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Home My WebLink AboutContract 49578-R1 M1234 T � RECEIVED o AUG2 2018 0 CITY OF FORT WORTH CITY SECRETARY Lr c REQUEST TO EXERCISE RENEWAL OPTIORONTRACTNO. CITYOFFORTWORTH City Secretary Contract No.49578 CITYSECRETARY `aS F August 13, 2018 6.' F Healthspace USA, Inc. Maureen Garrison, Chief Operating Officer 114 W Magnolia Street Suite 400 Box IIIA Bellingham, WA 98225 Re: REQUEST TO EXERCISE RENEWAL OPTION CSC No. 49578 (the"Contract") Renewal Term October 1, 2018 through September 30,2019 The above referenced Contract expires on October 1, 2018.Pursuant to the Contract,renewals are at the mutual agreement of the parties.This letter is to inform you that the City requests renewal of CSCNo. 49578 for an additional one year period, which will begin immediately upon the expiration of the current term and will end on September,2019. All other terms and conditions of CSC 49578 remain unchanged. Please return your signed agreement letter,along with a copy of your current insurance certificate, to the address set forth below. Please log onto BuySpeed Online at https://bso.fortworthtexas.gov/bso/to ensure that yourcompany information is correct and up-to-date. If you have any questions concerning this Request forContract Renewal,please contact me. Sincerely yours, Mailing Address: City of Fort Worth Regina Jones IT Finance—Regina Jones Administrative Technician 200 Texas Street Regina Jones gfortworthtexas.gov Fort Worth,TX 76102 817-392-6049 1 hereby acknowledge receipt of the Contract Renewal Notice for CSC No. 49578 for a one year period ending on September 30,2019. By: Maureen Garrison,COO Date: 08/13/2018 Signature FQRT A.A �Z CITY nI FORT WORTH: V r 7C1 CITY Vl' s Alanis,Assistant City Manager j .Ma •J.K e i Secre ry �_` Date: $ka,1 I I �' (if required)N/A _ OFFICIAL RECORD Approved Date: N/A CITY SECRETARY DATE(MM/DD/VVVV) .� CERTIFICATE OF LIABILITY INSURANCE 05/29/2018 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 be endorsed.If SUBROGATIONIS 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: HUB INTERNATIONAL NE LTD/PHS PHONE(A/C,No,Ext: (866 467-8730 a/c,No): 888) 443-6112 39320314 E-MAIL THE HARTFORD BUSINESS SERVICE ADDRESS: CENTER INSURER(S)AFFORDING COVERAGE NAICN 3600 WISEMAN BLVD INSURER A: Hartford Ins Co of the Midwest 37478 SAN ANTONIO, TX 78265 INSURED INSURER B HEALTH SPACE USA, INC. INSURER C: 114 W MAGNOLIA ST STE 400 111 A INSURER D: BELLINGHAM WA 98225 INSURER E: N INSURER F: N 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 b IND ICATED.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 TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTR INSR WVD MM/DD/YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED MED EXP(Any one person) PERSONAL&ADV INJURY — GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO LOC PRODUCTS-COMP/OP AGG dECT � OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ccide ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AI ITOS At ITOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE e EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION X PER OTH- ERAND EMPLOYERS'LIABILITY STATUTE V/N E.L.EACH ACCIDENT $500,000 A ANY PROP RIETOR/PARTNER/EXEC UTIVE NJ A X 39 WEC ZF5920 07/07/2018 07/07/2019 E.L.DISEASE-EA EMPLOYEE $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-POLICY LIMIT $500,000 If yes,describe under DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC000313, attached to this policy. CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1000 THROCKMORTON ST EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FORT WORTH TX 76102 AUTHORIZED REPRESENTATIVE �uaa1�o �aa��