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HomeMy WebLinkAboutContract 47463-R1 N►-j'2 3 4 S v ��G NOV bi6 CSCNo. 7 cP3 r,ITYC:: r`r,:'':offlH TY SRuRSThRY aITY OF FORT WORTH G ��SOITRACT RENEWAL NOTICE September 1,2018 Discovery Benefits,Inc. 4321 20`h Avenue Fargo,ND 58103 Re: NOTICE OF CONTRACT RENEWAL Health Savings Account Services—Group ID 25345 Contract No.CSC No.47463(the"Contract") Renewal Term No. 1:January 1,2019 to December 1,2019 The above referenced Contract will expire on December 31,2018.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 CSC No. 47463 for an additional one year period, which will begin immediately upon the expiration of the current term and will end on December 31, 2019. All other terms and conditions of CSC No. 47463 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 Notice of Contract Renewal. Please log onto BuySpeed Online at httn://fortworthtexas. ov/purchasin;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 yours, Meagan Whitwell Sr.Benefits Analyst Human Resources Department 817-392-7787 I hereby acknowledge receipt of the Contract Renewal Notice for CSC No.47463 for a one year period ending on December 31,2019. By: 2t�-r1r c_ 1 j e Ce_o Il-,! Date: P •nted Name andTitle ' OP o S re c� CORTH. ATTEST: S san Janis,Assistant City Manager Mary ayse, Secretary Date: (f< b' 14 M&C No. not re uired A RECOMMENDED BY: Name and Title Jo . Strong,Xssijiant City Attorney 1� �sco��ry H-50 cs c 4- -74-(.03 Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Name of Employee/Signature Title ❑ This form is N/A as No City Funds are associated with this Contract Printed Name Signature DATE ACORO® /YCERTIFICATE OF LIABILITY INSURANCE 10/29/2018 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 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 CONTANAME:CT Joni AlfSon Dawson Insurance Agency PHONE701-237-3311 n/°�c No):701-232 4442 721 1st Avenue North EMAIL Fargo ND 58102 ADDRESS: Oflla dawsonins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Illinois National Insurance Co 23817 INSURED DISCO-2 INSURER B Discovery Benefits Inc. 4321 20th Ave. SW INSURER C: Fargo ND 58103 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1800643380 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. INSR ADDLTYPE OF INSURANCE J=SUBR POLICY NUMBER MPOLICY/DD/YYYY MEFF M LICY EXP LTR IDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE 1:1 OCCUR PREMISES (E.occu ence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECU I IVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Prof/CyberLiab 012323183 11/30/2017 11/302018 Per Claim 10,000,000 Aggregate 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Worth 1000 Throckmorton Street AUTHORIZED REPRESENTATIVE Fort Worth TX 76102 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD