HomeMy WebLinkAboutCORRESPONDENCE - AGREEMENT MISC - SUSANNE DURKIN-SCHINDLERJuly 10, 2018
Susanne Durkin-Schindler
Attn: Susanne Durkin-Schindler
1737 Norwood Lane
Fort Collins, CO 80525
RE: Renewal, Facilitator for Energy Benchmarking, Scoring & Transparency Ordinance
Dear Ms. Durkin-Schindler:
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 two (2) additional years, August 15, 2018 through
August 14, 2020.
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 Marisa Donegon, Buyer at (970) 416-4377 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:kr
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: 6F765171-8C4B-4959-82B3-63DE8F082365
7/16/2018
EXHIBIT ___
CERTIFICATE OF EXEMPTION FROM VEHICLE LIABILITY INSURANCE
AND ACKNOWLEDGEMENT OF RISK/HOLD HARMLESS AGREEMENT
I, _________________________________ , as an owner / member / partner /
stockholder (check one) in ______________________________________ (insert business
name),
a Sole Proprietorship / Limited Liability Company / Partnership / Corporation (check
one), with a principal address of _________________________________________________
, certify to the City of Fort Collins, Colorado (the
“City”) that the aforementioned business will not utilize any motor vehicles in the course of
providing services to the City.
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 Certificate on behalf of the Business. I warrant the Business understands and
complies with the motor vehicle insurance requirements as required by law. If the nature of
the Business’s work for the City changes in such a manner that vehicles will be used in the
provision of services to the City, the Business shall provide the City with a Certificate of
Insurance evidencing proof of Vehicle Liability Insurance coverage in the amount of $1,000,000
with the City as a named additional insured. The Business shall provide such Certificate of
Insurance prior to utilization of any vehicles in the provision of services to the City.
On behalf of the Business, I acknowledge the Business shall maintain at all times vehicle
insurance in accordance with minimum requirements as required by law. 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, death, and property damage that arises
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.
By signing this Certificate, the Business acknowledges that it is responsible and liable for all
vehicle-related liabilities, and further requests the City waive its requirement of Vehicle Liability
Insurance.
BUSINESS:
By:
Printed:
Title:
DocuSign Envelope ID: 6F765171-8C4B-4959-82B3-63DE8F082365
1737 Norwood Lane Fort Collins, CO 80525
Susanne Durkin-Schindler
Susanne Durkin-Schindler
X
Susanne Durkin-Schindler
Susanne Durkin-Schindler
Owner
Date:
DocuSign Envelope ID: 6F765171-8C4B-4959-82B3-63DE8F082365
7/16/2018
EXHIBIT ___
CERTIFICATE OF EXEMPTION FROM STATUTORY WORKERS’ COMPENSATION LAW
AND ACKNOWLEDGEMENT OF RISK/HOLD HARMLESS AGREEMENT
I, _________________________________ , as an owner / member / partner /
stockholder (check one) in ______________________________________ (insert business
name), a Sole Proprietorship / Limited Liability Company / Partnership / Corporation
(check 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.
DocuSign Envelope ID: 6F765171-8C4B-4959-82B3-63DE8F082365
Susanne Durkin-Schindler
Susanne Durkin-Schindler
1737 Norwood Lane Fort Collins, CO 80525
X
BUSINESS:
By:
Printed:
Title:
Date:
DocuSign Envelope ID: 6F765171-8C4B-4959-82B3-63DE8F082365
Susanne Durkin-Schindler
Susanne Durkin-Schindler
7/16/2018
Owner
DocuSign Envelope ID: 6F765171-8C4B-4959-82B3-63DE8F082365