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HomeMy Public PortalAbout036-2017 - RSD-Overhead Door Co for mainteneanceAGREEMENT ORIGINAL THIS AGREEMENT made and entered into this 14- day of March, 2017, by and between the City of Richmond, Indiana, a municipal corporation acting by and through its Board of Sanitary Commissioners (hereinafter referred to as the "City") and Scott Door Service, Inc., 3162 West State Road 38, Richmond, Indiana 47374 (hereinafter referred to as the "Contractor"). SECTION I. STATEMENT AND SUBJECT OF WORK City sent a Proposal Sheet and a Price request seeking responses to service and/or repair the doors of the Sanitary District and Landfill and to service and/or repair Sanitary District overhead garage doors. The Request for Quotes and Price Request is attached hereto and incorporated herein by reference as Exhibit "A". City retains Contractor to service and/or repair the doors of the Sanitary District and Landfill and to service and/or repair Sanitary District overhead garage doors. The Response of Contractor is contained on Exhibit `B", is dated January 30, 2017, and is also hereby incorporated by reference and made a part of this Agreement. Contractor shall provide all work and services listed on Exhibit `B" Should any provisions, terms, or conditions contained in any of the documents attached hereto as Exhibits, or in any of the documents incorporated by reference herein, conflict with any of the provisions, terms, or conditions of this Agreement, this Agreement shall be controlling. The Contractor shall furnish all labor, material, equipment, and services necessary for the proper completion of all work specified. No performance of services shall commence until the following has been met: 1. The City is in receipt of any required certificates of insurance and/or warranties; 2. The City is in receipt of any required affidavit signed by Contractor in accordance with Indiana Code 22-5-1.7-11(a)(2);and 3. A purchase order has been issued by the Purchasing Department. SECTION Il. STATUS OF CONTRACTOR Contractor shall be deemed to be an independent contractor and is not an employee or agent of the City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the work. SECTION III. COMPENSATION City shall pay Contractor a sum not to exceed Fifteen Thousand Dollars and Zero Cents ($15,000.00) for 2017 for complete and satisfactory performance of the work required hereunder. The monies paid to Contractor are based upon an hourly fee schedule set forth in Exhibit `B", and attached with this Agreement. Contract No. 36-2017 Page 1 of 6 SECTION IV. TERM OF AGREEMENT This Agreement shall become effective when signed by all of the parties hereto and shall continue in effect until and including December 31, 2017, with an option to renew for the same cost for year 2018 and an option to renew for the same cost for year 2019. Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part, for cause, at any time by giving at least five (5) working days written notice specifying the effective date and the reasons for termination which shall include but not be limited to the following: a. failure, for any reason of the Contractor to fulfill in a timely manner its obligations under this Agreement; b. submission of a report, other work product, or advice, whether oral or written, by the Contractor to the City that is incorrect, incomplete, or does not meet reasonable professional standards in any material respect; c. ineffective or improper use of funds provided under this Agreement; d. suspension or termination of the grant funding to the City under which this Agreement is made; or e. unavailability of sufficient funds to make payment on this Agreement. In the event of such termination, the City shall be required to make payment for all work performed prior to the date this Agreement is terminated, but shall be relieved of any other responsibility herein. This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by setting forth the reasons for such termination, the effective date, and in the case of partial termination, the portion to be terminated. SECTION V. INDEMNIFICATION AND INSURANCE Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or property or any other claims which may arise from the Contractor's conduct or performance of this Agreement, either intentionally or negligently; provided, however, that nothing contained in this Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers, agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter maintain such insurance as will protect it from the claims set forth below which may arise out of or result from the Contractor's operations under this Agreement, whether such operations by the Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or by anyone for whose acts the Contractor may be held responsible. Coverage Limits A. Worker's Compensation & Statutory Disability Requirements B. Employer's Liability $100,000 Page 2 of 6 C. Comprehensive General Liability Section 1. Bodily Injury Section 2. Property Damage D. Comprehensive Auto Liability (if applicable) Section 1. Bodily Injury Section 2. Property Damage $1,000,000 each occurrence $2,000,000 aggregate $1,000,000 each occurrence $1,000,000 each person $1,000,000 each occurrence $1,000,000 each occurrence E. Comprehensive Umbrella Liability $1,000,000 each occurrence $2,000,000 each aggregate SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall, before commencing work under this Agreement, provide the City a certificate of insurance, or a certificate from the industrial board showing that the Contractor has complied with Indiana Code Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore subject to another state's worker's compensation law, Contractor may choose to comply with all provisions of its home state's worker's compensation law and provide the City proof of such compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law. SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program. Contractor is not required to verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists. Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to remedy the violation not later than thirty (30) days after the City notifies the Contractor of the violation. If Contractor fails to remedy the violation within the thirty (30) day period provided above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement will be terminated. If the City determines that terminating this Agreement would be detrimental to the public interest or public property, the City may allow this Agreement to remain in effect until the City procures a new contractor. If this Agreement is terminated under this section, then pursuant to IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages. Page 3 of 6 SECTION VIII. IRAN INVESTMENT ACTIVITIES Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in investment activities in Iran. In the event City determines during the course of this Agreement that this certification is no longer valid, City shall notify Contractor in writing of said determination and shall give contractor ninety (90) days within which to respond to the written notice. In the event Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran within ninety (90) days after the written notice is given to the Contractor, the City may proceed with any remedies it may have pursuant to IC 5-22- 16.5. In the event the City determines during the course of this Agreement that this certification is no longer valid and said determination is not refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves the right to consider the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of the ninety (90) day period set forth above. SECTION IX. PROHIBITION AGAINST DISCRIMINATION A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on behalf of Contractor or any sub -contractor shall not discriminate against any employee or applicant for employment to be employed in the performance of this Agreement, with respect to hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of race, religion, color, sex, disability, national origin, or ancestry. B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees: That in the hiring of employees for the performance of work under this Agreement of any subcontract hereunder, Contractor, any subcontractor, or any person acting on behalf of Contractor or any sub -contractor, shall not discriminate by reason of race, religion, color, sex, national origin or ancestry against any citizen of the State of Indiana who is qualified and available to perform the work to which the employment relates; 2. That Contractor, any sub -contractor, or any person action on behalf of Contractor or any sub -contractor shall in no manner discriminate against or intimidate any employee hired for the performance of work under this Agreement on account of race, religion, color, sex, national origin or ancestry; That there may be deducted from the amount payable to Contractor by the City under this Agreement, a penalty of five dollars ($5.00) for each person for each calendar day during which such person was discriminated against or intimidated in violation of the provisions of the Agreement; and 4. That this Agreement may be canceled or terminated by the City and all money due or to become due hereunder may be forfeited, for a second or any subsequent violation of the terms or conditions of this section of the Agreement. C. Violation of the terms or conditions of this Agreement relating to discrimination or intimidation shall be considered a material breach of this Agreement. Page 4 of 6 SECTION X. RELEASE OF LIABILITY Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents of the same from all liability which may arise in the course of Contractor's performance of its obligations pursuant to this Agreement. SECTION XI. MISCELLANEOUS This Agreement is personal to the parties hereto and neither party may assign or delegate any of its rights or obligations hereunder without the prior written consent of the other party. Any such delegation or assignment, without the prior written consent of the other party, shall be null and void. This Agreement shall be controlled by and interpreted according to Indiana law and shall be binding upon the parties, their successors and assigns. This document constitutes the entire Agreement between the parties, although it may be altered or amended in whole or in part at any time by filing with the Agreement a written instrument setting forth such changes signed by both parties. By executing this Agreement the parties agree that this document supersedes any previous discussion, negotiation, or conversation relating to the subject matter contained herein. This Agreement may be simultaneously executed in several counterparts, each of which shall be an original and all of which shall constitute but one and the same instrument. The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or mediation shall be required prior to the commencement of legal proceedings in said Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other action in any alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to bring such suit in front of other tribunals or in other venues. Any person executing this Contract in a representative capacity hereby warrants that he/she has been duly authorized by his or her principal to execute this Contract. In the event of any breach of this Agreement by Contractor, and in addition to any other damages or remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this Agreement, including but not limited to, City's reasonable attorney's fees. In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the provisions of this Agreement. Page 5of6 IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the day and year first written above, although signatures may be affixed on different dates. "CITY" THE CITY OF RICHMOND, M NA by and through its Board of Sanitary Commissioners By: :7�-- Sue Miller, President Date: ��-7111 7 APPROVE c DavidM. Snow, a City of Richmon , Indiana Date: �< <0 1 7- "CONTRACTOR" SCOTT DOOR SERVICE, INC. "!,7,i �eo, Printed: Gerald E. Scott Title: President Date: .3 — 17 / I Page 6 of 6 Affidavit of Employment Eligibility Verification The Contractor, Scott Door Service, Inc., by its President, Gerald E. Scott, affirms under the penalties of perjury that Contractor does not knowingly employ an unauthorized alien. If Contractor is self-employed and does not employ any employees, Contractor verifies he or she is a United States citizen or qualified alien. The Contractor has not knowingly employed or contracted with an unauthorized alien and shall not retain an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. The Contractor has required Contractor's subcontractors to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor will maintain this certification throughout the duration of the term of a contract with a subcontractor. I hereby verify under the penalty of perjury that the foregoing statement is true. Dated this day of March, 2017. (signature) Gerald E. Scott, as President of Scott Door Service, Inc. (printed name) PRICE REQUEST O N A� D u e A CM OF MCHMOND DEP ON IB�AINUES CHM0ND LIBERTY2380 V,11NDIANA47374 THIS IS NOT AN ORDER PHONE (765) 983-7450.FAX (765) 962-2669 7 VENDOR INSTRUCTIONS This is a request for a price for the services of materials SCOTT DOOR SERVICE, INC described below. Any additional specifications may be attached hereto. This is NOT an order and the City reserves 3162 WEST STATE ROAD 38 the right to accept all or part, or decline the entire proposal. Please complete your full name and phone number below RICHMOND, IN 47374 with signature; itemize all prices and charges where requested; and attach any explanation for any substitution to ATTN• GERALD SCOTT specifications altered. Return in a sealed envelope, in care of Richmond Sanitary District Board of Commissioners to the administration building at the address above by the specked date and time to be considered. DATE: REPLY MUST BE IN BY: PAYMENT TERMS: DELIVERY REQUIRED: January 27, 2017 10:OOAM on February 14, 2017 UPON RECEIPT OF INVOICE DELIVERED DESCRIPTION This is a price request for SERVICE/REPAIRS OF THE SANITARY DISTRICT AND LANDFILL DOORS AND OVERHEAD GARAGE DOORS: The period of Service will be from signing of Contract to December 31, 2017 with the option to renew for year two (2018) and year three (2019) at the same cost ending December 31, 2019. SERVICEIREPAIRS OF THE SANITARY DISTRICT AND LANDFILL GARAGE DOOR: LABOR -- -----------$ 100 1ST HOUR AND $ EA. ADDITIONAL HOUR EMERGENCY CALL LABOR i 50 1ST HOUR AND $ /r/ 5j00 EA. ADDITIONAL HOUR $7 W RESPONSE TIME AFTER CALL -IN 7l. m r— 0eq PLEASE ENTER ALL INFORMATION ON ATTACHED PROPOSAL SHEET. Richmond Sanitary District Board of Commissioners _ 2380 Liberty Avenue Richmond, IN 47374 Re: Service/Repairs RSD Doors & Garage Doors Please include Certificate of Insurance with Quote. Quote Valid UntikAj& nGG tin�o�oTING- Questions? Call Mike Clark at 765-983-7452 or Jeff Lohmoeller at 765-983-7464. BY: STATE TAX EXEMPTION # 003121909-001 fiW Za"oe&,in Richmond Sanitary District AUTHORIZED BY SIGNATURE TITLE DATE PHONE NUMBER PROPOSAL SHEET The Richmond Sanitary District is requesting quotes for: On -Call Door, Overhead Garage Door, and Gate Actuator Service and Repair for 2017, with Option to renew 2018 & Option to renew 2019 ending December 31, 2019 NAME OF CONTRACTOR Cf- OzOR 15� R V i " -71i/� ADDRESS 34.2 ��ccf� R� � W-6� CITY/STATE R / C h n% &-nd- • CERTIFICATE OF INSURANCE INCLUDED ( must meet the City of Richmond, IN requirements) YES ✓ NO • &VERIFICATION FORM FILLED OUT: • LOCAL PREFERENCE CLAIM: • IRAN INVESTMENT: 2017 YES NO YES / NO YES V NO Signing of Contract to December 31, 2016 H gpoe ��� Regular Hours k3$%m to 4:3 Opm Rate per Hour $ O/T$ Weekend Rate- Saturday Rate per Hour $ ��a Sunday Rate per hour $ Holiday Rate - Rate per Hour $ 9 "�f �0 2018 Signing of Contract to December 31, 2017 Regular Hours 73m to 4:30pm Rate per Hour $ �' O/T$ Weekend Rate -Saturday Rate per Hour $ 1(�1 ° 0 Sunday Rate per hour $ Holiday Rate - Rate per Hour $ 9 7i.6' 2019 Signing of Contract to December 31, 2019 Regular Hours 7.:.� to 4:30pm Rate per Hour $ O/T$ Weekend Rate — Saturday Rate per Hour $ �`f Sunday Rate per hour $9-/-60 Holiday Rate — Rate per Hour $ q ARTICLE F INSTRUCTIONS TO BIDDERS INDEMNIFICATION, INSURANCE, AND PROTECTION OF LIVES AND PROPERTY F.1 INDEMNIFICATION F. 1.1 The contractor shall indemnify and hold harmless the City of Richmond and its officers and employees from and against all claims, damages, losses, expenses, including but not limited to attorney's fees, arising out of or resulting from the performance of the contract, provided that any such claim, damage, loss or expense (a) is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property (other than goods, materials and equipment furnished under this contract) including the loss of use resulting there from, and (b) is caused in whole or in part by any negligent act or omission of the contractor, any subcontractor, or anyone directly employed by any of them or anyone for whole acts any of them may be liable, regardless of whether or not it is caused in part by a party indemnified hereunder. FF. 12 In any and all claims against the City or any of its officers or employees by any employee of the contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, the indemnification obligation under this paragraph G. 1 shall not be limited in any way by any limitation of the amount or type of damages, compensation or benefits payable by or for the contractor or any sub -contractor under worker's or workmen's compensation acts, disability benefit acts or other employee benefit acts. F.2 WORKER'S COMPENSATION INSURANCE F. 2.1 For contracts involving performance of work pursuant to the provisions of Indiana Code IC 22- 3-2-14 (a) bidders are required to furnish a certificate from the Indiana Worker's Board showing that such bidder has complied with IC 22-3-2-5, 22-3-5-1 and IC 22-3-5-2. F.3 INSURANCE F. 3.1 The Contractor shall, as prerequisite to this Agreement, purchase and thereafter maintain such insurance as will protect him from the claims set forth below which may arise out of or result from the Contractor's operations under this Agreement, whether such operations by the Contractor or by any Sub -contractors or by anyone who directly or indirectly employed by any of them, or by anyone for whose acts any of them may be liable. F.3.1 (con't) Coverage Limits A. Worker's Compensation & Statutory Disability Requirements B. Employer's Liability $100,000 C. Comprehensive General Liability Section 1. Bodily injury $1,000,000 each occurrence $2,000,000 aggregate Section 2. Property Damage $1,000,000 each occurrence D. Comprehensive Auto Liability Section 1. Bodily Injury $1,000,000 each person $1,000,000 each occurrence Section 2. Property Damage $1,000,000 each occurrence E. Comprehensive Umbrella Liability $1,000,000 each occurrence $2,000,000 each aggregate F. MalpracticeBrrors & Omissions $1,000,000 per claim Insurance $2,000,000 each aggregate I,; -Verify Requirements: 'Definitions: E Verify 1'ro ram - A electronic, verification of work authorization program of the IRegai Immigration Reform and Immigration Responsibility Act of 1996 (P.L. 104-208), Division C, Title IV, s,403(a), as amended,- operated by the United States Department of Homeland Security -or successor work authorization program designated• by the -UT ted States Department of Homeland Security' or. other fedexal agency authorized to very the work authorization statics of nearly hired employees under the immigration Reforn and control Act of 1986 (P.L. 99-603). Nn performance of services shall comrmmee until the following -has been met: 1, - The City is W receipt of any required ceriiicates of insurance',' 2. The City is in receipt of any required affidavit sued by Contractor in accordance with Indiana Code 22-5-1.7-11W 21, and 3. A purchase order has been issued by the Furchasimg Departmenf. afa1nix an An Anna an a nn3lnn Kama naxa Ynaanannxn as aax nx as max ananaana MAX art:axaxxaa NKnxl COWLIANCE WITH MIANA E VERIFY PROGRAM REt3UMMEl418 pursuant to Indiana Code 22-5-1.7, Contractor is required to enrollin and- verify the -work . eligibility status of all ziewly hired employees of the contractor through the Indiana E Verify program. Contractor is not .required to verify the work eligibility status of all newly hired. employees. -of the contractor through- the Indiana E-Verify program if the Indiana E-Verify program. no longer exists, Prior to the performance of this Agreement, Contractor shall. provide to the City its signed Affidavit aiming that Contractor does not knowingly employ an unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2), In the event Contractor violates IC 22-5-1.7 the Contractor shall be req*ed to remedy the violation not later than thirty (30) -days after the City notifies the Contractor of the violation. If Contractor fails to remedy the violation within the thirty (30) day period provided above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement will be terminated. If the City detei�ines that terminating. this Agreement would be detrimental to the public interest or public -property, the City may allow this Agreement to remain in effect until, the City propures a mew .contractor..If this Agreement is teminated umet Ibis section, then pursuant to IC22-5 1.7-13 (e) the Contractor will remain liable to the City fot' actual damages. Affidavit of Employment Eligibility Verification The Contractor, rt- % od-)bZ Jery �affirms under the � .penalties of per)ury that Contractor does not knowingly employ an unauthorized alien. If Contractor is self-employed and does, not employ any employees, Contractor verifies he or she is a United States citizen or qualified alien. - The Contractor has not knowingly employed or. contracted with an unauthorized alien and shall not retain an employee or contract with • a person that the Contractor subsequently learns is an' unauthorized alien fursuaut to Indiana Code 22-5-1.7, Contractor has enrolled in and verifiers the work eligibility status of all newly kited employees of the contractor through the Indiana E-Verify proms- The Contractor has required Contractor's subcontractors to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor will maintain this certification throughout the duration of the term of a contract with a subcontractor. I hereby verify under the penalty of perjury that the foregoing statement is true. Dated this day of ..JCinUe7r,20/1 (signature) (printed nam(-,) INDiANA LOCAL PRFF+'N' ZENCE CLAIM (Only fill out this Part if claiming to he a Local Indiana Business) Pursuant to Indiana Code 36-1-12-22, bWIT --(Name of Business) . claims a local Indiana business preference for the bid for Project in Wayne County, Indiana. (Name of Project) The Claim of applicability of the Local Indiana Business preference is based upon the following: (Check all that apply) L The location of the Business's principal place of business is: . . A) in Wayne County, or B) in an adjacent county. 2. The majority of the business's payroll, for the previous twelve (12) months from the date of this Bid, is to residents in Wayne or an adjacent county. 3. The majority of the business's employee's, for the previous twelve (12) months from the date of this Bid, are residents of Wayne or an adjacent county. . If business is deemed to be the apparent -low bidder, business shall provide information pursuant to Post -Bid submittal (Local Indiana Business Preference), to substantiate the claim -of a local Indiana business: IRAN INVESTMENT ACTIVITIES Pursuant to Indiana Code (IC) 5-22.16.5, Contractor certifies that Contractor is .uqt engaged irrWeAment activities hf Iran. -In the event City determines dtiring the course -of this Agreement that tlils certifkaftoW Is no longer valid, City shall notify Contractor in writing of said deterfninklon and shaft give contractor_ninew (90) days Within which tci respond to the written notice. In the event Contractor fails -to demonstr&_t-&the City that the Contractor has ceased investment activities in Iran within ninety (90) days after the written notice is given to the Contractor, the City'may proceed with Any remedies it may nave-pwsuant tor IC.5-22- 16.5. In the event the City, determines during the course of this Agreement that this certification -is no ' longer valid* and said determination is not refuted by Contractor iu the manner setforth in IC 5-22- 6.5, the City. reserves the .right to consider the Contractor to be hi breach of this Agreement and idrminate 1ht; agreement upon the expiration of the ninety (90) day period set forte above. - ® .444o n CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/30/2017 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 VanVleet Insurance Agency- Indiana 1 Glen Miller Parkway Richmond IN 47374 CONTACT NAME: Marcia Stroud PHONE Xt 765-935-5655 1C No : (765)935 $164 EJ ADDRESS: marcias@vanvleetinsurance.com INSURER(S)AFFORDING COVERAGE NAIC # INSURERA: Erie Insurance Group INSURED Scott Door Service Inc 3162 W State Rd 3B Richmond IN 47374-97351 INSURER B : Erie Insurance Group INSURERC: INSURER D: INSURER E INSURERF: 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 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 TR TYPEOFINSURANCE POLICY NUMBER POLICY EFF MMlDDIYYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES .occurrence $ 1000000 MED EXP (Anyone person) $ 6000 A Q41-3160663 6/31/16 6/31117 PERSONAL&ADV INJURY $ 1000000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 PRODUCTS -COMP/OPAGG $ 2000000 X POLICYDJECT LOC OTHER: AUTOMOBILE LIABILITY Ea accl den SINGLE LIMB $ 1000000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Q05-3140062 5/31/16 5/31/17 PROPERTYDAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION WORKERS COMPENSATION _ STATUTE ERH $ E_L EACH ACCIDENT $ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUitVE E.LDISEASE-EAEMPLOYE $ OFRCER/MEMBER EXCLUDED? ❑ (Me ndato ry i n N H) N/A E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION 0F0PERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) l.tK I IrII.H I C I'1VLUCfC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Richmond Department of Sanitation 2380 Liberty Ave Richmond IN 47374 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - t d Fax: Email:962-2669 © 1988-2015 ACORD CORPORATION. All rlgh s reserve . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ n® _'`��(-V(--Jf CERTIFICATE OF LIABILITY INSURANCE DATE /30/2/ 17 01/30/2017 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 Andrew Hulett C/o HUB International Midwest Limited 55 East Jackson Boulevard CONTACT NAME: PHONE 312 429-2251 ( C A/c o E ( ) C. No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # Chicago, IL 60604 INSURERA: Zurich -American Insurance Company 16535 INSURED Human Capital Concepts, LLC Alt. Emp: Scott Door Service, Inc. 1075 Broad Ripple Ave Suite 255 INSURER B : INSURER C Indianapolis, IN 46220 INSURER D : INSURER E : INSURER F : r+n11c0AnC¢ f'=0TlGlr'ATI= NIIMRFR•1RW14n392R907 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 LTR TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ PRO- LOC POLICY ❑ JECT $ OTHER: AUTOMOBILE LIABILITY Ea acccidentSINGLE LIMIT $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION X I STATUTE ERH $ E.L. EACH ACCIDENT $ 1,000,000 A AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) N/A WC 96-95-685 04 06/01/2016 06/01/2017 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below Location Coverage Period: 12125/2016 06/01/2017 Client# 50223-IN DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Scott Door Service, Inc. s Coverage iprovided for only those co -employees 3162 State Road 38 West of, but not subcontractors Richmond, IN 47374 to: TE HOLDER City of Richmond Dept of Sanitation 2380 Liberty Avenue Richmond, IN 47374 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