HomeMy WebLinkAboutResolution - 2021-R0167 - Contract 15810 with Sanford and Tatum 5.11.2021Resolution No. 2021-R0167
Item No. 8.7
May 11, 2021
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute
for and on behalf of the City of Lubbock, a Professional Services Agreement for
property/casualty insurance broker and consulting services between the City of Lubbock and
Heritage-RM dba Sanford & Tatum Insurance Agency and USI Southwest, Inc., and related
documents. Said Agreement is attached hereto and incorporated in this resolution as if fully
set forth herein and shall be included in the minutes of the City Council.
THAT the City Manager or designee may execute any routine documents and forms
associated with said insurance coverage.
Passed by the City Council on
May 11, 2021
-1:�
DANIEL M. POPE, MAYOR
ATTEST:
Rebe a Garza, City Secr to
APPROVED AS TO CONTENT:
D. B u Koste ch, Chief i cial Officer
APPROVED AS TO FORM:
Jeff artse11, Assistant City Attorney
vw:ccdocs/RES.PSAgrmt-Heritage-RM dba Sanford & Tatum Insurance
April 21, 2021
Resolution No. 2021-R0167
Contract 15810
City of Lubbock, TX
Consulting and Broker Services for City Property and Casualty Insurance Agreement
This Service Agreement (this "Agreement") is entered into as of the Itl lay of May 2021
("Effective Date") by and between Heritage-RM. LLC dba Sanford & Tatum: USI Southwest. Inc..
(the Contractor), and the City of Lubbock (the "City").
RECITALS
WHEREAS, the City has issued a Request for Proposals 21-15810-KM, Consulting and Broker
Services for City Property and Casualty Insurance.
WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best
meets the needs of the City for this service; and
WHEREAS, Contractor desires to perform as an independent contractor to provide Consulting and
Broker Services for City Property and Casualty Insurance, upon terms and conditions maintained in this
Agreement; and
NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and
Contractor agree as follows:
City and Contractor acknowledge the Agreement consists of the following exhibits which are
attached hereto and incorporated herein by reference, listed in their order of priority in the event of
inconsistent or contradictory provisions:
1. This Agreement
2. Exhibit A — General Requirements
3. Exhibit B — Proposal Price Sheet
4. Exhibit C — Insurance
Scope of Work
Contractor shall provide the services that are specified in Exhibit A. The Contractor shall comply with all
the applicable requirements set forth in Exhibit B and Exhibit C attached hereto.
Article 1
1.1 The contract shall be for a term of one year, with the option of four, one-year extensions, if
mutually agreed upon in writing by the Director of Purchasing and Contract Management and the
Consultant(s), said date of term beginning upon formal approval. The Contractor must
maintain the insurance coverage required during the term of this contract including any
extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file
with the Purchasing and Contract Management Department as required by contract or
contract may be terminated for non-compliance.
12 The Contractor shall not assign any interest in this Agreement and shall not transfer any
interest in the Agreement, whatsoever, without prior consent of the City.
13 All funds for payment by the City under this Agreement are subject to the availability of an
annual appropriation for this purpose by the City. In the event of non -appropriation of funds
by the City Council of the City of Lubbock for the goods or services provided under the
Agreement, the City will terminate the Agreement, without termination charge or other
liability, on the last day of the then -current fiscal year or when the appropriation made for
the then -current year for the goods or services covered by this Agreement is spent, whichever
event occurs first. If at any time funds are not appropriated for the continuance of this
Agreement, cancellation shall be accepted by the contractor on 30 days prior written notice,
but failure to give such notice shall be of no effect and the City shall not be obligated under
this Agreement beyond the date of termination.
1.4 This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30 day
written notice. The City of Lubbock reserves the right to award the canceled contract to the
next lowest and best bidder as it deems to be in the best interest of the city.
Article 2 Miscellaneous.
2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in
accordance with the laws of said State, without reference to choice of law provisions.
2.2 This Agreement is performable in, and venue of any action related or pertaining to this
Agreement shall lie in, Lubbock, Texas.
2.3 This Agreement and its Exhibits contain the entire agreement between the City and
Contractor and supersedes any and all previous agreements, written or oral, between the
parties relating to the subject matter hereof. No amendment or modification of the terms of
this Agreement shall be binding upon the parties unless reduced to writing and signed by
both parties.
2.4 This Agreement may be executed in counterparts, each of which shall be deemed an original.
2.5 In the event any provision of this Agreement is held illegal or invalid, the remaining
provisions of this Agreement shall not be affected thereby.
2.6 The waiver of a breach of any provision of this Agreement by any parties or the failure of
any parties otherwise to insist upon strict performance of any provision hereof shall not
constitute a waiver of any subsequent breach or of any subsequent failure to perform.
2.7 This Agreement shall be binding upon and inure to the benefit of the parties and their
respective heirs, representatives and successors and may be assigned by Contractor or the
City to any successor only on the written approval of the other party.
2.8 All claims, disputes, and other matters in question between the Parties arising out of or
relating to this Agreement or the breach thereof, shall be formally discussed and negotiated
between the Parties for resolution. In the event that the Parties are unable to resolve the
claims, disputes, or other matters in question within 30 days of written notification from the
aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies
available at law or in equity.
2.9 At any time during the term of the contract, or thereafter, the City, or a duly authorized audit
representative of the City or the State of Texas, at its expense and at reasonable times,
reserves the right to audit Contractor's records and books relevant to all services provided to
the City under this Contract. In the event such an audit by the City reveals any errors or
overpayments by the City, Contractor shall refund the City the full amount of such
overpayments within 30 days of such audit findings, or the City, at its option, reserves the
right to deduct such amounts owing the City from any payments due Contractor.
2.10 The City reserves the right to exercise any right or remedy to it by law, contract, equity, or
otherwise, including without limitation, the right to seek any and all forms of relief in a court
of competent jurisdiction. Further, the City shall not be subject to any arbitration process
prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein
are cumulative and not exclusive, and may be exercised concurrently. To the extent of any
conflict between this provision and another provision in, or related to, this do.
2.11 The contractor shall not assign or sublet the contract, or any portion of the contract, without
written consent from the Director of Purchasing and Contract Management. Should consent
be given, the Contractor shall insure the Subcontractor or shall provide proof of insurance
from the Subcontractor that complies with all contract Insurance requirements document, this
provision shall control.
2.12 Contractor acknowledges by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the
descriptive material contained herein and any additional associated documents and
Amendments. The City disclaims any terms and conditions provided by the Contractor
unless agreed upon in writing by the parties. In the event of conflict between these terms
and conditions and any terms and conditions provided by the Contractor, the terms and
conditions provided herein shall prevail. The terms and conditions provided herein are the
final terms agreed upon by the parties, and any prior conflicting terms shall be of no force
or effect.
2.13 Contractor acknowledges by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the
descriptive material contained herein and any additional associated documents and
Amendments. The City disclaims any terms and conditions provided by the Contractor unless
agreed upon in writing by the parties. In the event of conflict between these terms and
conditions and any terms and conditions provided by the Contractor, the terms and conditions
provided herein shall prevail. The terms and conditions provided herein are the final terms
agreed upon by the parties, and any prior conflicting terms shall be of no force or effect.
2.14 TEXAS GOVERNMENT CODE SECTION 2252.152
The Contractor (i) does not engage in business with Iran, Sudan or any foreign terrorist
organization and (ii) it is not listed by the Texas Comptroller under Section 2252.153, Texas
Government Code, as a company known to have contracts with or provide supplies or
services to a foreign terrorist organization. As used in the immediately preceding sentence,
"foreign terrorist organization" shall have the meaning given such term in Section
2252.151, Texas Government Code.
2.15 TEXAS PUBLIC INFORMATION ACT
The requirements of Subchapter J, Chapter 552, Government Code, may apply to this
contract and the contractor or vendor agrees that the contract can be terminated if
the contractor or vendor knowingly or intentionally fails to comply with a
requirement of that subchapter.
To the extent Subchapter J, Chapter 552, Government Code applies to this agreement,
Contractor agrees to: (1) preserve all contracting information related to the contact as
provided by the records retention requirements applicable to the governmental body for the
duration of the contract; (2) promptly provide to the governmental body any contracting
information related to the contract that is in the custody or possession of the entity on request
of the governmental body; and (3) on completion of the contract, either: (A) provide at no
cost to the governmental body all contracting information related to the contract that is in the
custody or possession of the entity; or (B) preserve the contracting information related to the
contract as provided by the records retention requirements applicable to the governmental
body.
2.16 TEXAS GOVERNMENT CODE SECTION 2271.002
The Contractor warrants that it complies with Chapter 2271.002 of the Texas
Government Code by verifying that:
1. The Contractor does not boycott Israel; and
2. The Contractor will not boycott Israel during the term of the Agreement.
Pursuant to Section 2271.002, Texas Government Code:
"Boycott Israel " means refusing to deal with, terminating business activities with,
or otherwise taking any action that is intended to penalize, inflict economic harm
on, or limit commercial relations specifically with Israel, or with a person or entity
doing business in Israel or in an Israeli -controlled territory, but does not include an
action made for ordinary business
purposes; and
"Company" means a for profit sole proprietorship, organization, association,
corporation, partnership, joint venture, limited partnership, limited liability
partnership, or any limited liability company, including a wholly owned subsidiary,
majority -owned subsidiary, parent company or affiliate of those entities or business
associations that exist to make a profit.
2.17 CONFIDENTIALITY
The Contractor shall retain all information received from or concerning the City and the
City's business in strictest confidence and shall not reveal such information to third parties
without prior written consent of the City, unless otherwise required by law.
2.18 INDEMNITY
The Contractor shall indemnify and save harmless the city of Lubbock and its elected
officials, officers, agents, and employees from all suits, actions, losses, damages, claims, or
liability of any kind, character, type, or description, including without limiting the generality
of the foregoing, all expenses of litigation, court costs, and attorney's fees, for injury or death
to any person, or injury to any property, received or sustained by any person or persons or
property, to the extent arising out of, related to or occasioned by, the negligent acts of the
Contractor, its agents, employees, and/or subcontractors, related to the performance,
operations or omissions under this agreement and/or the use or occupation of city owned
property. The indemnity obligation provided herein shall survive the expiration or
termination of this agreement.
-----INTENTIONALLY LEFT BLANK-----
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above written. Executed in triplicate.
CITY OF L BOCK
BY:
Daniel M. Pope, Mayor
ATTEST:
Rebe Garza, City Secreta
APP OVED AS TO CONTENT:
Lainey Morrison, Risk Manager
APPROVED AS TO FORM
Jeff Hartsel , D puty City Attorney
CONTRACTORS
Authorized Representative
Diannah Tatum, Co -CEO
Print Name
Heritage — RM, LLC dba Sanford & Tatum
Company Name
5241 981h Street
Address
Lubbock, TX
79424
City, State, Zip Code
BY:
Authorized Representative
Robb Pridemore
Print Name
USI Southwest, Inc.
Company Name
303 N. Oregon, Ste. 310
Address
El Paso TX 79901
City, State, Zip Code
Exhibit A
City of Lubbock, TX
RFP 21-15810-KM
Consulting and Broker Services for City Property and Casualty Insurance
GENERAL REQUIREMENTS
1 INTENT
It is the intent of the City to obtain proposals for professional property/casualty insurance
consultant/broker services to assist in the management of the City's various insured and self -
funded programs. Such services would include, but not be limited to the review, analysis,
recommendation, and placement of all insured and self -funded programs in the areas of
Property, Auto, General Liability, Law Enforcement Liability, Employment Practices
Liability, Public Officials Errors and Omissions, Airport Liability, Workers' Compensation,
Boiler & Machinery, as well as processing policy change endorsements, policy review
and audit. The City may determine that it is in its best interest to have the consultant/
broker prepare Requests for Proposals for its insurance needs. It is also the City's intent that
the successful broker shall put all lines of insurance in place, as listed in the scope of work,
to begin coverage on October 1, 2021, or at its renewal after that date. All insurance
policies obtained through the successful consultant/broker must be net of commission.
1 SCOPE OF WORK
A. Insurance Brokerage Services Included:
1. Represent the City in all negotiations with insurance providers on all issues including those
related to premiums, plan designs, and contracts;
2. Prepare applications and supporting documents based on data collected and direct input
from the City to solicit proposals/quotes for all insurance contracts, including but not
limited to third party administration and risk assessments;
3. Analyze and evaluate proposals/quotes received for renewals based on cost, claim payment
procedures, customer service, carrier reputation and financial responsibility and any other
unique or required features;
4. Provide proposals/quotes to City for insurance carriers whose Best's Rating is A-VII or
better, or in the event the carrier's Best's Rating does not meet this criteria, sufficient
rationale shall be presented to the City for approval prior to placement, however, nothing
in this Agreement shall make the Broker/Consultant responsible for the solvency of any
insurer with which it places City's risk;
5. Recommend to the City the most economical programs based on premium to transfer risk
relative to the amount of risk retained;
6. Provide City with sufficient information on all proposals/quotes received for all insurance
contracts; and
7. Provide due diligence marketing report for each line of coverage marketed.
B. Execution of Contracts and Agreements Included:
1. Ensure that contracts from insurance providers are executed and delivered as expeditiously
as possible upon payment of premiums by the City;
2. Review and ensure the accuracy and correctness of insurance contracts prior to delivery to
City; and
3. Assist in resolution of conflicts with insurance carriers that may arise during the term of
the contracts.
C. Presentations and Meetings Included:
1. Prepare and present insurance placement to Executive Management and Council;
2. Prepare and present stewardship reports to Executive Management and Council as
requested, however no more than biannually;
3. Meet with Executive Management as needed for special or unique circumstances; and
4. Confer, in person, by phone or email, with Risk Management, as necessary, to assure
the delivery of Services.
D. Consultation Included:
1. Provide resources, as necessary, to advise City on various insurance matters;
2. Assist City with risk transfer/retention for contracts, leases and bonds;
3. Conduct biannual claim reviews with Executive Management and/or Risk Management
to identify potential loss control measures that would be beneficial to the City; and
4. Analyze City's loss exposure and advise the City of any inadequacies of coverage in
existing policies and make appropriate recommendations.
5. Explore options, and upon City's approval, place coverages not currently purchased by
the City
E. Other Requirements Included:
1. Performing required services on a timely basis;
2. Providing timely, comprehensive and clear reporting;
3. Prepare Certificate of Insurance forms as requested by the City;
4. Coordinate special projects requested by the City; and
5. Obtain insurance company loss runs as requested by the city.
F. Current City insurance policies anticipated for renewal:
1. Municipal package excess liability to include; general liability, automobile liability with
UM/UIM and med pay, law enforcement liability, public officials errors and omissions,
employee benefits administration, and employment practices liability;
2. Property insurance;
3. Property insurance for Montford Dam;
4. Inland marine insurance including fine arts, radio towers, and broadcasting and sound
equipment;
5. Boiler and machinery insurance;
6. Crime insurance
7. Airport liability insurance with airport owner's liability and non -owned aircraft liability
8. Pipeline liability insurance
9. Tenant user lease insurance policy (TULIP)
10. Workers' compensation
11. Cyber liability
12. Med Mal
13. UAV coverage
The City recognizes the following:
SERVICES
The services to be provided by the Broker/Consultant hereunder are provided for the
exclusive benefit of City. The services, recommendations, proposals, and information
provided by the Broker/Consultant are not to be distributed to, used by, or relied upon by
other parties. Furthermore, if the services to be provided by the Broker/Consultant
hereunder shall be deemed by City to apply to any insurance policy/policies in effect prior
to the Effective Date of this Agreement, then the Broker/Consultant's services shall not be
assumed by City to remedy or resolve any deficiencies in such policy/policies. The
Broker/Consultant will neither assume nor accept liability for any deficiencies, errors, or
oversights inherent in such policy/policies until such time as the Broker/Consultant has
had adequate opportunity to review such policy/policies and to provide recommendations
to City concerning same.
The services described above are the only services to be provided by the Broker/Consultant
to City under this Agreement. Any additional services requested by City, and the
corresponding compensation therefore, shall be separately negotiated by the
Broker/Consultant and City.
Notwithstanding the foregoing, to the extent that state law prohibits value added services
that are unrelated to the insurance products being sold, this Agreement may be modified
so that the scope of services and the corresponding compensation therefore is compliant
under state law.
2. INSURER SOLVENCY
The Broker/Consultant does not guarantee the solvency of any insurer with which it places
City's risks.
3. RECORD RETENTION
The Broker/Consultant will retain its records of all matters relating to this Agreement in
accordance with the Broker/Consultant's record retention policy, (a copy of which will be
made available to City upon request), and all applicable laws and regulations.
4. OWNERSHIP OF WORK PRODUCT, TRADE SECRETS AND TRADEMARKS
The Broker/Consultant and City shall each retain individual ownership of all materials,
ideas, concepts, inventions, discoveries, plans, product names, proprietary information,
patents, copyrights, documents, data, programs, training materials, slogans, artwork,
research data and results and marketing designs that each provides to this consulting effort
(the "Existing Materials"). All Existing Materials shall be subject to the terms and
conditions of the confidentiality provisions contained herein. Any and all ideas, concepts,
inventions, discoveries, plans, product names, proprietary information, patents,
copyrights, documents, data, programs, training materials, slogans, artwork, research data
and results and marketing designs (the "Work Product") conceived or developed between
the Broker/Consultant and City hereunder, to the extent that such Work Product is distinct
from the individually -owned Existing Materials, shall become the sole and exclusive
property of City. City agrees to hereby grant the Broker/Consultant an unlimited non-
exclusive license to use the Work Product, which license shall include use among the
Broker/Consultant's affiliates.
CONFIDENTIAL INFORMATION
"Confidential Information" shall mean non-public information revealed by or through a
party to this Agreement (a "Disclosing Party") to the other party (a "Receiving Party")
including (a) information expressly or implicitly identified as originating with or
belonging to third parties, or marked or disclosed as confidential, (b) information
traditionally recognized as proprietary trade secrets, and (c) all forms and types of
financial, business (including customer information), scientific, technical, economic, or
engineering information, including patterns, plans, compilations, program devices,
formulas, designs, prototypes, methods, techniques, processes, procedures, programs or
codes, whether tangible or intangible, and whether or how stored, compiled, or
memorialized physically, electronically, graphically, photographically, or in writing.
A. As to any Confidential Information disclosed by the Disclosing Party to the Receiving
Party, the Receiving Party will take reasonable precautions in accordance with procedures
it follows with respect to its own important confidential information to prevent disclosure,
directly or indirectly, of all or any portion of the Confidential Information.
B. Except as may be required by law or legal process, the Receiving Party agrees not to
otherwise use the Confidential Information obtained hereunder in the absence of written
permission received from the Disclosing Party. The Receiving Party further agrees to
return to Disclosing Party all Confidential Information received hereunder upon written
request therefore.
C. The obligations hereunder remain in full force and effect until and unless: (a) the Receiving
Party can show that such Confidential Information was in the Receiving Party's possession
prior to the date of the disclosure by Disclosing Party; or (b) such Confidential Information
was obtained by the Receiving Party after the date of this Agreement from a party other
than Disclosing Party, and the Receiving Party has no knowledge that said party is under
an obligation of confidentiality to the Disclosing Party with respect to such information;
or (c) such Confidential Information becomes generally available to the trade, or to the
public, through sources other than Receiving Party; or (d) such Confidential Information
is developed at any time by the Receiving Party independent of information or materials
disclosed by Disclosing Party to the Receiving Party.
D. In the event that the Receiving Party is requested or required (by oral questions,
interrogatories, requests for information or documents, subpoena, civil investigative
demand or similar process) to disclose any Confidential Information furnished by the
Disclosing Party, it is agreed that the Receiving Party will cooperate with the Disclosing
Party and provide the Disclosing Party with prompt notice of such request(s) or
requirement(s) so that the Disclosing Party may seek an appropriate protective order, at its
sole cost, or waive compliance by the Receiving Party with the provisions of this
Agreement. If, in the absence of a protective order or the receipt of a waiver hereunder, the
Receiving Party is nonetheless, in the opinion of the Receiving Party, legally required to
disclose the Confidential Information forwarded by the Disclosing Party, the Receiving
Party may disclose such information without liability hereunder, provided, however, that
the Receiving Party shall disclose only that portion of such Confidential Information which
it considers that it is legally required to disclose.
E. Upon termination of this Agreement, or upon Disclosing Party's earlier request, Receiving
Party shall promptly deliver to Disclosing Party all Confidential Information and any other
material which Disclosing Party furnishes to Receiving Party in connection with this
Agreement.
Exhibit B
City of Lubbock, TX
RFP 21-15810-KM
Consulting and Broker Services for City Property and Casualty Insurance
Proposal Price Sheet
(To be completed and returned with Proposal)
Price Sheet
Proposer's Name: USI Insurance: Sanford and Tatum
Pricing shall be in a firm fixed price for the term of the contract.
Unit
ITEM
QTY
of
ADESCRIPTION
TOTAL COST
(+/-)
Measure
1.
1
Annually
Annual Fee for all coverages, as specified herein.
$ 75,000
Prepared by: Robb Pridemore Diannah Tatum
Title: USI President El Paso Co -CEO
Date: 03-31-2021 0 - 1-2021
Exhibit C
INSURANCE REQUIREMENTS
291. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance
Certificate to the City, which shall be completed by an agent authorized to bind the named
underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall
furnish and contain all required information referenced or indicated thereon. THE CITY SHALL
HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH
CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY.
292 The City reserves the right to review the insurance requirements of this section during the effective
period of the contract and to require adjustment of insurance coverages and their limits when deemed
necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims
history of the industry as well as the Contractor.
293. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are approved
by the City, the Contractor shall obtain and maintain in full force and effect for the duration of this
contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by
companies approved by the State of Texas and acceptable to the City, in the following type(s) and
amount(s):
TYPE OF INSURANCE
GENERAL LIABILITY
® Commercial General Liability ❑ Other
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
® To Include Products of Complete Operation Endorsements
® PROFESSIONAL LIABILITY
® CYBER LIABILITY
AUTOMOTIVE LIABILITY
® Any Auto
❑ Scheduled Autos
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form
GARAGE LIABILITY
❑ All Owned Autos
❑ Hired Autos
COMBINED SINGLE LIMIT
General Aggregate $2,000,000
Products-Comp/Op AGG X
Personal & Adv. Injury X
Contractual Liability X
Fire Damage (Any one Fire)
Med Exp (Any one Person) _
General Aggregate $2,000,000
General Aggregate $2,000,000
Combined Single Limit
Each Occurrence $1,000,000
Each Occurrence
Aggregate
❑ Any Auto Auto Only - Each Accident
Each Accident Aggregate
❑ BUILDER'S RISK ❑ 100° o of the Total Contract Price
❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs
❑ POLLUTION
❑ CARGO
® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY $1,000,000
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.
® To inchide products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Lubbock on all coverages, except
IMPORTANT: POLICY ENDORSEMENTS
The Contractor will provide copies of the policies without expense, to the City and all endorsements thereto
and may make any reasonable request for deletion, revision, or modification of particular policy terms,
conditions, limitations, or exclusions (except where policy provisions are established by law or regulation
binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by the
City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall
pay the cost thereof. Any costs will be paid by the Contractor.
REQUIRED PROVISIONS
The Contractor agrees that with respect to the above required insurance, all insurance contracts and
certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following
required provisions:
a. Name the City of Lubbock and its officers, employees, and elected representatives as additional
insureds, (as the interest of each insured may appear) as to all applicable coverage;
b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change;
c. Provide for notice to the City at the address shown below by registered mail;
d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees,
and elected representatives for injuries, including death, property damage, or any other loss to
the extent same may be covered by the proceeds of insurance;
e. Provide that all provisions of this contract concerning liability, duty, and standard of care together
with the indemnification provision, shall be underwritten by contractual liability coverage
sufficient to include such obligations within applicable policies.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less
than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF
INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing & Contract Management
City of Lubbock
1314 Avenue K, Floor 9
Lubbock, Texas 79401
294 Approval, disapproval, or failure to act by the City regarding any insurance supplied by the
Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents
as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability
by the insurance company exonerate the Contractor from liability.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
1
CERTIFICATION OF FILING
Certificate Number:
2021-730707
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Heritage-RM, LLC dba Sanford & Tatum
Lubbock, TX United States
Date Filed:
03/25/2021
2
Name of governmental entityor state agency that is a party tot the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
04/21/2021
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
RFP 21-15810-KM
Property & Casualty Insurance
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5
Check only if there is NO Interested Party. ❑
6
UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
runny piuviueu by i exas ttnics t.,ommission www.etnics.state.tx.us Version V1.1.ceffd98a
CERTIFICATE OF INTERESTED PARTIES FORM 1295
l of l
Complete Nos. 1- 4 and 6 if there are Interested parties.
OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 it there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
2021-730707
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Heritage-RM, LLC dba Sanford & Tatum
Lubbock, TX United States
Date Filed:
03/25/2021
2 Name of governmental entity or state agency that Is a party tot the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
RFP 21-15810-KM
Property & Casualty Insurance
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there Is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is Diannah Tatum and my date of birth is
My address is 5241 98th Street f .tihhnck TX 79424 USA
(street) (city) (state) (zip codo) (country)
I declare under penalty of perjury that the foregoing Is true and correct.
Executed in Lubbock county, State or 'Texas on the201h day of April 20 21
-(yea-- —•
(month)' r)
`
Signature of authorized agent of contracting business entity
(Doderant)
v...... t. ....1.1. l.y , a...J L111.ya yV1111111aWW11 Www.etnics.state.tx.us Version Vl.l.ceffd98a
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
2021-741054
i Name of business entity filing form, and the city, state and country of the business entity's place
of business.
USI Southwest, Inc.
El Paso, TX United States
Date Filed:
04/20/2021
2 Name of governmental entity or state agency that Is a party tot the contract for which the orm is
being filed.
City of Lubbock
Date Acknowledged:
04/21/2021
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
15810
Consulting and Broker Services for City Property and Casualty Insurance
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
rurms proviaeu Dy i exas units .�ornmission www.etnlcs.state.tx.us Version V1.1.ceffd98a
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
2021-741054
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
USI Southwest, Inc.
El Paso, TX United States
Date Filed:
04/20/2021
2 Name of governmental entity or state agency that is a parry tot the contract for is t e form is
being filed.
City of Lubbock
Date Acknowledged:
3 Provide the Identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
15810
Consulting and Broker Services for City Property and Casualty Insurance
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 UNSWORN DECLARATION
My name is Robb Pridemore and my date of birth is
My address is 303 N. Oregon, Suite 310 El Paso TX 79901 USA
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in El Paso County, State of Texas , on the 20th day of April 20 21
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
vnna Nivviucu uy 1 cxcw r-uncs %,umrnission www.etrncs.state.tx.us Version V1.1.ceffd98a