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This Agreement will be in full force and effect only when it has been approved and executed by the duly authorized City officials. IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date. 1'CITY" CITY OF CHANDLER Recommended By: Andrew Goh, P.E. CIP City Engineer MAYOR APPROVED AS TO FORM: ATTEST: "CONSULTANT" Entellus, Inc. Signature Print Name Title City Attorney City Clerk Signer Email Address City of Chandler Professional Services Agreement Date D, ,hlir \/1/,wl,c: fl. I ltilitioc: non::>rtrnont r::>nit::,I Orniortc: ni\licinn Seal Page 12 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/15/2021 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 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 Phone: (480) 368-1800 Fax: (480) 368-1702 CONTACT NAME: Southwest Professional Insurance Consultants SOUTHWEST PROFESSIONAL INSURANCE CONSULTANTS 7689 E. PARADISE LANE, SUITE 5 SCOTTSDALE AZ 85260 PHONE (A/C, No, Ext): (480) 368-1800 FAX (A/C, No): (480) 368-1702 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Company 13056 INSURED ENTELLUS INC. 3033 N. 44th Street Phoenix, AZ 85018 INSURER B : RLI Insurance Company 13056 RLI Insurance Company 13056 INSURER C : RLI Insurance Company 13056 INSURER D: RLI Insurance Company 13056 INSURER E : COVERAGES CERTIFICATE NUMBER: 13772 INSURER F : 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X PSB0001271 11/01/20 11/01/21 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ 1,000,000 MED. EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY X X PSA0001072 11/01/20 11/01/21 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE (per accident) $ $ C X UMBRELLA LIAB OCCUR X X PSE0001219 11/01/20 11/01/21 EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE AGGREGATE $ 5,000,000 DED EXCESS LIAB RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PSW0001258 11/01/20 11/01/21 X PER STATUTE OTH- ER Y / N E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ 1,000,000 E Professional Liability RDP0041469 11/01/20 11/01/21 Per Claim $2,000,000 Aggregate $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER CANCELLATION City of Chandler 215 E Buffalo Street Chandler, AZ 85225 paula.brown@chandleraz.gov 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 Attention: Paula Brown Dan Hardesty ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. DATE SUPPLEMENT TO CERTIFICATE OF LIABILITY INS # 13772 JUN 15 2021 DESCRIPTION OF OPERATIONS, LOCATIONS, VEHICLES Professional Liability - Claims Made - Retroactive Date 12/06/1985 City of Chandler, its officers, officials, agents, and employees are added as additional insured on a primary and non-contributary basis as required by written contract as respects to general liability only for ongoing work per form PPB 304 02 12. Waiver of Subrogation applies as respects general liability as required by written contract per form PPB 304 02 12. Blanket Waiver of Subrogation applies to Workers Compensation per form WC 00 03 13. City of Chandler, its officers, officials, agents, and employees are added as additional insured as required by written contract as respects auto liability only for ongoing work per form PPA 300 03 13. Project No. WA1912.451 Water Main Replacements 2019 Construction Management Services Certificate # 13772 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by ___________________________________________ WC 00 03 13 (Ed. 4-84) 10430 Entellus, Inc. PSW0001258 11-01-2020 RLI Insurance Company (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) Any person or organization that you have agreed with in a written contract to provide this agreement.