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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 7598 BACKFLOW PREVENTION PROGRAMFebruary 5, 2018
Backflow Solutions Inc
Attn: Christine Walsh
12609 S Laramie Ave
Alsip, IL 60803
RE: Renewal, 7598 Backflow Prevention Program
Dear Ms. Walsh:
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, April 28, 2018 through
April 27, 2019.
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 Pat Johnson, CPPB, Senior Buyer at (970) 221-6816 if you have any
questions regarding this matter.
Sincerely,
Gerry S. Paul
Director of Purchasing
__________________________________________ _________________
Signature Date
(Please indicate your desire to renew 7598 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: 7293BB1A-80FD-41E2-A860-A69F4AC27BA4
2/7/2018
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 have ADDITIONAL INSURED provisions or 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 ONLY
AUTOS ONLY AUTOS
NON-OWNED
OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
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 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
$
$
1900 E Golf Rd, Suite 650
DSP Insurance Services
Cert ID 22504
PO Box 580
Admiral Insurance Company 24856
Continental Insurance Co. 35289
Continental Casualty Company 20443
Valley Forge Insurance 20508
Technology Insurance Company, In 42376
12/27/2017
12609 S. Laramie Ave.
Y
6016191796 1/1/2018 1/1/2019
B
Prof/Poll Liability
N
1/1/2018 1/1/2019
Y
6016191801
D
C
E
A
X
X
X
X
J Stephen Pohl
Schaumburg IL 60173
Fort Collins CO 80522
Alsip IL 60803
(847) 934-6100
(708) 389-5600
(847) 934-6186
X
X X
X
X
X
1,000,000
500,000
1,000,000
1,000,000
1,000,000
5,000,000
5,000,000
15,000
2,000,000
Contractural Liab
6016191751 1/1/2018 1/1/2019
TWC3455016 1/1/2018 1/1/2019
1,000,000
1,000,000
2,000,000
2,000,000
The City of Fort Collins
215 N. Mason St, 2nd Floor
Additional insured on General Liability and Auto Liability when required by written contract: The
City of Fort Collins
Backflow Solutions, Inc.
Each Claim/
Aggregate
FEI-ECC-20920-02 1/1/2018 1/1/2019
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DocuSign Envelope ID: 7293BB1A-80FD-41E2-A860-A69F4AC27BA4