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HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - INSTITUTE FOR MARKET TRANSFORMATIONMarch 1, 2018 Institute for Market Transformation Attn: Cliff Majersik 1707 L St. NW, Suite 1050 Washington DC 20036 RE: Contract Renewal, Institute for Market Transformation Dear Mr. Majersik: 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, 2018 through December 31, 2018. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of your 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 me at (970) 221-6779 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew this agreement 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: EE81BA02-23C1-4A5A-AE8E-FF24DBFF3D75 3/20/2018 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSTFOR-07 STACEYREID 1 1 1 Institute for Market Transformation, Inc. 1707 L Street NW, Suite 1050 Washington, DC 20036 NFP Property & Casualty Services, Inc. SEE PAGE 1 SEE PAGE 1 SEE P 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance Additional Info General Liability Amendment - Aggregate Limits of Insurance (Per Location) CG 25 04 05 09 Additional Insured - Owners, Lessees or Contractors CG 20 10 04 13 Additional Insured - State or Political Subdivisions - Permits CG 20 12 04 13 Additional Insured - Mortgagee, Assignee or Receiver CG 20 18 04 13 Additional Insured - Charitable Institutions CG 20 20 11 85 Additional Insured - Volunteers CG 20 21 07 98 Additional Insured - Designated Person or Organization CG 20 26 04 13 **(Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy.) Additional Insured - Lessor of Leased Equipment - Automatic Status - Lease CG 20 34 04 13 Additional Insured - Owners, Lessees or Contractors - Completed Operations CG 20 37 04 13 Additional Insured - Primary and Non-Contributory Endorsement for Public Entities ANI-RRG-E61 02 17 Additional Insured - Managers or Lessors of Premises ANI-RRG-E67 08 17 Additional Insured - Designated Person or Organization (FOOD CONTRIBUTIONS OR CLIENT REFERRALS) ANI-RRG-E25 12 15 (Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy, in consideration of food contributions or client referrals you receive from them.) Waiver of Transfer of Rights of Recovery Against Others ANI-RRG-E26 04 17 Automobile Waiver of Transfer of Rights of Recovery Against Others to us (Waiver of Subrogation) CA 04 44 10 13 Comp Deductible - $0 Collision Deductibke - $100 Workers Compensation Blanket Waiver of Subrogation (except in a few states) DocuSign Envelope ID: EE81BA02-23C1-4A5A-AE8E-FF24DBFF3D75 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. 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 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 3/20/2018 (301) 581-7323 (301) 214-7001 10023 Institute for Market Transformation, Inc. 1707 L Street NW, Suite 1050 Washington, DC 20036 00914 297000 10833 A 1,000,000 X 2017-06578 11/24/2017 11/24/2018 500,000 20,000 1,000,000 2,000,000 2,000,000 A 1,000,000 X 2017-06578 11/24/2017 11/24/2018 A 5,000,000 2017-06578-UMB 11/24/2017 11/24/2018 5,000,000 B 16WBCZT7312 11/24/2017 11/24/2018 1,000,000 1,000,000 1,000,000 C Property CWB0015522-01 - 06578 11/24/2017 BPP 57,900 D E&O/Prof Liab VPPL010848 12/23/2017 12/23/2018 $2M/$2M When required by written contract and subject to the terms and conditions of the policy: The certificate holder is included as an Additional Insured with respect to General Liability and Automobile Liability. City of Fort Collins; Financial Services Purchasing Division 215 N. Mason Street, 2nd Floor Fort Collins, CO 80522 INSTFOR-07 STACEYREID NFP Property & Casualty Services, Inc. 707 Westchester Avenue Suite 201 White Plains, NY 10604 Stacey Reid stacey.reid@nfp.com Alliance of Nonprofits for Insurance RRG Hartford - Rated Multiple Companies North American Elite Insurance Company Gemini Insurance Company 10,000 X 11/24/2018 X X X X X X X DocuSign Envelope ID: EE81BA02-23C1-4A5A-AE8E-FF24DBFF3D75