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HomeMy WebLinkAbout569118 SCOTT TECHNOLOGIES DBA SCOTT SAFETY - CONTRACT - BID - 8270 SCBA EQUIPMENT SERVICINGAmendment #01 for 8270 Page 1 of 2 First Amendment to the Services Agreement between The City of Fort Collins and Scott Technologies Inc. dba Scott Safety This First Amendment to the Service Agreement (the “Second Amendment”) is entered into by and between Scott Technologies Inc. dba Scott Safety (the “Service Provider”) and the City of Fort Collins, Colorado (the “City”). WHEREAS, the Service Provider and the City previously entered into a Services Agreement dated June 1, 2016 (the “Agreement”); and WHEREAS, the City desires to expand the original Scope of Services to add additional work herein; and WHEREAS, the parties agree to amend the Contract Sum for the expanded Scope of Services and additional work; and WHEREAS, Service Provider agrees to perform additional work herein; NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises herein contained, the parties agree as follows: 1. The City of Fort Collins wishes to extend the term of the Agreement as amended for one (1) additional year, January 1, 2017 through December 31, 2017. To complete the renewal, attach a current copy of insurance naming the City as an additional insured for General and Automotive Liability within the next fifteen days. 2. The parties hereby amend the Agreement, Exhibit “A”- Scope of Services, to replace the section titled “Equipment/Personnel requiring servicing in 2016” with the following: Equipment/Personnel requiring servicing in 2017: QTY Description 150 Scott SCBA w/o regulator- annual testing and repair as needed 450 Cylinders and valve assemblies for hydro testing and valve repair as required by DOT. Note: all cylinders purchased new in 2016 250 Personnel for annual fit testing (PFA personnel plus select other government personnel as determined by PFA) 185 Facepieces for testing and repair as required 200 Regulator– annual testing 5 Quarterly compressor air quality tests and maintenance 3. The City hereby modifies and replaces Article 5 of the Agreement as follows: Contract Sum. PFA shall pay the Service Provider annually for the performance of this Contract, subject to additions and deletions provided herein, ninety eight thousand dollars ($98,000). PFA shall pay the Service Provider in monthly payment installments proportionate to the total annual cost. DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F Amendment #01 for 8270 Page 2 of 2 Except as expressly amended by this First Amendment, all other terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties have executed this First Amendment the day and year shown. THE CITY OF FORT COLLINS, COLORADO By: _________________________________ Gerry Paul Director of Purchasing Date: ______________________________ ATTEST: _________________________________ City Clerk APPROVED AS TO FORM: _______________________________ Assistant City Attorney SCOTT TECHNOLOGIES INC. DBA SCOTT SAFETY By: __________________________________ Trent Smith VP- Americas Sales and Service Date: _______________________________ DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F 1/30/2017 insurance 2/6/2017 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 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 AUTOS AUTOS NON-OWNED HIRED AUTOS ALL OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 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 AGENCY NAMED INSURED EFFECTIVE DATE: THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RiskWorks® rm.Certificates® Marsh USA Inc. FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT: Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States Business Process Automation for Risk Management, Insurance, and Trade Finance Gay Clontz (Email: gclontz@tycoint.com Phone: 704-291-8304) To learn what EXIGIS can do for your business visit exigis.com or call 800.928.1963 WORKERS COMPENSATION: Workers Compensation "AOS" Policy includes coverage for the following states: AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, & WV. PRIMARY COVERAGE: The General Liability and Automobile Liability policies are primary and not excess of or contributing with other insurance or self-insurance, where required by written lease or written contract. For General Liability, this applies to both ongoing and completed operations. WAIVER OF SUBROGATION: The General Liability, Automobile Liability, Workers Compensation and Employers Liability policies include a waiver of subrogation in favor of the certificate holder and any other person or organization to the extent required by written contract. For Monitoring services, Waiver of Subrogation does not apply. ADDITIONAL INSURED – AUTOMOBILE LIABILITY: The Automobile Liability policy, if required by written contract, includes coverage for Additional Insureds as required by such written contract. ADDITIONAL INSURED – GENERAL LIABILITY: For General Liability, if required by written contract, the following are included as additional insureds, as required pursuant to a written contract with a named insured, per attached Policy Endorsements A2 and A2A: THE CERTIFICATE HOLDER LISTED ON THIS CERTIFICATE OF LIABILITY INSURANCE, AND EACH OTHER PERSON OR ORGANIZATION REQUIRED TO BE INCLUDED AS AN ADDITIONAL INSURED PURSUANT TO A WRITTEN CONTRACT WITH THE NAMED INSURED. LIMIT OF LIABILITY: The Liability Limit that applies is the amount indicated on the face of this Certificate of Liability Insurance, or the minimum Liability limit that is required by the written contract, whichever is less. If there is no contract then the Liability Limit is limited to $1,000,000. LIMIT OF UMBRELLA/EXCESS LIABILITY: If the primary insurance policies noted on the face of this Certificate of Liability Insurance satisfy the combination of minimum primary limits and minimum Umbrella/Excess Liability limits required by the written contract, the Umbrella/Excess Liability limits shown on the face of this Certificate of Liability Insurance do not apply. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: This endorsement modifies the notice of cancellation of insurance provided hereunder: Should any of the above described policies be cancelled, other than for non-payment, before the expiration date thereof, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. Additional Insureds:officers, agents and employees and PFA (Poudre Fire Authority) AGENCY CUSTOMER ID: LOC #: Page 2 of 2 NAIC POLICY NUMBER CARRIER 25 CERTIFICATE OF LIABILITY INSURANCE ----------------------------------------------------------------------------------------------------------------------------------------------- G L 2 8 9 0 0 1 1 0 1 2 I L 1 0 ( 1 2 / 0 6 ) O L D R E P U B L I C I N S U R A N C E C O M P A N Y A D D I T I O N A L I N S U R E D - O W N E R S , L E S S E E S O R C O N T R A C T O R S - S C H E D U L E D P E R S O N O R O R G A N I Z A T I O N - E N D O R S E M E N T A 2 N a m e d I n s u r e d E n d o r s e m e n t N u m b e r P o l i c y P r e f i x P o l i c y N u m b e r P o l i c y P e r i o d E f f e c t i v e D a t e o f E n d o r s e m e n t I s s u e d B y T H I S E N D O R S E M E N T C H A N G E S T H E P O L I C Y . P L E A S E R E A D I T C A R E F U L L Y . T h i s e n d o r s e m e n t m o d i f i e s i n s u r a n c e p r o v i d e d u n d e r t h e f o l l o w i n g : C O M M E R C I A L G E N E R A L L I A B I L I T Y C O V E R A G E P A R T S C H E D U L E N a m e O f A d d i t i o n a l I n s u r e d P e r s o n ( s ) O r O r g a n i z a t i o n ( s ) : L o c a t i o n ( s ) O f C o v e r e d O p e r a t i o n s : I n f o r m a t i o n r e q u i r e d t o c o m p l e t e t h i s S c h e d u l e , i f n o t s h o w n a b o v e , w i l l b e s h o w n i n t h e D e c l a r a t i o n s . A . S e c t i o n I I - W h o i s A n I n s u r e d i s a m e n d e d t o i n c l u d e a s a n a d d i t i o n a l i n s u r e d t h e p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) s h o w n i n t h e S c h e d u l e , b u t o n l y w i t h r e s p e c t t o l i a b i l i t y f o r " b o d i l y i n j u r y " , " p r o p e r t y d a m a g e " o r " p e r s o n a l a n d a d v e r t i s i n g i n j u r y " c a u s e d s o l e l y b y : 1 . Y o u r a c t s o r o m i s s i o n s ; o r 2 . T h e a c t s o r o m i s s i o n s o f t h o s e a c t i n g o n y o u r b e h a l f ; i n t h e p e r f o r m a n c e o f y o u r o n g o i n g o p e r a t i o n s f o r t h e a d d i t i o n a l i n s u r e d ( s ) a t t h e l o c a t i o n ( s ) d e s i g n a t e d a b o v e . B . W i t h r e s p e c t t o t h e i n s u r a n c e a f f o r d e d t o t h e s e a d d i t i o n a l i n s u r e d s , t h e f o l l o w i n g a d d i t i o n a l e x c l u s i o n s a p p l y : T h i s i n s u r a n c e d o e s n o t a p p l y t o " b o d i l y i n j u r y " o r " p r o p e r t y d a m a g e " o c c u r r i n g a f t e r : 1 . A l l w o r k , i n c l u d i n g m a t e r i a l s , p a r t s o r e q u i p m e n t f u r n i s h e d i n c o n n e c t i o n w i t h s u c h w o r k , o n t h e p r o j e c t ( o t h e r t h a n s e r v i c e , m a i n t e n a n c e o r r e p a i r s ) t o b e p e r f o r m e d b y o r o n b e h a l f o f t h e a d d i t i o n a l i n s u r e d ( s ) a t t h e l o c a t i o n o f t h e c o v e r e d o p e r a t i o n s h a s b e e n c o m p l e t e d ; o r 2 . T h a t p o r t i o n o f " y o u r w o r k " o u t o f w h i c h t h e i n j u r y o r d a m a g e a r i s e s h a s b e e n p u t t o i t s i n t e n d e d u s e b y a n y p e r s o n o r o r g a n i z a t i o n o t h e r t h a n a n o t h e r c o n t r a c t o r o r s u b c o n t r a c t o r e n g a g e d i n p e r f o r m i n g o p e r a t i o n s f o r a p r i n c i p a l a s a p a r t o f t h e s a m e p r o j e c t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ocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F G L 2 8 9 0 0 2 1 0 1 2 I L 1 0 ( 1 2 / 0 6 ) O L D R E P U B L I C I N S U R A N C E C O M P A N Y A D D I T I O N A L I N S U R E D - O W N E R S , L E S S E E S O R C O N T R A C T O R S - C O M P L E T E D O P E R A T I O N S - E N D O R S E M E N T A 2 A N a m e d I n s u r e d E n d o r s e m e n t N u m b e r P o l i c y P r e f i x P o l i c y N u m b e r P o l i c y P e r i o d E f f e c t i v e D a t e o f E n d o r s e m e n t I s s u e d B y T H I S E N D O R S E M E N T C H A N G E S T H E P O L I C Y . P L E A S E R E A D I T C A R E F U L L Y . T h i s e n d o r s e m e n t m o d i f i e s i n s u r a n c e p r o v i d e d u n d e r t h e f o l l o w i n g : C O M M E R C I A L G E N E R A L L I A B I L I T Y C O V E R A G E P A R T S C H E D U L E N a m e O f A d d i t i o n a l I n s u r e d P e r s o n ( s ) O r O r g a n i z a t i o n ( s ) : L o c a t i o n A n d D e s c r i p t i o n O f C o m p l e t e d O p e r a t i o n s : I n f o r m a t i o n r e q u i r e d t o c o m p l e t e t h i s S c h e d u l e , i f n o t s h o w n a b o v e , w i l l b e s h o w n i n t h e D e c l a r a t i o n s . S e c t i o n I I - W h o I s A n I n s u r e d i s a m e n d e d t o i n c l u d e a s a n a d d i t i o n a l i n s u r e d t h e p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) s h o w n i n t h e S c h e d u l e , b u t o n l y w i t h r e s p e c t t o l i a b i l i t y f o r " b o d i l y i n j u r y " o r " p r o p e r t y d a m a g e " c a u s e d s o l e l y b y " y o u r w o r k " a t t h e l o c a t i o n d e s i g n a t e d a n d d e s c r i b e d i n t h e S c h e d u l e o f t h i s e n d o r s e m e n t p e r f o r m e d f o r t h a t a d d i t i o n a l i n s u r e d a n d i n c l u d e d i n t h e " p r o d u c t s - c o m p l e t e d o p e r a t i o n s h a z a r d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ocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F 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 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 AUTOS AUTOS NON-OWNED HIRED AUTOS ALL OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 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 AGENCY NAMED INSURED EFFECTIVE DATE: THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RiskWorks® rm.Certificates® Marsh USA Inc. FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT: Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States Business Process Automation for Risk Management, Insurance, and Trade Finance Gay Clontz (Email: gclontz@tycoint.com Phone: 704-291-8304) To learn what EXIGIS can do for your business visit exigis.com or call 800.928.1963 WORKERS COMPENSATION: Workers Compensation "AOS" Policy includes coverage for the following states: AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, & WV. PRIMARY COVERAGE: The General Liability and Automobile Liability policies are primary and not excess of or contributing with other insurance or self-insurance, where required by written lease or written contract. For General Liability, this applies to both ongoing and completed operations. WAIVER OF SUBROGATION: The General Liability, Automobile Liability, Workers Compensation and Employers Liability policies include a waiver of subrogation in favor of the certificate holder and any other person or organization to the extent required by written contract. For Monitoring services, Waiver of Subrogation does not apply. ADDITIONAL INSURED – AUTOMOBILE LIABILITY: The Automobile Liability policy, if required by written contract, includes coverage for Additional Insureds as required by such written contract. ADDITIONAL INSURED – GENERAL LIABILITY: For General Liability, if required by written contract, the following are included as additional insureds, as required pursuant to a written contract with a named insured, per attached Policy Endorsements A2 and A2A: THE CERTIFICATE HOLDER LISTED ON THIS CERTIFICATE OF LIABILITY INSURANCE, AND EACH OTHER PERSON OR ORGANIZATION REQUIRED TO BE INCLUDED AS AN ADDITIONAL INSURED PURSUANT TO A WRITTEN CONTRACT WITH THE NAMED INSURED. LIMIT OF LIABILITY: The Liability Limit that applies is the amount indicated on the face of this Certificate of Liability Insurance, or the minimum Liability limit that is required by the written contract, whichever is less. If there is no contract then the Liability Limit is limited to $1,000,000. LIMIT OF UMBRELLA/EXCESS LIABILITY: If the primary insurance policies noted on the face of this Certificate of Liability Insurance satisfy the combination of minimum primary limits and minimum Umbrella/Excess Liability limits required by the written contract, the Umbrella/Excess Liability limits shown on the face of this Certificate of Liability Insurance do not apply. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: This endorsement modifies the notice of cancellation of insurance provided hereunder: Should any of the above described policies be cancelled, other than for non-payment, before the expiration date thereof, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. Additional Insureds:City of Fort Collins officers, agents, employees and PFA (Poudre Fire Authority) AGENCY CUSTOMER ID: LOC #: Page 2 of 2 NAIC POLICY NUMBER CARRIER 25 CERTIFICATE OF LIABILITY INSURANCE ----------------------------------------------------------------------------------------------------------------------------------------------- G L 2 8 9 0 0 1 1 0 1 2 I L 1 0 ( 1 2 / 0 6 ) O L D R E P U B L I C I N S U R A N C E C O M P A N Y A D D I T I O N A L I N S U R E D - O W N E R S , L E S S E E S O R C O N T R A C T O R S - S C H E D U L E D P E R S O N O R O R G A N I Z A T I O N - E N D O R S E M E N T A 2 N a m e d I n s u r e d E n d o r s e m e n t N u m b e r P o l i c y P r e f i x P o l i c y N u m b e r P o l i c y P e r i o d E f f e c t i v e D a t e o f E n d o r s e m e n t I s s u e d B y T H I S E N D O R S E M E N T C H A N G E S T H E P O L I C Y . P L E A S E R E A D I T C A R E F U L L Y . T h i s e n d o r s e m e n t m o d i f i e s i n s u r a n c e p r o v i d e d u n d e r t h e f o l l o w i n g : C O M M E R C I A L G E N E R A L L I A B I L I T Y C O V E R A G E P A R T S C H E D U L E N a m e O f A d d i t i o n a l I n s u r e d P e r s o n ( s ) O r O r g a n i z a t i o n ( s ) : L o c a t i o n ( s ) O f C o v e r e d O p e r a t i o n s : I n f o r m a t i o n r e q u i r e d t o c o m p l e t e t h i s S c h e d u l e , i f n o t s h o w n a b o v e , w i l l b e s h o w n i n t h e D e c l a r a t i o n s . A . S e c t i o n I I - W h o i s A n I n s u r e d i s a m e n d e d t o i n c l u d e a s a n a d d i t i o n a l i n s u r e d t h e p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) s h o w n i n t h e S c h e d u l e , b u t o n l y w i t h r e s p e c t t o l i a b i l i t y f o r " b o d i l y i n j u r y " , " p r o p e r t y d a m a g e " o r " p e r s o n a l a n d a d v e r t i s i n g i n j u r y " c a u s e d s o l e l y b y : 1 . Y o u r a c t s o r o m i s s i o n s ; o r 2 . T h e a c t s o r o m i s s i o n s o f t h o s e a c t i n g o n y o u r b e h a l f ; i n t h e p e r f o r m a n c e o f y o u r o n g o i n g o p e r a t i o n s f o r t h e a d d i t i o n a l i n s u r e d ( s ) a t t h e l o c a t i o n ( s ) d e s i g n a t e d a b o v e . B . W i t h r e s p e c t t o t h e i n s u r a n c e a f f o r d e d t o t h e s e a d d i t i o n a l i n s u r e d s , t h e f o l l o w i n g a d d i t i o n a l e x c l u s i o n s a p p l y : T h i s i n s u r a n c e d o e s n o t a p p l y t o " b o d i l y i n j u r y " o r " p r o p e r t y d a m a g e " o c c u r r i n g a f t e r : 1 . A l l w o r k , i n c l u d i n g m a t e r i a l s , p a r t s o r e q u i p m e n t f u r n i s h e d i n c o n n e c t i o n w i t h s u c h w o r k , o n t h e p r o j e c t ( o t h e r t h a n s e r v i c e , m a i n t e n a n c e o r r e p a i r s ) t o b e p e r f o r m e d b y o r o n b e h a l f o f t h e a d d i t i o n a l i n s u r e d ( s ) a t t h e l o c a t i o n o f t h e c o v e r e d o p e r a t i o n s h a s b e e n c o m p l e t e d ; o r 2 . T h a t p o r t i o n o f " y o u r w o r k " o u t o f w h i c h t h e i n j u r y o r d a m a g e a r i s e s h a s b e e n p u t t o i t s i n t e n d e d u s e b y a n y p e r s o n o r o r g a n i z a t i o n o t h e r t h a n a n o t h e r c o n t r a c t o r o r s u b c o n t r a c t o r e n g a g e d i n p e r f o r m i n g o p e r a t i o n s f o r a p r i n c i p a l a s a p a r t o f t h e s a m e p r o j e c t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ocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F G L 2 8 9 0 0 2 1 0 1 2 I L 1 0 ( 1 2 / 0 6 ) O L D R E P U B L I C I N S U R A N C E C O M P A N Y A D D I T I O N A L I N S U R E D - O W N E R S , L E S S E E S O R C O N T R A C T O R S - C O M P L E T E D O P E R A T I O N S - E N D O R S E M E N T A 2 A N a m e d I n s u r e d E n d o r s e m e n t N u m b e r P o l i c y P r e f i x P o l i c y N u m b e r P o l i c y P e r i o d E f f e c t i v e D a t e o f E n d o r s e m e n t I s s u e d B y T H I S E N D O R S E M E N T C H A N G E S T H E P O L I C Y . P L E A S E R E A D I T C A R E F U L L Y . T h i s e n d o r s e m e n t m o d i f i e s i n s u r a n c e p r o v i d e d u n d e r t h e f o l l o w i n g : C O M M E R C I A L G E N E R A L L I A B I L I T Y C O V E R A G E P A R T S C H E D U L E N a m e O f A d d i t i o n a l I n s u r e d P e r s o n ( s ) O r O r g a n i z a t i o n ( s ) : L o c a t i o n A n d D e s c r i p t i o n O f C o m p l e t e d O p e r a t i o n s : I n f o r m a t i o n r e q u i r e d t o c o m p l e t e t h i s S c h e d u l e , i f n o t s h o w n a b o v e , w i l l b e s h o w n i n t h e D e c l a r a t i o n s . S e c t i o n I I - W h o I s A n I n s u r e d i s a m e n d e d t o i n c l u d e a s a n a d d i t i o n a l i n s u r e d t h e p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) s h o w n i n t h e S c h e d u l e , b u t o n l y w i t h r e s p e c t t o l i a b i l i t y f o r " b o d i l y i n j u r y " o r " p r o p e r t y d a m a g e " c a u s e d s o l e l y b y " y o u r w o r k " a t t h e l o c a t i o n d e s i g n a t e d a n d d e s c r i b e d i n t h e S c h e d u l e o f t h i s e n d o r s e m e n t p e r f o r m e d f o r t h a t a d d i t i o n a l i n s u r e d a n d i n c l u d e d i n t h e " p r o d u c t s - c o m p l e t e d o p e r a t i o n s h a z a r d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ocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F C A 2 8 9 0 0 2 1 0 1 6 P a g e 1 o f 1 I n c l u d e s c o p y r i g h t e d m a t e r i a l o f I n s u r a n c e S e r v i c e s O f f i c e , I n c . , w i t h i t s p e r m i s s i o n . I L 1 0 ( 1 2 / 0 6 ) O L D R E P U B L I C I N S U R A N C E C O M P A N Y T H I S E N D O R S E M E N T C H A N G E S T H E P O L I C Y . P L E A S E R E A D I T C A R E F U L L Y . A D D I T I O N A L I N S U R E D - A U T O M A T I C S T A T U S W H E N R E Q U I R E D B Y C O N T R A C T O R A G R E E M E N T T h i s e n d o r s e m e n t m o d i f i e s i n s u r a n c e p r o v i d e d u n d e r t h e f o l l o w i n g : B U S I N E S S A U T O C O V E R A G E F O R M A . S E C T I O N I I - C O V E R E D A U T O S L I A B I L I T Y C O V E R A G E , A . C o v e r a g e , 1 . W h o I s A n I n s u r e d , i s a m e n d e d t o i n c l u d e a s a n a d d i t i o n a l i n s u r e d a n y p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) f o r w h o m y o u a r e p e r f o r m i n g o p e r a t i o n s w h e n y o u a n d s u c h p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) h a v e a g r e e d i n a c o n t r a c t o r a n y o t h e r a g r e e m e n t t h a t s u c h p e r s o n ( s ) o r o r g a n i z a t i o n ( s ) b e a d d e d a s a d d i t i o n a l i n s u r e d o n y o u r p o l i c y . T h e s t a t u s o f a n a d d i t i o n a l i n s u r e d u n d e r t h i s e n d o r s e m e n t e n d s w h e n y o u r o p e r a t i o n s f o r t h a t a d d i t i o n a l i n s u r e d a r e c o m p l e t e d . B. T h e m o s t w e w i l l p a y o n b e h a l f o f t h e a d d i t i o n a l i n s u r e d d e s c r i b e d i n P a r a g r a p h A . a b o v e i s t h e l e s s e r o f t h e a m o u n t p a y a b l e u n d e r S E C T I O N I I - C O V E R E D A U T O S L I A B I L I T Y C O V E R A G E , C . L i m i t s o f I n s u r a n c e o r t h e a m o u n t o f i n s u r a n c e r e q u i r e d b y t h e c o n t r a c t o r a g r e e m e n t . C . N o t w i t h s t a n d i n g a n y r e q u i r e m e n t , t e r m o r c o n d i t i o n o f a n y c o n t r a c t o r a g r e e m e n t w i t h r e s p e c t t o w h i c h t h i s e n d o r s e m e n t m a y p e r t a i n , t h e i n s u r a n c e a f f o r d e d t o t h e a d d i t i o n a l i n s u r e d i s s u b j e c t t o a l l t h e t e r m s , e x c l u s i o n s a n d c o n d i t i o n s o f t h e C o m m e r c i a l A u t o C o v e r a g e F o r m t o w h i c h t h i s e n d o r s e m e n t i s a t t a c h e d . 1 ; 8 &                  . S L R W S R  ' S R X V S P W   - R G                                   DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD $10,000,000 Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States ACE Property and Casualty Insurance Company 10/1/2016 10/1/2016 20699 INC IN GEN AGG MWC 308342 00 (AOS – See pg 2) MWXS 308343 (OH & WA) X $5,000,000 $5,000,000 A A 10/1/2016 10/1/2016 X MWZY 308341 B X A Project: City of Fort Collins, CO (Service Agrmt) Please refer to attached ACORD 101 for further remarks. Please see bottom of Acord 101 $7,250,000 X Contractual Liability X $5,000,000 $250,000 X A A $5,000,000 Marsh USA Inc. 411 E. Wisconsin Avenue Suite 1300 Milwaukee, WI 53202 10/1/2017 10/1/2017 City of Fort Collins Attn: Purchasing Dept P. O. Box 580 215 North Mason Street Fort Collins, Colorado 80524 United States XCU Included X 10/1/2016 10/1/2016 $5,000,000 NEW HAMPSHIRE (CSL) 2/3/2017 24147 10/1/2017 10/1/2017 MARSH USA INC, BY: Kathleen E. Theisen X Old Republic Insurance Company $30,000,000 X $10,000,000 G28162509 001 MWZX 308372 (NH) X 1674842 - A 10/1/2017 10/1/2017 MWTB 308344 (Excludes NH) MWTB 308371 (NH) $50,000 N $10,000,000 10/1/2017 X A X $7,500,000 10/1/2016 NEW HAMPSHIRE (CSL) DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD $10,000,000 Scott Technologies of DE, Inc., DBA Scott Safety 4320 Goldmine Road Monroe, NC 28110 United States ACE Property and Casualty Insurance Company 10/1/2016 10/1/2016 20699 INC IN GEN AGG MWC 308342 00 (AOS – See pg 2) MWXS 308343 (OH & WA) X $5,000,000 $5,000,000 A A 10/1/2016 10/1/2016 X MWZY 308341 B X A Project: City of Fort Collins, CO (Service Agrmt) Please refer to attached ACORD 101 for further remarks. Please see bottom of Acord 101 $7,250,000 X Contractual Liability X $5,000,000 $250,000 X A A $5,000,000 Marsh USA Inc. 411 E. Wisconsin Avenue Suite 1300 Milwaukee, WI 53202 10/1/2017 10/1/2017 City of Fort Collins Attn: Purchasing Dept P. O. Box 580 215 North Mason Street Fort Collins, Colorado 80524 United States XCU Included X 10/1/2016 10/1/2016 $5,000,000 NEW HAMPSHIRE (CSL) 10/2/2016 24147 10/1/2017 10/1/2017 MARSH USA INC, BY: Kathleen E. Theisen X Old Republic Insurance Company $30,000,000 X $10,000,000 G28162509 001 MWZX 308372 (NH) X 1587003 - A 10/1/2017 10/1/2017 MWTB 308344 (Excludes NH) MWTB 308371 (NH) $50,000 N $10,000,000 10/1/2017 X A X $7,500,000 10/1/2016 NEW HAMPSHIRE (CSL) DocuSign Envelope ID: C95BA33F-D259-4B10-858A-D678F18D7E9F