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Home My WebLink AboutContract 45594-R1 (2)CSC No. ISS94a1 CITY OF FORT WORTH CONTRACT RENEWAL NOTICE 5/21/15 T Smith Inspection & Testing, LLC. 7473 Airport Freeway Fort Worth, TX 761 18 Re: NOTICE OF CONTRACT RENEWAL Requirements Contract Contract No. CSC No. 45594 (the "Contract") Renewal Term No.,: June 11, 2015 to June 10, 2016 / The above referenced Contract will expire on June 10, 2015. 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. 45594 for an additional one year period, which will begin immediately upon the expiration of the current term and will end on June 10, 2016. All other terms and conditions of CSC No. 45594 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 httm//fortworthtexas.aov/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 yours, Darian Gavin, Contract Compliance Specialist FMS, Purchasing Division 817-392-2057 - Direct 817-392-8440 - Fax I hereby acknowledge receipt of the Contract Renewal Notice for CSC No. 45594 for a one year period ending on June 10, 2016. By: Arthur Etherly, Ill, Chief Operating Officer Printed Naine and Title Signature Date: 3/ez /g01 CITY OF FORT WORTH: A TEST: 'yeah A Fernando Costa, Assistant City Manager Date: 4/ / • i _ae'V's-ra-te SCANNED ORD i �4' (It1 , f, Lt '- ��1 Nan ��f,�i�f�� j Mary J. Kayser, City Secretary M&C No. C-26764 Jat OR& 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(les) must 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 CON MCI NAME: Bradley Insurance Agency PHONE ( C. (Jo. EXB omit ADDRESS: 1415 Summit Avenue Fort Worth, TX 76102 INSURED CERTIFICATE OF LIABILITY INSURANCE T Smith Inspection & Testing,LLC. Terry Smith 2211 Century Center B1vd.ste101/mailing Irving, TX. 75062 (8J..7) ”9-99$3 set 04' 1 # COVERAGES CERTIFICATE NUMBER* DATE(MM/DD/YYYY) 5/22/2015 817-332-8288 I aC•Na):817-332-8289 INSURER(S) AFFORDING COVERAGE INSURER A : United Specialty Insurance Company INSURER B:Mercury County Mutual Insurance Company INSURER C : Scottsdale Insurance Company INSURER D: Texas Mutual Insurance Company 22945 INSURER E : The Hartford INSURER F : Lloyd t s of London 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. Mn ADDL TYPE OF INSURANCE NSR GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE ITC I OCCUR A X. $.s'in0 BT/Af7 DED Y Y USA4066257 PER CLAIM GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY 17 72i LOC AUTOMOBILE LIABILITY B C D X ANYAUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LIAB I X EXCESS LIAB DED (X RETENTION $ 1 0 , OOn WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NN) If yes, describe under DESCRIPTION OF OPERATIONS below E Property OCCUR CLAIMS -MADE Y/N ra SUER %ND Y Y BA420000006276 XLS0092280-01 NIA Y 0001213688 Y Y 46SBABN6733 F Professional PGIARK01923-02 POLY EXP POLICY NUMBER (MM/DD Y) (MM/DDY/YYYY) 03/17/201s 03/17/2016 10/23/2014 10/23/2015 03/19/2015 03/19/2016 06/29/2014 06/29/2015 01/17/2015 01/17/2010 04/20/2015 04/20/201s LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG UUMUINEU SINGLE UMI (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) RTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE X ITORYWC STATU- UMITS I OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT NAIL/ $ 1 nfA, n00 $ 100,000 $ 5,000 $ Excluded $ 2,000.000 $ Included $ $ 1,000,000 s $ $ $10,000,000 $10,000,000 $ $ 1,000,000 $ 1,000,000 $ 1,000,000 Valuable Papers $100,000 $1,000,000 Per Occurance DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Project:Annual Geotechnical Material Testing and Enviornmental Requirements Contract -Developer. city of Fort Worth, Douglas W. Wiersig, PE, Ph.D., Director, Department of Transportation and Public Works, City of Fort Worth is included as Additional Insured on General Liability, Auto Liability, and Umbrella Liability follows form. Waiver of Subrogation is in their favor on General Liability, Auto Liability, Umbrella Liability, and Workers Compensation policies. Ten (10) day notice. CERTIFICATE HOLDER CANCELLATION City of Fort Worth, Douglas W. Wiersig, Ph.D., Director, Dept. of Transportation and Public Works, City of Fort Worth 1000 Throckmorton Street Fort Worth, TX. 76102 PH: 817-392-7913(Egaolt RD CORPORATION. A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 088-2010 AC ACORD25(2010/05) The ACORD name and logo are registered marks of ACORO