HomeMy WebLinkAboutContract 52362-R2 Date: 07/24/20 CSC No. 52362-R2
Time:4:06 pm
CITY OF FORT WORTH
REQUEST TO EXERCISE RENEWAL OPTION
GK Techstar July 15, 2020
Attn: Greg Scoggins
802 W 13"
Deer Park, TX 77536
Re: Contract Renewal Notice
Contract No. CSC No. 52362
Renewal Term No, R2: October 1, 2020 to September 30,2021
The above referenced Contract with the City of Fort Worth expires on September 30,
2020, Pursuant to the Contract, contract renewals are at the mutual agreement of the parties.
This letter is to infbrm you that the City is requesting 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,
To agree to renew the Contract for an additional one(1)year period,please sign and
return this request to exercise renewal option, along with a copy of your current insurance
certificate, to the address set forth below.
Please log onto PeopleSoft Purchasing at Ittt ://f'or(��'orthlexas.Lo�-/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.
Sin rely,
Darla Morales
Parts Material Supervisor
817-392-4932
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OFFICIAL RECORD
CITY SECRETARY
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FT.WORTH, TX
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Contract Renewal Page ] of 2
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ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
'lu`1a'&4LWe administration of this contract,including
By; Dana Burghdoff(J 23,2020 11CDn ensuring all performance and reporting
Name: Dana Burghdoff requirements,
Title: Assistant City Manager
By• C--
APPROVAL RECOMMENDED: Name; Darla Morales
Title: Parts Material Supervisor
APPROVED AS TO FORM AND
By: Christopher Hard (Jul20,202013:06CDO LEGALITY:
Name; Chris Harder
aq�oR),
Title; Water Director apF oR°°load
�s o
ATTEST: ��'�0
pvg o°°=d By: Mack(Jul 23,202018:58 CDT)
°°° °° � Name; Doug Black
By: 0/ a°a1 neXASppp Title: Assistant City Attorney
Name: Mary J Kayser
Title: City Secretary CONTRACT AUTHORIZATION:
M&C: NO
Date Approved
Form 1295 Certification No.:
GK Techstar
BY: ,•% _
Name: a=` ! ,11 ".--.�';--x,,,
Title; r�.r.•,�I t
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OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
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Contract Renewal Page 2 of 2
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nsured Workers'Compensation and Employers'Liability Policy
Named I Endorsement Number
insperily,INC.UC/F
GK TECHSTAR,LLC Policy Number
19001 Crescent Springs Drive Symbol:RWC Number:C66698506
Kingwood,TX 77339
Policy Period Effective Date of Endorsement
1o/1/2o19 TO 10/1/2020 10/1/2019
Issued By(Name of Insurance Company)
Indemnity Insurance Co.of North America
Insert the Policy number.The remainder of the Information is to be com leled onl when this endorsement Is Issued subsequent to the preparatlon of the policy,
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the
Information Page,
We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our
right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury
arising out of the operations described in the Schedule,where you are required by a written contract to obtain this waiver
from us,
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The
premium for this endorsement is shown in the Schedule.
Schedule
1, (X) Specific Waiver
Name of person or organization:
City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
( ) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to
furnish this waiver.
2. Operations:
3. Premium:
The premium charge for this endorsement shall be INCLUDED percent of the premium developed on payroll
in connection with work performed for the above person(s)or organization(s)arising out of the operations
described.
4. Advance Premium: INCLUDED
A-uWorze epresenta ve
WC 42 03 048(06/14) 0.)Copyright 2014 National Council on Compensation Insurance,Inc. All Rights Reserved.
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HDI
Certificate of Insurance
This certificate is Issued as a matter of information only and confers no rights upon the
certificate holder. It does not amend, extend or alter the coverage afforded by the policy listed
below.
Name and Address of Insured Grieshaber Verwaltungsgeseilschaft mbH
Hauptstr. 1 - 5
D-77709 Wolfach
Additional Named Insured: GK Techstar LLC
802 W 13th Street
Deer Park,TX 77536-3166
USA
Insurer: HDI Global SE
Postfach 51 03 69
30633 Hannover
Federal Republic of Germany
This is to certify that the insurance policy listed below has been issued to the company or
organization named herein as insured and Is in force at this time. Regardless of any requirement,
contractual agreement or other documentation for which this certificate is being requested or
may pertain,the insurance coverage afforded by the captioned policy will be limited to and still j
subject to its original terms,conditions and exclusions,
Type of Insurance: General Liability-comprehensive form-including
Premises Operations and Products/Completed
Operations Hazard \
Coverage for the above Additional Insured is provided as follows:
• Coverage for"Difference in Conditions (DIC)"as far as scope coverage of the policy described
herein is wider than scope of coverage of the local primary policy, for example Employer's j
Liability and excess Automobile coverage.
• Coverage for"Difference in Limits(DIL)" between the limits of liability of the local primary
$ 10.000,000 and the limits of liability of the policy described herein,
Policy Number: 39908390 01155 113
Period of insurance: 01.01.2019-01,01.2021. I I
The policy shall be renewed automatically for an additional year,
unless cancelled three months prior to the expiration date,
Limits of Liability Bodily Injury and/or Property Damage combined
EUR 25,000,000,00 each occurrence
EUR 50,000,000,00 aggregate i
Employer's Liability EUR 5,000,000,00 each occurrence !
and excess Automobile EUR 5,000,000,00 aggregate
coverage
Policy Territory: worldwide. _
I. IIn) bri SE
Stuttgart, 11.12.2019
HDI Global SE Nit nner Sir-
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WON ')crII[)I:99,9%Nhl61ort SF
an4 0,1?a 1101 llarrpllldrlvnhand dcr(helSchen lndaib(e V.a.C,
HDI Global SE Handelsreglster.Shz Hannover htip:Nwww,hdi.global Ha donnover B 60iz Vorsltzeadsr dos Aurslchtsrals:Torsion Love
HR Hann er 210820 Vorsland:Dc Edgar Puls(Vorsitzender), o
Yves&tz,Frank Honing,David Hullin,
Clemens JungsthOfol,Dr,Thomas Kuhnl,Jens Wohlihat g I
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