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HomeMy WebLinkAboutContract 51990-R1 DocuSign Envelope ID: 32D8E01F-6C2E-4EA1-83A7-65EB7D18BODA CSC No. r 1 W O CITY OF FORT WORTH CONTRACT RENEWAL NOTICE GNP°0S June 10, 2019 Luna Data Solutions Inc. Attn: Dana R. Jones 1408 W. Koenig Ln, Ste D Austin, TX 78756 Re: Contract Renewal Notice Contract No. CSC No. 51990 (the "Contract") Renewal Term No. 1: August 1$, 2019 to August 11, 2020 1..a The above referenced Contract with the City of Fort Worth expires on August 10, 2019 (the "Expiration Date"). Pursuant to the Contract, contract renewals are at the sole option of the City. This letter is to inform you that the City is exercising its right to renew the Contract for an additional one (1) year period, which will begin immediately after the Expiration Date. All other terms and conditions of the Contract remain unchanged. Please return this signed acknowledgement letter, along with a copy of your current insurance certificate, to the address set forth below, acknowledging receipt of the Contract Renewal Notice. Failure to provide a signed acknowledgment does not affect the renewal. Please log onto PeopleSoft Purchasing at http://fortworthtexas.goy/purchasing to insure that your company information is correct and up-to-date. If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number listed below. Sincerely, Vickie L. Anderson Administrative Technician 200 Texas Street Fort Worth, TX 76102 Vickie.Andersongfortworthtexas. ov 817-392-2788 OFFICIAL RECORD Y Contract Renewal FT. ., .ho DocuSign Envelope ID: 32D8E01F-6C2E-4EA1-83A7-65EB7D18BODA CSC No. ACCEPTED AND AGREED: CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including By: ensuring all performance and reporting Name: TusanWanis requirements. Title: ant City Manager By: APPROVAL RECOMMENDED: Name: Steve Streifte4 Title: Assistant Director, IT Solutions APPROVED AS TO FORM AND By: LEGALITY: Name: Title: ATTEST: By: Name:,Jo B. S b ng Title: Xssistant City A orney By: �`' CONTRACT AUTHORIZATION: Name: Mary ay er �;`� � ` M&C: N Title: City Secretary Date Approved: NA Form 1295 Certification No.: a Luna Data Solutions Inc. Docu Signed by: ulna � ,�bin.t.S By: Name: Dana ones Title: CEO OFFICIAL RECORD CITY SECRETARY ET WORTH,TX Contract Renewal Page 2 of 2 DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 6n0/2019 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). PRODUCER CONTACT NAME: Amy Mobley Heaton Bennett insurance PHONE 512 354-7179 512-372-8818 A/C No Ext: (A/C,No): A Member of Agent First Alliance,LLC ADDRESS: ainy@insureaustin.com 3933 Steck Ave.B 119 INSURER(S)AFFORDING COVERAGE NAIC# Austin TX 78759 INSURER A: HARTFORD UNDERWRITERS INS CO 19682 INSURED INSURER B: HARTFORD UNDERWRITERS INS CO 30104 Luna Data Solutions,Inc INSURER C: HARTFORD FIRE INSURANCE COMPANY 19682 PO Box 140393 INSURER D: INSURER E: Austin TX 78714 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 OCCUR PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE � MED EXP(Any one person) $ 10,000 A 65SBAZRO917 05/08/2019 05/08/2020 PERSONAL EADVINJURY $ 1,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AUTOS ONLY AUTOS 65SBAZRO917 05/08/2019 05/08/2020 BODILY INJURY(Per accident) $ HIRED NON-OWNED $ X AUTOS ONLY X AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB ICLAIMS-MADE 65SBAZRO917 05/08/2019 05/08/2020 AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE ER ND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑Y N/A 65WECNV5147 05/08/2019 05/08/2020 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C CRIME-Employee Dishonesty 65TP0333198 11/20/2018 11/20/2019 each occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is additional insured with Waiver of Subrogation per policy foml SS 00 08 04 05. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS. 200 Texas Street AUTHORIZED REPRESENTATIVE Fort Worth,TX 76102 Nw+e y Hea4v.., ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _ LOC#: ADDITIONAL REMARKS SCHEDULE Page z of z AGENCY NAMED INSURED Heaton Bennett Insurance Luna Data Solutions, Inc POLICY NUMBER PO BOX 140393 UDC4000916-EO-18 AUSTIN,TX 78714 CARRIER NAIC CODE HISCOX 10200 EFFECnVEDATE: 11/20/2018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE PROFESSIONAL LIABILITY $2,000,000 EACH CLAIM $2,000,000 AGGREGATE ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD