Loading...
HomeMy WebLinkAboutContract 47770-A2CITY SEC,RETAFt SECOND RENEWAL TO CITY SECRETARY CONTRACT NO. 47770 AS, on May 12, 2016, the City of Fort Worth ("City") and Ace Pipe Cleaning, 6 9 ` ractor"), collectively the ("Parties"), made and entered into City Secretary Contract 70 (M&C C-27692, May 3, 2016) (the "Contract") for Large Diameter Pipe CCTV and Cleaning Services at Various Locations Citywide; and WHEREAS, the Contract was renewed and amended on November 7, 2016; and WHEREAS, the Contract is approaching the end of its term as renewed; and WHEREAS, the Contract may be renewed up to four times at the same terms, conditions, and unit prices as originally bid; and WHEREAS, the Parties desire to renew the Contract, as amended, for an additional term; NOW, THEREFORE, the Parties, hereby agree as follows: I. The Contract, as amended, is hereby renewed, effective as of the date subscribed by the designated Assistant City Manager. Expiration shall be as described in the amended Contract. II. All other terms and conditions of the Contract not amended herein remain unaffected and in full force and effect, are binding on the Parties and are hereby ratified by the Parties. IN WITNESS WHEREOF, the City and the Contractor have each executed this First Renewal and Amendment in multiple counterparts by and through each Party's duly authorized signatory. Ace Pipe Cleaning, Inc. Contractor: Bruce Vantin Secretary/Treasurer 1 Date: /I 18 City of Fort Worth h„ . r Ghapa SvsGv1 A (a►�iS Assistant City Manager Date: Approval Recommended: Keeth Morgan, Dire or W ter Department OF CONTRACT RENEWAL 2 CSC NO. 47770 Page l FICIAL RECORD .Ace Pipe Cleaning Large Diameter Pipe CCTV and Cleaning Services at various Locations Citywide CITY SECRETARY FT. WORTH, TX Contract Compliance Manager: By signing, I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuriX all performance and reporting requirements. Name) G A h Title) w5 tyr— M&C E-2-7 r Date:-93—�H3 Approved as to Form and Legality: Qf�� Douglas W. Black Sr. Assistant City Attorney Attest Mary J. Iia* City Secretary CONTRACT RENEWAL 2 CSC NO. 47770 Ace Pipe Cleaning Large Diameter Pipe CCTV and Cleaning Services at Various Locations City-wide OFFICIAL RECORD CITY SECRETARY 2 FT. WORTH, TX ti Request for Taxpayer Give Form to the Form ■ (Rev. November 2017) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your Income lax relurn). Name it. required on this line; do not leave this line blank. ACE PIPE CLEANING, INC. 2 Business name/disregarded entity name, if different from above Cl)3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to mfollowing seven boxes. certain entities, not individuals; see CL C ❑ Individual/sole proprietor or ❑ C Corporation ❑./ S Corporation ❑ Partnership ❑ Trust/estate instructions on page 3): e� single -member LLC Exempt payee code (if any) cA�� ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) I- 0 ` 2 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code(if any) a another LLC that is not disregarded from the owner for U.S, federal tax purposes. Otherwise, a single -member LLC Ilrat is disregarded from the owner should check the appropriate box for the tax classification of its owner. Other (see instructions) ► (Applies to accou-- s maintained outside the U.S) 6 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 6601 UNIVERSAL AVE e City, state, and ZIP code KANSAS CITY, MO 64120 7 List account number(s) here (optionall Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number MI �n – m For individuals, this is generally your social security number (Sate). However, for a backup wlien, sole resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later, or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Ennployer identification number Number To Give the Requester for guidelines on whose number to enter. F__T__1 I I I I— I 111119JIIOIvIMuLIMU 11alla Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. arylI Signature of Here U.S. person ►_ General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and Its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-IN7 (interest earned or paid) Date 11 1/11/2018 • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) ACORV CERTIFICATE OF LIABILITY INSURANCE AT o10/E3/2017DmrY) 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 MARSH USA INC. 540 W. MADISON CONTACT NAME' n/c° No Ext): ac No): E-MAIL ADDRESS: CHICAGO, IL 60661 Attn: chicago.CertRequest@marsh.com COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 ACE PI INSURED ACE PIPE CLEANING, INC. INSURER B: American Zurich Insurance Company 40142 INSURER C : American Guarantee and Liability Insurance Company 26247 6601 UNIVERSAL AVENUE INSURER D: KANSAS CITY, MO 64120 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI -007835823-41 REVISION NUMBER: 13 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. INSR LTR TYPE OF INSURANCE DDL SUER POLICY NUMBER POLICY EFF MM DDIYYYY POLICY EXP MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 9377201-14 10/31/2017 10131/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1E OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 X MED EXP (Any one person) $ 10,000 XCU INCLUDED PERSONAL d ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY ECT 1:1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP 9377199-14 10131/2017 10131/2018 COMBINED SINGLE LIMIT $ 2,000,000 0 accident BODILY INJURY (Per person) $ XttANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROP ER TY DAMAGE acciden Per $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR AUC591694712 10/31/2017 10131/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? F_N] (Mandatory in NH) N/A WC 9377202-14 WC012261902 (WI) / / 7 1013112017 10/31/2018 1013112018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: INTERCEPTOR ASSESSMENT PROGRAM CONTRACT 1; LARGE DIAMETER SANITARY SEWER CCN, SONAR AND LASER INSPECTION; PROJECT #ICAP09-1, PE45-0707015-539120 THE CITY OF FORT WORTH, ITS OFFICERS, EMPLOYEES AND SERVANTS IS AN ADDITIONAL INSURED UNDER GENERAL LIABILITY, AUTOMOBILE LIABILITY AND EXCESS LIABILITY, BUT ONLY TO THE EXTENT REQUIRED BY THEIR WRITTEN CONTRACT WITH THE NAMED INSURED FOR OPERATIONS PERFORMED BY THE NAMED INSURED. A WAIVER OF SUBROGATION APPLIES UNDER THE WORKERS COMPENSATION POLICY FOR OPERATIONS PERFORMED BY THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 THROCKMORTON STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FORT WORTH, TX 76102 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MukherjeeQytGpU @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 227309 _ LOC #: Chicago A� i ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA INC. NAMED INSURED ACE PIPE CLEANING, INC. 6601 UNIVERSAL AVENUE KANSAS CITY, MO 64120 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance THE INSURANCE AFFORDED TO THE ADDITIONAL INSUREDS IS PRIMARY INSURANCE OVER ANY OTHER VALID OR COLLECTIBLE INSURANCE THAT THE ADDITIONAL INSUREDS MAY HAVE WITH RESPECT TO LOSS UNDER THIS POLICY. OTHER INSURANCE OF ANY ADDITIONAL INSUREDS APPLICABLE TO LOSS IS IN EXCESS OVER THIS ENDORSEMENT AND THE AMOUNT OF THE COMPANY'S LIABILITY UNDER THIS POLICY SHALL NOT BE REDUCED BY THE EXISTENCE OF SUCH OTHER INSURANCE, PROVIDED, HOWEVER, THAT THIS PARAGRAPH DOES NOT APPLY (i) TO LOSS CAUSED SOLELY BY THE NEGLIGENCE OF SUCH ADDITIONAL INSUREDS, OR III) TO LIABILITY OF THE ARCHITECT, ENGINEER OR SURVEYOR ARISING OUT OF (1) PREPARING, APPROVING OR FAILING TO PREPARE OR APPROVE MAPS, SHOP DRAWINGS, OPINIONS, REPORTS, SURVEYS, FIELD ORDERS, CHANGE ORDERS OR DRAWINGS AND SPECIFICATIONS, OR (2) GIVING DIRECTIONS OR INSTRUCTIONS. OR FAILING TO GIVE THEM. IF THAT IS THE PRIMARY CAUSE OF THE INJURY OR DAMAGE. THE INSURANCE PROVIDED UNDER THIS ENDORSEMENT WILL BE PRIMARY AND NOW CONTRIBUTORY ONLY IF A WRITTEN CONTRACT REQUIRES IT, ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD