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HomeMy WebLinkAboutBID - 8480 HAULING SERVICES 2017BID 8480 Hauling Services 2017 Page 1 of 15 INVITATION TO BID 8480 HAULING SERVICES 2017 BID OPENING: 3:00 P.M. (our clock), MARCH 10, 2017 The City of Fort Collins is requesting bids from firms for hauling services. Sealed bids will be received and publicly opened at the office of the Director of Purchasing and Risk Management, PO Box 580, 215 North Mason St., 2nd floor, Fort Collins, Colorado 80522, at the time and date noted on the bid proposal and/or contract documents. If delivered, they are to be sent to 215 North Mason Street, 2nd Floor, Fort Collins, Colorado 80524. If mailed, the address is P.O. Box 580, Fort Collins, 80522-0580. Bids must be received at the Purchasing Office prior to 3:00 p.m. (our clock), March 10, 2017. The City encourages all disadvantaged business enterprises to submit bid in response to all invitations to bid. No individual or business will be discriminated against on the grounds of race, color, sex, or national origin. It is the City’s policy to create a level playing field on which DBEs can compete fairly and to ensure nondiscrimination in the award and administration of all contracts. Questions concerning the scope of the bid should be directed to Project Manager, Bennett Ashbaugh at (425) 241-3697 or bashbaugh@fcgov.com. Questions regarding bid submittal or process should be directed to Elliot Dale, Buyer, at (970) 221-6777 or edale@fcgov.com. All questions must be submitted in writing via email to Bennett Ashbaugh , with a copy to Elliot Dale, no later than 5:00 PM our clock on March 1, 2017. Questions received after this deadline will not be answered. A copy of the Bid may be obtained at http://www.bidnetdirect.com/colorado/city-of-fort-collins. Special Instructions All bids must be properly signed by an authorized representative of the company with the legal capacity to bind the company to the agreement. Bids may be withdrawn up to the date and hour set for closing. Once bids have been accepted by the City and closing has occurred, failure to enter into contract or honor the purchase order will be cause for removal of supplier's name from the City of Fort Collins' bidders list for a period of twelve months from the date of the opening. The City may also pursue any remedies available at law or in equity. Bid prices must be held firm for a period of forty-five (45) days after bid openings. Submission of a bid is deemed as acceptance of all terms, conditions and specifications contained in the City's specifications initially provided to the bidder. Any proposed modification must be accepted in writing by the City prior to award of the bid. Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov.com/purchasing BID 8480 Hauling Services 2017 Page 2 of 15 Only bids properly received by the Purchasing Office will be accepted. All bids should be clearly identified by the bid number and bid name contained in the bid proposal. No proposal will be accepted from, or any purchase order awarded, to any person, firm or corporation in default on any obligation to the City. Bids must be furnished exclusive of any federal excise tax, wherever applicable. Bidders must be properly licensed and secure necessary permits wherever applicable. The City may elect where applicable, to award bids on an individual item/group basis or on a total bid basis, whichever is most beneficial to the City. The City reserves the right to accept or reject any and all bids, and to waive any irregularities or informalities. Sales prohibited/conflict of interest: no officer, employee, or member of City Council, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies or services where such officer or employee exercises directly or indirectly any decision- making authority concerning such sale or any supervisory authority over the services to be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity, favor, entertainment, kickback or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Freight terms: unless otherwise noted, all freight is F.O.B. Destination, Freight Prepaid. All freight charges must be included in prices submitted on proposal. Discounts: any discounts allowed for prompt payment, etc., must be reflected in bid figures and not entered as separate pricing on the proposal form. Purchasing restrictions: your authorized signature of this bid assures your firm's compliance with the City's purchasing restrictions. A copy of the resolutions is available for review in the Purchasing Office or the City Clerk's Office. Request Resolution 91-121 for cement restrictions. Collusive or sham bids: any bid deemed to be collusive or a sham bid will be rejected and reported to authorities as such. Your authorized signature of this bid assures that such bid is genuine and is not a collusive or sham bid. Bid results are posted online at http://www.bidnetdirect.com/colorado/city-of-fort-collins. Gerry Paul Purchasing Director BID 8480 Hauling Services 2017 Page 3 of 15 CITY OF FORT COLLINS BID PROPOSAL BID #8480 Hauling Services 2017 BID OPENING: March 10, 2017, 3:00 p.m. (our clock) WE HEREBY ENTER OUR BID FOR THE CITY OF FORT COLLINS' REQUIREMENTS FOR 8480 HAULING SERVICES 2017 PER THE BID INVITATION AND ANY REFERENCED SPECIFICATIONS: ATTENTION: SPECIAL INSTRUCTIONS The following must be provided in the bid submittal package: 1) Completed Bid Schedule (This will become Exhibit “B” in your Services Agreement). You must completely fill out the contact information portion. 2) Insurance certificate (meeting the requirements set forth in Exhibit “C” of the Services Agreement) naming the City of Fort Collins as an additional insured for General Liability and Automobile. 3) Evidence of workman’s compensation insurance as required by Exhibit “C” (if more than one truck & driver are being listed by contractor). If there is only one driver and driver is the owner of the business, workman’s compensation insurance is not required. Instead vendor must sign and submit Exhibit “D” – Certificate of Exemption from Statuatory Worker’s Compensation Law. 4) Copy of alcohol and controlled substances testing program for each driver. 5) Copy of CDL Driver’s license for each driver. 6) Signed and dated Services Agreement (attached). All required fields are highlighted in yellow. Failure to submit any of the above will result in your bid being considered non- responsive and you will be ineligible for the April 2017-April 2018 hauling season. All responsive and responsible bidders will be emailed a copy of their fully executed Service Agreement. BID 8480 Hauling Services 2017 Page 4 of 15 EXHIBIT A SCOPE OF WORK 1. Service Provider must be able to provide the equipment bid and a qualified driver Sunday through Saturday at any time, within one hour of being called by the City Representative or designated Truck Boss. Phone contact with a company representative, qualified to dispatch equipment, must be available at all times. The City Representative will try to schedule night/weekend work in advance, if possible. Vendor must own all trucks. 2. The equipment and the driver shall be used primarily to haul asphalt from various asphalt plants to the job site as directed by the City Representative. Material from the job site may also be hauled to various other job sites, or dump sites located around the City, as directed by the City Representative. Other City departments may use this bid for hauling. Equipment and drivers shall report in at the time and location, as directed by the City Representative, mechanically sound and fully prepared to work a full day. 3. All Drivers must have a valid CDL license, and be qualified to operate the equipment. Any driver (contractor) who operates a commercial motor vehicle, as defined in §382.107, in intrastate or interstate commerce and is subject to the commercial driver’s license requirement of 49 CFR part 383 must be included in an alcohol and controlled substances testing program under the Federal Highway Administration’s rule. Documentation of proof must be submitted with this bid. 4. Drivers must be mentally and physically alert, and capable of maintaining safe control of their vehicle at all times. Drivers must be properly dressed for work in the construction environment. a. Hard Hats – ANSI approved, must be worn all times when outside a vehicle or equipment. b. Eye Protection – ANSI Approved, must be worn when drivers are exposed to machines, equipment, or operations that present a potential eye injury. c. Footwear, suitable footwear that fits and provides adequate protection from hazards present at the construction site must be worn at all times. d. Safety Vests – ANSI Class II must be worn at all times on the job site or public right- of-way. Night work will require a Class III Safety Vest. e. No Animals / pets are allowed on facilities or job sites. 5. All drivers must attend a pre-construction meeting to review the scope of work. 6. All equipment must comply with all DOT, CDL, and any other local/State/Federal requirements including able to clear Port of Entry, Portable Scales, and possess current inspection stickers. Trucks must be equipped with an effective load covering tarp, asphalt apron (asphalt lip), and backup alarms. The City of Fort Collins reserves the right to remove any truck from a jobsite that has equipment maintenance issues such as bald tires, leaks, and/or any issue which takes the equipment out of DOT compliance. Repeat issues of non-compliance will result in a one (1) year suspension and/or contract termination. BID 8480 Hauling Services 2017 Page 5 of 15 7. All work shall be done in a professional, SAFE, courteous and efficient manner. The driver shall exercise the utmost courtesy to other drivers, the City, and the public including foul language on the job and during radio communications. 8. Drivers must use appropriate sanitary facilities as provided by the City on each job site or facility. 9. The City shall not be responsible for any equipment failures, damage to equipment, or maintenance required on the equipment. The vendor is responsible for all fuel required. 10. The City has adopted a “Limitation on Engine Idling” to discourage the idling of vehicle engines. Contractor must comply with turning off vehicles instead of idling for long periods (more than three minutes, as a general rule). The City also desires that contractors run biodiesel in their trucks. 11. Any damage caused by the vendor's equipment or driver shall be the sole responsibility of the vendor. The vendor shall indemnify and hold harmless the City for any damage done by the vendor's equipment/driver to any member of the public, private property, and any part of the right-of-way. . 12. At no time whatsoever shall the driver be considered or become a City employee. However the driver must understand that their actions reflect upon the City. 13. The City will not guarantee hours. Vendors will be used on an as-needed basis, depending on job site, availability and type of equipment. The City reserves right to choose which truck or tractor/trailer is utilized on each project that meets the best interests of the City. 14. In the event a vendor chooses to pull off a City project to work for another company or contractor, the City reserves the right to utilize other vendors in their place for the duration of the project at the City Representative’s discretion. Also, a Vendor may not return until the start of the next job. Exceptions will be at the City Representative’s discretion which may include mechanical breakdowns, illnesses, etc. 15. Hours worked must be approved at the end of each day by the City Representative. Hours will be counted from the time of arrival on the job site (not from the time of notification), and will end after the last load is unloaded. In the event, that a project is cancelled for the day and the City Representative is unable to provide a one hour cancellation notice the Vendor shall be paid one hour show up time. 16. The City shall have the option to proceed with calling the next available vendor if the lowest cost vendor is not available and/or cannot commit to support the project duration. In case of a tie based on the hourly rates quoted, the City Representative will alternate calling the tied vendors. Vendors who want to work for the City, but were not included in the original bid, will be added to the end of the list, regardless of price, upon submission of all required documentation and subsequent approval by the City. When special conditions arise, the City shall have the option to choose the vendor to fit any special equipment needs. 17. This is a one (1) year agreement. At the option of the City, the Agreement may be extended for additional one year periods not to exceed four (4) additional one year periods. Pricing shall be firm for the initial year. Price changes may be proposed only at the time of the annual renewal and shall be subject to negotiation. In no event will price changes exceed BID 8480 Hauling Services 2017 Page 6 of 15 the Denver - Boulder CPI-U as published by the Colorado State Planning and Budget Office. Written notice of renewal shall be provided to the Service Provider and mailed no later than 30 days prior to contract end. 18. The City will award to all responsive and responsible bidders. However, the City intends to prioritize and utilize vendors based on price, availability, responsiveness, and equipment. 19. All drivers must provide Workman’s Compensation insurance in accordance with Exhibit “C” of the Services Agreement, unless you own and drive your own truck. Owners who do not sub-lease their trucks must provide a completed workman’s compensation waiver (Exhibit “D”). Owner must immediately notify the City of any changes to this status. 20. If changes, the owners who sub-lease a truck must provide a drivers name with copy of CDL driver’s license, insurance including liability/workman’s compensation and proof of alcohol and controlled substances testing program under the Federal Highway Administration’s rule. It is the owner’s responsibility to immediately send any changes in driver’s, to the City Purchasing department, and include the required above documentation. Non- compliance will result in a one (1) year suspension and/or contract termination. 21. The City of Fort Collins has adopted a new Dust Prevention and Control Manual: http://www.fcgov.com/purchasing/pdf/dust_prevention_control_manual.pdf. All operations conducted under this Agreement shall be performed in accordance with the stated procedures and requirements.” 22. The City reserves the right to discipline companies for violations of these rules. The first violation will result in a written warning. Any subsequent violation will result in, depending on the violation, suspension and/or contract termination. BID 8480 Hauling Services 2017 Page 7 of 15 EXHIBIT B BID SCHEDULE - 8480 Hauling Services 2017 You may attach a separate page with an equipment list -- Please include Contractor name on it. EQUIPMENT YR MAKE MODEL CU. YDS. HP $/HR. TRACTOR/TRL TRUCKS with trailer $ $ $ $ TANDEM DUMP TRUCKS $ $ $ $ $ $ $ TANDEM DUMP TRUCKS W/PUP $ $ TYPES OF TRAILERS (for example: End, Belly, Bottom) Not paid for separately - included with Tractor/Trailer Failure to provide said equipment with qualified drivers as listed in the bid submitted will result in contract termination and possible exclusion of the vendor from bidding on City hauling services for a minimum of 3 years. FIRM NAME Are you a Corporation, Partnership, DBA, LLC, or PC SIGNATURE PRINT NAME ADDRESS PHONE CELL PHONE EMAIL BID 8480 Hauling Services 2017 Page 8 of 15 SERVICES AGREEMENT 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 , 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. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of three (3) pages and incorporated herein by this reference. Irrespective of references in Exhibit A to certain named third parties, Service Provider shall be solely responsible for performance of all duties hereunder. 2. Contract Period. This Agreement shall commence April 1, 2017, and shall continue in full force and effect until March 31, 2018, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed four (4) additional one year periods. Renewals and pricing changes shall be negotiated by and agreed to by both parties. Written notice of renewal shall be provided to the Service Provider and mailed no later than thirty (30) days prior to contract end. 3. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its 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. 4. Early Termination by City/Notice. 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 delivered 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 addresses: Service Provider: Copy to: Attn: City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 BID 8480 Hauling Services 2017 Page 9 of 15 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, 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. 5. Contract Sum. The City shall pay the Service Provider for the performance of this Contract, subject to additions and deletions provided herein, in accordance with the attached Exhibit "B", consisting of one (1) page, and incorporated herein by this reference. 6. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 7. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 8. 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. 9. 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. 10. 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 or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. 11. Warranty. a. Service Provider warrants that all work performed hereunder shall be performed with BID 8480 Hauling Services 2017 Page 10 of 15 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 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. 12. 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. 13. 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. 14. 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 representatives, successors and assigns of said parties. 15. 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 BID 8480 Hauling Services 2017 Page 11 of 15 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 C, 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 Purchasing Director, 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. 16. 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. 17. Law/Severability. The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement. 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. 18. 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 BID 8480 Hauling Services 2017 Page 12 of 15 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. 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. THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul Purchasing Director DATE: COMPANY NAME By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: BID 8480 Hauling Services 2017 Page 13 of 15 EXHIBIT C 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. BID 8480 Hauling Services 2017 Page 14 of 15 SAMPLE CERTIFICATE OF INSURANCE The City of Fort Collins PO Box 582 Fort Collins, CO 80522 BID 8480 Hauling Services 2017 Page 15 of 15 EXHIBIT D CERTIFICATE OF EXEMPTION FROM STATUTORY WORKERS’ COMPENSATION LAW AND ACKNOWLEDGEMENT OF RISK/HOLD HARMLESS AGREEMENT I, _________________________________ , as an owner / member / partner / stockholder (circle one) in ______________________________________ (insert business name), a Sole Proprietorship / Limited Liability Company / Partnership / Corporation (circle one), with a principal address of , certify to the City of Fort Collins, Colorado (the “City”) that the aforementioned business has no employees as defined by the Workers’ Compensation Act of Colorado, C.R.S. §§ 8-40-101, et seq., (the “Act”) other than those owners, members, partners, directors or other principals that have elected to be exempt from Workers’ Compensation coverage in accordance with Colorado law. On behalf of said business and its officers, agents, insurers, heirs, legal representatives, successors and assigns (collectively the “Business”), I warrant that I have full authority to execute this Exhibit on behalf of the Business. I warrant I understand the requirements of the Act with respect to providing Workers’ Compensation coverage for any employees of the Business. If the Business’s status changes in such a manner that requires Workers’ Compensation Insurance, the Business shall provide the City with a Certificate of Insurance evidencing proof of Workers’ Compensation Insurance coverage and Employer’s Liability Insurance coverage as required by the Agreement. The Business shall provide such Certificate of Insurance prior to the employees’ start of work for the City. On behalf of the Business, I acknowledge the Business may be contracting to engage in activities that involve a risk of personal injury, that the Business is capable of performing the activities, and that the Business shall take all necessary precautions to prevent injury. The Business does hereby waive, release and forever discharge and hold harmless the City, its officers, employees, agents and insurers from any and all liability, damages, claims, causes of action and demands with respect to any bodily injury, personal injury, illness, or death that may result from the performance of the Agreement, either in law or equity, whether caused by the negligence or breach of contract of the City its officers, employees, agents and insurers or otherwise. The Business also understands that the City, its officers, employees, agents and insurers do not assume any responsibility for, or obligation to, provide the Business with financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of any bodily injury, personal injury, illness or death The Business agrees to defend, indemnify, and hold harmless the City from any and all such claims. As an independent contractor, the Business acknowledges that neither the Business nor any person employed by or serving the Business is entitled to workers’ compensation benefits from the City. The Business hereby waives any rights or claims to workers’ compensation benefits from the City, and agrees to indemnify and hold the City harmless against any claims for such benefits by any officer, director, owner, employee, or servant of the Business or any other person claiming through the Business. By signing this Certificate, the Business acknowledges that it is responsible and liable for all work-related injuries, and further requests the City waive its requirement for evidence of Workers’ Compensation Insurance. BUSINESS: By: Printed: Title: Date: