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HomeMy WebLinkAboutContract 52893-R4 CSC No. 52893-R4 CITY OF FORT WORTH REQUEST TO EXERCISE RENEWAL OPTION November 4, 2020 Environmental Improvements Inc. Attn: Michael Carpenter 517 N. Kealy Lewisville, TX 75057 Re: Contract Renewal Notice Purchase No. CSC052893-R4 (the "Contract") Renewal Term No. 4: October 12, 2020 to October 11, 2021 The above referenced Contract with the City of Fort Worth expires on October 12, 2020 (the "Expiration Date"). Pursuant to the Contract, contract renewals are at the mutual agreement of the parties. This letter is to inform you that the City is requesting to renew the Contract,inclusive of the terms and conditions as set forth in the original ITB, 16-0372, 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 http://fortworthtexas.gov/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, now= s" Monica Saenz/Admin Assistant 817-392-8267 OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX Contract Renewal Page 1 of 2 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: Dana Burghdoff(Nov 6,20 1:1005T) ensuring all performance and reporting Name: Dana Burghdoff requirements. Title: Assistant City Manager By: APPROVAL RECOMMENDED; Name: M n Phillips Christopher Harder Title: Engineering Manager By: 1:hristopher Harder(Nov 6,2020 08:57 CS'Q Name: Chris Harder APPROVED AS TO FORM AND Title: Water Director LEGALITY: ATTEST. PpoF F°Rr�o�d By: Mack(Nov 6,202010:25 CSC o � - �-+d Name: Doug Black Pv� =C °op* o* j Title: Assistant City Attorney TEXAso`�" p4400 By: CONTRACT AUTHORIZATION: Name: Mary J. Kayser M&C: Title: City Secretary Date Approved: Form 1295 Certification No.: N 0 rr-e M be- -'l.. 0 ZPate) �f By: Name: p e Oro Wh Title: �Vit, r�sin�- OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX Contract Renewal Page 2 of 2 ENVIIMP-01 TGILDART A�4RQ` CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 21271227�2ozo 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 CAMEACT Theresa L.Gildart W.M.Jones&Company,Inc. PHONE FAX 11111 Wilcrest Green Drive,Suite 420 (A/C,No,Ext):(713)465-0766 (AIC,No):(713)465-0421 Houston,TX 77042 al DRlEss:theresag@wmjonesco.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:United Fire&Casualty Insurance Company 13021 INSURED INSURER B:Texas Mutual Insurance Company 22945 Environmental Improvements,Inc. INSURER C: 617 N.Mealy INSURER D: Lewisville,TX 75057 INSURER E: 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 CONTRACTOR 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. ILT ADDL SUBR POLICY EFF POLICY EXP LT TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDIYYYYI (MM/DD/YYYYILIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 85320345 3/1/2020 3/1/2021 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,600 X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 000 Ea accident $ Ix ANY AUTO 85320345 3/1/2020 3/1/2021 BODILY INJURY Per Person) $ OWNED SCHEDULED AUTOS ONLY AUTOS p BODILY INJURY Per accident $ AUTOS ONLY L AUTOS OtY PPe0acad ntDAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE 85320345 3/1/2020 3/112021 AGGREGATE $ 3,000,000 DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ST UTE ER ANY OFFICEROPRIETOREXRTNERI?ECUTIVE Y� N/A 0002007994 1/1/2020 111/2021 1,000,000 (Mandatory in NH) E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYE $ PERATIONS below 1 ������� If yes,describe under 1,000,000 T T DESCRIPTION OF O E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The General Liability and Auto policies include a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status.The General Liability,Auto and Workers Compensation policies include a blanket automatic waiver of subrogation endorsement that provide waiver of subrogation status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Texas Street ACCORDANCE WITH THE POLICY PROVISIONS. Fort Worth,TX 76102 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form W'9 Request for Taxpayer Give Form to the (Rev.October2018) Identification Number and Certification requester,Do not Department of the Treasury Send t0 the IRS.Internal Revenue Service Go to wwWdrs,gov/FormW9 for Instructions and the latest Information, 1 Name(as shown on your Income tax return).Name Is required on this line;do not leave this line blank, ENVIRONMENTAL IMPROVEMENTS,INC. 2 Business name/disregarded entity name,If different from above cli a 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 following seven boxes. certain entitles,not indlviduais;see C instructions on page 3): o ❑ Indfviduallsole proprietor or 0 C Corporation ❑8 Corporation ❑ Partnership ❑Trust/estate In ai single-member LLC Exempt payee code(ir any) .2 '5 ❑ Limited liability company,Enter the lax.classification(C=C corporation,S=S corporation,A=Partnership)►. p Note.Check the appropriate box In the line above for the tax classification of the single member owner, Do not chock 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 aC IE another LLC that is not disregarded from the owner for U.S,federal tax purposes,Otherwise,a single-member LLC that code(if any) is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other(see instructions)► (Appeee ro_c Qnrs mainlain d-1ssde me u,a.) 5 Address(number,street,and apt,or suite no.)See Instructions, Requester's name and address(optional) 1183 BRITTMOORE RD.,STE,100 MAILING:PO BOX 79266 6 City,state,and ZIP code HOUSTON,TX 77043 HOUSTON,TX 77279 7 List account number(s)here(optional) Tax aver Identification Number(TIN) Enter your TIN in the appropriate box,The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding.For individuals,this is generally your social security number(Sate).However,for a resident alien,sale proprietor;or disregarded entity,see the instructions for PartI,later.For other entities,It Is your employer Identification number(EIN).If you do not have a number,see How to get a 7/N,later. or Note:If the account is in more than one name,see the instructions for line 1,Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter, 7 4 — 1 5 4 6 1.8 2 E 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(IRA),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 11,later. Sign Signature of J Here U.S.person► Date►101 l j-%A.. General Instructions Form 1099-DIV(dividends including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise .noted, Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.frs.gov1Form1N9. •Form 1099-8(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An Individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage Interest),1098-E(student loan Interest), Information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-0(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption taxpayer Identification number(ATIN),or employer identification number -Form 1099-A(acquisition or abandonment of secured property) (E1N),to report on an information return the amount paid to you,or other Use Form W-9 only If you are a U.S,person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TiN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What Is backup withholding; later. Cat.No,10231X Form W-9(Ray.10-2018)