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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8173 ACTUALRIAL VALUATION STUDY ANNUALAugust 20, 2018 Milliman Attn: Joel Stewart 1400 Wewatta Street, Suite 300 Denver, CO 0202-5549 RE: 8173 Actuarial Valuation Study Annual Dear Mr. Stewart: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions. The term will be extended for one (1) additional year, November 1, 2018 through October 31, 2019. If the renewal is acceptable to your firm, please sign this letter in the space provided, and attach a current copy of insurance naming the City as an additional insured for General Liability and Automobile within the next fifteen 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 Paul Purchasing Director __________________________________________ ________________ Signature Date (Please indicate your desire to renew 8173 by signing this letter and returning it to Purchasing Division within the next fifteen days.) GP: 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: FFC697D2-F7CF-476C-AB7F-51714CA213C8 8/24/2018 Holder Identifier : 7777777707070700077761616045571110767717016204447207442027772507300072640577046230130773415113563000307137150233631103075736734671377650727511467406661207764015170076570076727242035772000777777707000707007 7777777707070700073525677115456000722000516136113107023337243062010071322373531630010702222734306311007023327243172000071233363431720000712232634207311107022237352172011077756163351765540777777707000707007 Certificate No : 570072762329 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/24/2018 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. PRODUCER Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (312) 381-1000 INSURED INSURER A: National Fire Ins. Co. of Hartford 20478 INSURER B: Valley Forge Insurance Co 20508 INSURER C: The Continental Insurance Company 35289 INSURER D: American Casualty Co. of Reading PA 20427 INSURER E: INSURER F: FAX (A/C. No.): (312) 381-7007 CONTACT NAME: Milliman, Inc. 1301 Fifth Avenue Ste. 3800 Seattle WA 98101 USA COVERAGES CERTIFICATE NUMBER: 570072762329 REVISION NUMBER: 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. Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL TYPE OF INSURANCE INSD POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC CNA PARAMOUNT General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through K. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part; and (2) was executed prior to: (a) the bodily injury or property damage; or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A. through K. below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization’s liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization’s financial control of a Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner’s liability for bodily injury, property damage or personal and advertising injury as co-owner of such premises. C. Grantor of Franchise Any person or organization that has granted a franchise to a Named Insured, but only with respect to such person or organization’s liability for bodily injury, property damage or personal and advertising injury as grantor of a franchise to the Named Insured. D. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named Insured’s maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. CNA74879XX (1-15) Policy No: 6071865195 Page 2 of 13 Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 06/30/2018 Insured Name: MILLIMAN INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 CNA PARAMOUNT General Liability Extension Endorsement E. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. F. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor’s real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. G. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver’s liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured’s ownership, maintenance, or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. H. State or Governmental Agency or Subdivision or Political Subdivisions – Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such state or governmental agency or subdivision or political subdivision’s liability for bodily injury, property damage or personal and advertising injury arising out of: 1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured’s behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. Bodily injury or property damage included within the products-completed operations hazard. With respect to this provision’s requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. CNA74879XX (1-15) Policy No: 6071865195 Page 3 of 13 Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 06/30/2018 Insured Name: MILLIMAN INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 40020009560718651956087 DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 CNA PARAMOUNT General Liability Extension Endorsement I. Trade Show Event Lessor 1. With respect to a Named Insured’s participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization’s liability for bodily injury, property damage or personal and advertising injury caused by: a. the Named Insured’s acts or omissions; or b. the acts or omissions of those acting on the Named Insured’s behalf, in the performance of the Named Insured’s ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. J. Vendor Any person or organization but only with respect to such person or organization’s liability for bodily injury or property damage arising out of your products which are distributed or sold in the regular course of such person or organization’s business, provided that: 1. The coverage granted by this paragraph does not apply to: a. bodily injury or property damage for which such person or organization is obligated to pay damages by reason of the assumption of liability in a contract or agreement unless such liability exists in the absence of the contract or agreement; b. any express warranty unauthorized by the Named Insured; c. any physical or chemical change in any product made intentionally by such person or organization; d. repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. any failure to make any inspections, adjustments, tests or servicing that such person or organization has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. demonstration, installation, servicing or repair operations, except such operations performed at the such person or organization’s premises in connection with the sale of a product; g. products which, after distribution or sale by the Named Insured, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for such person or organization; or h. bodily injury or property damage arising out of the sole negligence of such person or organization for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) the exceptions contained in Subparagraphs d. or f. above; or (2) such inspections, adjustments, tests or servicing as such person or organization has agreed with the Named Insured to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This Paragraph J. does not apply to any insured person or organization, from whom the Named Insured has acquired such products, nor to any ingredient, part or container, entering into, accompanying or containing such products. CNA74879XX (1-15) Policy No: 6071865195 Page 4 of 13 Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 06/30/2018 Insured Name: MILLIMAN INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 CNA PARAMOUNT General Liability Extension Endorsement 3. This Paragraph J. also does not apply: a. to any vendor specifically scheduled as an additional insured by endorsement to this Coverage Part; b. to any of your products for which coverage is excluded by endorsement to this Coverage Part; nor c. if bodily injury or property damage included within the products-completed operations hazard is excluded by endorsement to this Coverage Part. K. Other Person Or Organization Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such additional insured is an Insured solely for bodily injury, property damage or personal and advertising injury for which such additional insured is liable because of the Named Insured’s acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: 1. for bodily injury, property damage, or personal and advertising injury arising out of the rendering or failure to render any professional service; 2. for bodily injury or property damage included within the products-completed operations hazard; nor 3. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part. 2. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED’S INSURANCE A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured’s own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured’s own insurance means insurance on which the additional insured is a named insured. B. With respect to persons or organizations that qualify as additional insureds pursuant to paragraph 1.K. of this endorsement, the following sentence is added to the paragraph above: Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization. 3. BODILY INJURY – EXPANDED DEFINITION Under DEFINITIONS the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer’s authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE CNA74879XX (1-15) Policy No: 6071865195 Page 5 of 13 Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 06/30/2018 Insured Name: MILLIMAN INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 40020009560718651956088 DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 SCA 23 500D (Ed. 10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT – BA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE 1. Which are no longer in force; or A. Who Is An Insured 2. Whose limits have been exhausted. The following is added to Section II, Paragraph A.1., B. Bail Bonds and Loss of Earnings Who Is An Insured: Section II, Paragraphs A.2.a.(2) and A.2.a.(4) are 1. a. Any incorporated entity of which the Named revised as follows: Insured owns a majority of the voting stock on 1. In a.(2), the limit for the cost of bail bonds is the date of inception of this Coverage Form; provided that increased from $2,000 to $5,000, and , 2. In a.(4), the limit for the loss of earnings is b. The insurance afforded by this provision A.1. does not apply to any such entity that is an increased from $250 to $500 a day. "insured" under any other liability "policy" C. Fellow Employee providing "auto" coverage. Section II, Paragraph B.5 does not apply. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or Such coverage as is afforded by this provision C. is joint venture, and over which you maintain excess over any other collectible insurance. majority ownership interest. II. PHYSICAL DAMAGE COVERAGE The insurance afforded by this provision A.2.: A. Towing a. Is effective on the acquisition or formation Section III. Paragraph A.2., is revised to include Light date, and is afforded only until the end of the Trucks up to 10,000 pounds G.V.W. policy period of this Coverage Form, or the next anniversary of its inception date, B. Glass Breakage – Hitting A Bird Or Animal – whichever is earlier. Falling Objects Or Missiles b. Does not apply to: The following is added to Section III, Paragraph A.3.: (1) "Bodily injury" or "property damage" With respect to any covered "auto," any deductible caused by an "accident" that occurred shown in the Declarations will not apply to glass before you acquired or formed the breakage if such glass is repaired, in a manner organization; or acceptable to us, rather than replaced. (2) Any such organization that is an "insured" C. Transportation Expenses under any other liability "policy" providing Section III, Paragraph A.4.a. is revised, with respect "auto" coverage. to transportation expense incurred by you, to provide: 3. Any person or organization that you are obligated a. $60 per day, in lieu of $20; subject to to provide Insurance where required by a written contract or agreement is an insured, but only with b. $1,800 maximum, in lieu of $600. respect to legal responsibility for acts or omissions D. Loss of Use Expenses of a person for whom Liability Coverage is afforded under this policy. Section III, Paragraph A.4.b. is revised, with respect to loss of use expenses incurred by you, to provide: 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a a. $1,000 maximum, in lieu of $600. contract or agreement in that "employee’s" name, with your permission, while performing duties E. Personal Property related to the conduct of your business. The following is added to Section III, Paragraph A.4. "Policy," as used in this provision A. Who Is An c. We will pay up to $500 for loss to Personal Insured, includes those policies that were in force on Property which is: the inception date of this Coverage Form but: (1) Owned by an "insured"; and SCA 23 500D Copyright, CNA Corporation, 2000. Page 1 of 3 (Ed. 10/11) Includes copyrighted material of the Insurance Services Office used with its permission. SCA 23 500D (Ed. 10/11) (2) In or on the covered "auto." your permission, while performing duties related to the conduct of your business. This coverage applies only in the event of a total theft of your covered "auto." c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, This insurance is excess over any other collectible cost of replacement or $75,000 whichever is insurance and no deductible applies. less minus a $500 deductible for each F. Rental Reimbursement covered auto. No deductible applies to "loss" caused by fire or lightning. The following is added to Section III, Paragraph A.4.: d. We will pay for rental reimbursement expenses d. The physical damage coverage as is provided incurred by you for the rental of an "auto" because by this provision will be limited to the types of of "loss" to a covered "auto." Payment applies in physical damage coverage(s) provided on addition to the otherwise applicable amount of your owned "autos." each coverage you have on a covered "auto." No deductibles apply to this coverage. e. Such physical damage coverage for hired "autos" will: 1. We will pay only for those expenses incurred during the policy period beginning 24 hours (1) Include loss of use, provided it is the after the "loss" and ending, regardless of the consequence of an "accident" for which policy’s expiration, with the lesser of the the Named Insured is legally liable, and following number of days: as a result of which a monetary loss is sustained by the leasing or rental (a) The number of days reasonably required concern. to repair or replace the covered "auto"; or, (2) Such coverage as is provided by this (b) 15 days. provision G.e.(1) will be subject to a limit 2. Our payment is limited to the lesser of the of $750 per "accident." following amounts: H. Airbag Coverage (a) Necessary and actual expenses incurred; The following is added to Section III, Paragraph B.3. or, The accidental discharge of an airbag shall not be (b) $25 per day subject to a maximum of considered mechanical breakdown. $375. I. Electronic Equipment 3. This coverage does not apply while there are spare or reserve "autos" available to you for Section III, Paragraphs B.4.c and B.4.d. are deleted your operations. and replaced by the following: 4. If "loss" results from the total theft of a c. Physical Damage Coverage on a covered covered "auto" of the private passenger type, "auto" also applies to "loss" to any we will pay under this coverage only that permanently installed electronic equipment amount of your rental reimbursement including its antennas and other accessories expenses which is not already provided for d. A $100 per occurrence deductible applies to under the Physical Damage Coverage the coverage provided by this provision. Extension. J. Diminution In Value G. Hired "Autos" The following is added to Section III, Paragraph B.6. The following is added to Section III. Paragraph A.: Subject to the following, the "diminution in value" 5. Hired "Autos" exclusion does not apply to: If Physical Damage coverage is provided under a. Any covered "auto" of the private passenger this policy, and such coverage does not extend to type you lease, hire, rent or borrow, without a Hired Autos, then Physical Damage coverage is driver for a period of 30 days or less, while extended to: performing duties related to the conduct of SCA 23 500D (Ed. 10/11) "employee’s" name, with your permission, Such "executive officers" are "insureds" while while performing duties related to the conduct using a covered "auto" described in this provision. of your business. IV. BUSINESS AUTO CONDITIONS c. Such coverage as is provided by this A. Duties In The Event Of Accident, Claim, Suit Or provision is limited to a "diminution in value" Loss loss arising directly out of accidental damage and not as a result of the failure to make The following is added to Section IV, Paragraph repairs; faulty or incomplete maintenance or A.2.a. repairs; or the installation of substandard parts. (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have d. The most we will pay for "loss" to a covered such knowledge, unless such "accident" or "auto" in any one accident is the lesser of: "loss" is known to you or if you are not an (1) individual, to any of your executive officers or $5,000; or partners or your insurance manager. (2) 20% of the "auto’s" actual cash value The following is added to Section IV, Paragraph (ACV) A.2.b. III. Drive Other Car Coverage – Executive Officers (6) Your "employees" may know of documents The following is added to Sections II and III: received concerning a claim or "suit." This will not mean that you have such knowledge, 1. Any "auto" you don’t own, hire or borrow is a unless receipt of such documents is known to covered "auto" for Liability Coverage while being you or if you are not an individual, to any of used by, and for Physical Damage Coverage your executive officers or partners or your while in the care, custody or control of, any of your insurance manager. "executive officers," except: B. Concealment, Misrepresentation or Fraud a. An "auto" owned by that "executive officer" or a member of that person’s household; or The following is added to Section IV, Paragraph B.2. b. An "auto" used by that "executive officer" while Your failure to disclose all hazards existing on the date working in a business of selling, servicing, of inception of this Coverage Form shall not prejudice repairing or parking "autos." you with respect to the coverage afforded provided such failure or omission is not intentional. Such Liability and/or Physical Damage Coverage as is afforded by this provision will be: C. Policy Period, Coverage Territory (1) Equal to the greatest of those coverages Section IV, Paragraph B.7.b.(5) is revised to provide: afforded any covered "auto"; and a. 45 days of coverage in lieu of 30 days (2) Excess over any other collectible V. DEFINITIONS insurance. Section V. Paragraph C. is deleted and replaced by 2. For purposes of this provision, "executive officer" means a person holding any of the officer the following: positions created by your charter, constitution, by- "Bodily injury" means bodily injury, sickness or disease laws or any other similar governing document, sustained by a person, including mental anguish, and, while a resident of the same household, mental injury or death resulting from any of these includes that person’s spouse. SCA 23 500D Copyright, CNA Corporation, 2000. Page 3 of 3 (Ed. 10/11) Includes copyrighted material of the Insurance Services Office used with its permission. 00020007260718272724771 DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 a. Any covered "auto" you lease, hire, rent or your business; and borrow without a driver; and b. Any covered "auto" of the private passenger b. Any covered "auto" hired or rented by your type hired or rented by your "employee" "employee" without a driver, under a contract without a driver for a period of 30 days or less, in that individual "employee’s" name, with under a contract in that individual SCA 23 500D Copyright, CNA Corporation, 2000. Page 2 of 3 (Ed. 10/11) Includes copyrighted material of the Insurance Services Office used with its permission. DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 00020007260718272724770 DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000 $1,000,000 $15,000 $1,000,000 $2,000,000 $2,000,000 A 06/30/2018 06/30/2019 General Liability 6071865195 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X X BODILY INJURY (Per accident) $1,000,000 B 06/30/2018 06/30/2019 Auto Liability Deductible - $1,000 COMBINED SINGLE LIMIT (Ea accident) C 6071827272 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 06/30/2018 Umbrella Liability C UMBRELLA LIAB 6071837378 06/30/2019 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER C 06/30/2018 06/30/2019 PER STATUTE A WC 6 71866153 06/30/2018 06/30/2019 D WC 6 71865178 06/30/2018 06/30/2019 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A N Workers Compensation WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WC 6 71865486 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is added as Additional Insured as respects the General Liability and Automobile Liability as required per written contract. Umbrella is a follow form. 30 day notice of cancellation except 10 days for non-payment. CERTIFICATE HOLDER CANCELLATION CityREPRESENTATIVE of Fort Collins AUTHORIZED Attn: John Voss P.O. Box 580 Fort Collins CO 80522 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DocuSign Envelope ID: FFC697D2-F7CF-476C-AB7F-51714CA213C8