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Boulder Indoor Soccer, Inc - 20210630-8077 ServiceOULDER ORK ExcellenceforInspiredFuture STANDARD Contract Routing Cover Sheet Please print and attach to your document You can view the status of your contract using the Contract Tracking Status Page. Routing Number 20210630-8077 Originating Dept Parks & Recreation Contact Person Charlotte O'Donnell Phone Number 3034137223 Project Manager / Contract Megann Lohman E-mail lohmanm@bouldercolorado.gov Administrator Counter Parties Boulder Indoor Soccer Contract Title / Type First Amendment to Services Contract for a Recreation Program Number Description Extension of service contract for Boulder Indoor Soccer through June 30, 2022. Special Instructions Amount Expense Type INCOMING • Dept. Head Signature NOTE; Originating Department: Identify with a check mark all areas document needs to be routed. • Purchasing • Budget • Sales Tax • CAO I _I_ -- • City Manager • Central Records Contract Tracking Home I Signature Routing Form I Track Contract Status I Update Contract Status FIRST AMENDMENT TO SERVICES CONTRACT FOR A RECREATION PROGRAM DATED SEPTEMBER 2,2020 This First Amendment is made as of the `LZ day of �LItic 2021_1 by and between the City of Boulder, Colorado, a Colorado home rule municipality("City"), and Boulder Indoor Soccer, Inc. a Colorado corporation ("Contractor"). The City and Contractor may hereinafter be referred to individually as a"Party" or collectively as the "Parties." A. The Parties entered into a contract for recreation program services (the "Contract") dated September 2, 2020, for Contractor to provide adult soccer recreational programming on behalf of the City;and B. The Parties wish to amend the terms of the Contract to extend the term to June 30, 2022 and to clarify the promises and obligations of the Parties. NOW THEREFORE, in consideration of the promises and obligations set forth below, the Parties agree to amend the Contract as follows: 1. By this First Amendment, the Parties agree to extend the term of the Contract through June 30, 2022. A certificate of insurance shall be provided to the City evidencing coverage for the extended term of the Contract. 2. Except as amended herein,the Contract shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 1 IN WITNESS WHEREOF, the Parties to this First Amendment have caused it to be executed by their authorized officers as of the day and year first above written. This First Amendment may be executed in counterparts, each of which shall be original, but all of which together shall constitute a fully binding and executed First Amendment. CONTRACTOR By: Print Name: a�+-���� Title: C)z,..r /?._!ai�/a• CITY OFBOULDER 61 — City Manager ATTEST: 4AL tz City Clerk APPROVED AS TO FORM: City Att Y's Office T 2 r �w�_ DATE(MM/DD/YYYY) AC"1?6 CERTIFICATE OF LIABILITY INSURANCEF�� 6,2H/2oz I 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 Phone: (804)354-9020 CONTACT Jane Greenwood Fax: (866)352-1401 NAME: PHOThe Monument Sports Group A/C NNo Ext: aC No): 1365 Overbrook Road ADDRESS: Jane@monumentsports.com Suite#1 INSURER(S)AFFORDING COVERAGE NAIC# Richmond,Virginia 23220 INSURER A: The Hanover Insurance Company 22292 INSURED INSURER B: Boulder Indoor Soccer Inc;BIS Holdings LLC INSURER C: 3203 Pearl Street INSURER D: Boulder,CO 80301 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2977 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYYY W MM/DD/YY ✓ COMMERCIAL GENERAL LIABILITY ZBR901148710 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 A AMAGE ToRETE CLAIMS-MADE [.,,I OCCUR 'PREMISES Ea occurrence $ 1,000,000 ✓ Incl Participants MED EXP(Any one person) $ EXC u e PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 ✓ POLICY1:1 PRO ❑ LOC PRODUCTS-COMP/OP AGG $ Included PRO- OTHER: Abuse/Mol $ 1,000,000 AUTOMOBILE LIABILITY ZBR 9011487 10 2/1/2021 2/1/2022 COMBINED SINGLE LIMIT $ 1,000,000 A Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident ✓ UMBRELLA LIAB ✓ OCCUR UHR D174138 04 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB 1,000,000 CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ff yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate holder is named as additional insured if required by written contract per form #421-2915. This certificate is issued in reference to the named insured's operations and subject to the terms, conditions and other provisions of the policies. CERTIFICATE HOLDER CANCELLATION Holder's Nature of Interest:Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Boulder Parks and Roc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5660 Sioux Dr Boulder,CO 80303 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r � 777,2021 AC"1?6 w�_ CERTIFICATE OF LIABILITY INSURANCEM/DD/YYYY) `� 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 Phone: (804)354-9020 CONTACT Jane Greenwood Fax: (866)352-1401 NAME: PHOThe Monument Sports Group A/C NNo Ext: aC No): 1365 Overbrook Road ADDRESS: Jane@monumentsports.com Suite#1 INSURER(S)AFFORDING COVERAGE NAIC# Richmond,Virginia 23220 INSURER A: The Hanover Insurance Company 22292 INSURED INSURER B: Boulder Indoor Soccer Inc;BIS Holdings LLC INSURER C: 3203 Pearl Street INSURER D: Boulder,CO 80301 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2977 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYYY W MM/DD/YY ✓ COMMERCIAL GENERAL LIABILITY ZBR901148710 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 A AMAGE ToRETE CLAIMS-MADE [.,,I OCCUR 'PREMISES Ea occurrence $ 1,000,000 ✓ Incl Participants MED EXP(Any one person) $ EXC u e PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 ✓ POLICY1:1 PRO ❑ LOC PRODUCTS-COMP/OP AGG $ Included PRO- OTHER: Abuse/Mol $ 1,000,000 AUTOMOBILE LIABILITY ZBR 9011487 10 2/1/2021 2/1/2022 COMBINED SINGLE LIMIT $ 1,000,000 A Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident ✓ UMBRELLA LIAB ✓ OCCUR UHR D174138 04 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB 1,000,000 CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ff yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate holder is named as additional insured if required by written contract per form #421-2915. This certificate is issued in reference to the named insured's operations and subject to the terms, conditions and other provisions of the policies. CERTIFICATE HOLDER CANCELLATION Holder's Nature of Interest:Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Boulder Parks and Roc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1777 Broadway Boulder,CO 80306 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD