EFFECTIVE DATE 9/1/2016 MO 7/6/16 DocuSign Envelope ID: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY COVERAGE PART ENDORSEMENT G-121486-B (07/2001) Page 1 of 1 Additional Insured – Person or Entity In consideration of the premium paid, and subject to the Professional Liability limit of liability shown on the certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below (the “additional insured”) is an insured under this Coverage Part but only as respects its liability for your medical incidents and solely to the extent that: 1. a professional liability claim is made against you and the additional insured; and 2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co- defendants. In no event is there any coverage provided under this policy for a medical incident that is the direct liability of the additional insured. Poudre Fire Authority 102 Remington St Fort Collins, CO 80524 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. 2 POLICY NO. 419073969 ISSUED TO Joanne Rupert ENDORSEMENT EFFECTIVE DATE 9/1/2016 MO 7/6/16 DocuSign Envelope ID: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF DocuSign Envelope ID: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF DocuSign Envelope ID: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF DocuSign Envelope ID: 2DBA8F2B-7621-4C6B-B5E4-6002274622BF