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New Hampshire Department of Health and Human ServicesMaintenance and Repair of Commercial Kitchen EquipmentState of New HampshireDepartment of Health and Human ServicesAmendment #1 to the Maintenance and Repair ofCommercial Kitchen Equipment ContractThis 1st Amendment to the Maintenance and Repair of Commercial Kitchen Equipment contract(hereinafter referred to as "Amendment #1") dated this 11th day of March, 2019, is by and between theState of New Hampshire, Department of Health and Human Services (hereinafter referred to as the "State"or "Department") and ITW Food Equipment Group LLC (hereinafter referred to as "the Contractor"), aLimited Liability Corporation with a place of business at 701 South Ridge Avenue, Troy, OH 45374.WHEREAS, pursuant to an agreement (the "Contract") approved by the Governor and Executive Councilon August 22, 2018, (Item #8), the Contractor agreed to perform certain services based upon the termsand conditions specified in the Contract as amended and in consideration of certain sums specified; andWHEREAS, the State and the Contractor have agreed to make changes to the scope of work, paymentschedules and terms and conditions of the contract; andWHEREAS, pursuant to Form P-37, General Provisions, Paragraph 18, and Exhibit C-1, Revisions toGeneral Provisions Paragraph 6; the State may modify the scope of work and the payment schedule ofthe contract upon written agreement of the parties and approval from the Governor and Executive Council;andWHEREAS, the parties agree to extend the term of the agreement and increase the price limitation tosupport the continued delivery of these services; andNOW THEREFORE, in consideration of the foregoing and the mutual covenants and conditions containedin the Contract and set forth herein, the parties hereto agree to amend as follows:1. Form P-37 General Provisions, Block 1.3, Contractor Name to read:ITW Food Equipment Group LLC.2. Form P-37 General Provisions, Block 1.7, Completion Date, to read:June 30, 2021.3. Form P-37, General Provisions, Block 1.8, Price Limitation, to read: 57,000.4. Form P-37, General Provisions, Block 1.9, Contracting Officer for State Agency, to read:Nathan D. White, Director.5. Form P-37, General Provisions, Block 1.1 0, State Agency Telephone Number, to read:603-271-9631.6. Amend Exhibit A, Scope of Services; Section 2., Scope of Services; Subsection 2.2 to read:2.2The Contractor shall schedule quarterly preventative maintenance with the New HampshireHospital Director of Food and Nutrition Services.7. Delete Exhibit A-1 Kitchen Equipment List and replace with Exhibit A-1 -Amendment #1 KitchenEquipment List.8. Delete Exhibit B, Methods and Conditions Precedent to Payment; in its entirety and place withExhibit B- Amendment #1 Methods and Conditions Precedent to Payment.11W Food Equipment Group LLCSS-2018-NHH-08-KITCHAmendment #1Page 1 of 3
New Hampshire Department of Health and Human ServicesMaintenance and Repair of Commercial Kitchen EquipmentThis amendment shall be effective upon the date of Governor and Executive Council approval.IN WITNESS WHEREOF, the parties have set their hands as of the date written below,State of New HampshireDepartment of Health and Human Servicescik'J JC(Chief Executive Officer, NHHITW Food Equipment Group LLCNd .s---L/-/9DateTitle: Acknowledgement of Contractor's signature:L/ l,State ofN ·County of ltJ on ,-)'.-jbefore the undersigned officer,personally appeared the person identified directly above, or satisfactorily proven to be the person whose name issigned above, and acknowledged that s/he executed this document in the capacity indicated above.tf,:-.\\\\\1111111 II If1e'(\, \?\b.c.""'''''t. '" fi.\N.J ·/:)''- . o\c.'( 'f. Name and Title of Notary or Justice of the Peace\\·· jf)! cOA y'rf-i1," · ;-z · ./ s ' : t't\· ;. . o: -- ·· ' t .: §- oY.q"·,fUB'-' ;V·· y §My Commission Expires: ::::::: :.:::: 23 124: "-4N. Pf. 'ISs!.0. ,,,,,,'J!,;s·ti\ ,.#./iflllll\\1\\\\\\'1:ITW Food Equipment Group LLCSS-2018-NHH-08-KITCHAmendment #1Page 2 of 3
New Hampshire Department of Health and Human ServicesMaintenance and Repair of Commercial Kitchen EquipmentThe preceding Amendment, having been reviewed by this office, is approved as to form, substance, and execution.OFFICE OF THE ATTORNEY GENERALt;fjj ZDIV.Date'Title:S(;xtJ.J.Pt.JA--wy.l;;I hereby certify that the foregoing Amendment was approved by the Governor and Executive Council of the Stateof New Hampshire at the Meeting on:(date of meeting)OFFICE OF THE SECRETARY OF STATEDate11W Food Equipment Group LLCSS-20 18-N HH-08-KITC HName:Title:Amendment #1Page 3 of 3
S·,:·) ::·!···r·51 STATE OF NEW HAMPSHIREDEPARTMENT OF HEALTH AND HUMAN SERVICESNEW HAMPSHIRE HOSPITAL36 CLINTON STREET, CONCORD, NH 03301603-271-5300 1-800-852-3345 Ext. 5300Fax: 603-271-5395 TDD Access: 1-800-735-2964www.dhhs.nh.govJeffrey A. MeyersCommissionerLori A. ShibinetteChief Executive OfficerJune 4, 2019His Excellency, Governor Christopher T. Sununuand the Honorable CouncilState HouseConcord, New Hampshire 03301REQUESTED ACTIONAuthorize the Department of Health and Human Services, New Hampshire Hospital, to exercisea renewal option and amend an existing sole source agreement with ITW Food Equipment Group LLC(Vendor #168818), 701 South Ridge Avenue, Troy OH 45374, to provide maintenance and repair on thecommercial kitchen equipment at New Hampshire Hospital by increasing the price limitation by 40,000from 17,000 to 57,000 and by extending the completion date from June 30, 2019 to June 30, 2021,effective upon Governor and Executive Council approval. 30% Other Funds, 70% General Funds.This agreement was originally approved by the Governor and Executive Council on August 22,2018 (Item #8).Funds are anticipated to be available in State Fiscal Year 2020 and SFY 2021, upon theavailability and continued appropriation of funds in the future operating budget, with authority to adjustamounts within the price limitation and adjust encumbrances between State Fiscal Years through theBudget Office if needed and justified.05-95-94-940010-8410 HEALTH AND SOCIAL SERVICES DEPT OF HEALTH AND HUMAN SVCS,HHS: NEW HAMPSHIRE HOSPITAL, NEW HAMPSHIRE HOSPITAL, NHH aintenance Other ThanBuildings and GroundsMaintenance Other ThanBuildings and GroundsMaintenance Other ThanBuildings and GroundsActivityCode94026400CurrentBudget 17,000Increase/(Decrease) 0ModifiedBudget 17,00094026400 0 20,000 20,00094026400 0 20,000 20,000Total:------- 17,000- - - -L 0,00'! L 57,00 EXPLANATIONThis request is sole source because the agreement originally approved by the Governor andExecutive Council on August 22, 2018 (Item #8) is sole source.
Exhibit A-1 -Amendment #1Kitchen Equipment ListTable 1: NHH APS Main KitchenQty.11112111111111111112EquipmentHobart Electric Pot WasherHobart Electric SlicerUnivex Electric Mixer (3o gal)Hobart MixerBlodget Gas OvensGroen Electric KettleTee Char-broilerPitco Gas FryerRobot CoupeSalvajor Electric Food Waste DisposerSalvajor Electric Food Water DisposerHobart Electric DishwasherMetro Food WarmerDelfield Steamers (4 wells, L-shaped)Dake Steam Table (4 wells)Vulcan SteamerVulcan Flat Top/ OvenVulcan Gas Range/ OvenVulcan Tilting SkilletVulcan Convection Ovens1Vulcan 6-Gas Top FTN/ADEE/4T-40T1361CSG14R301 Series D500N/AN/AFT900SC539-HDS USLT-4EP304MVSX56VGMT36S500N/AVG-30SG4D-11D1VGMT 365-50011 Hm012493141 45481704249481704250481704328----Table II: NHH APS Building Cafeteria Serving LineQty.1111111EquipmentHatco Glo Ray Electric Heated DisplayStar Max FryerWells Electric Serving CounterToast MasterStar Double Sided GrillContinental WarmerStar-Max Griddle (Electric)--ModelFST- /AGXS141212A000315224073 6CHSDN/AMW12201N/ATable Ill: Brown Building KitchenQty.111111EquipmentUnivex MixerHobart SlicerVulcan Char-BroilerHotCo Water BoosterSalvajor Food Waste DisposerVulcan Convection OvenITW Food Equipment Group 201712VCCB36-1C-24200GC04SExhibit A-1- Amendment #1Page 1 of 185721I-Contractor InitialsDatelM5-''-l/7
Exhibit A-1 - Amendment #1Kitchen Equipment List111111111Vulcan SteamerVulcan Range- Six BurnerVulcan GriddleCecilware Gas FryolaterRobot CoupeSalvajor Food Waste Disposerlnsinger 1 Rack Dishwasher (Hot Water)Metro Warmer CabinetCeilware Gas FryerITW Food Equipment Group LLC/Hobart55-2018-NHH-08-KITCHRev. 01/08/19VSX5N/AN/AN/AN/AN/AInstalled 2004Installed 2004Installed 2004200Commander 18-4C17551108970457CMZOOOInstalled 2004N/AExhibit A-1- Amendment #1Page 1 of 2N/AContractor InitialsDateA,s--L{--JCj
New Hampshire Department of Health and Human ServicesMaintenance and Repair of Commercial Kitchen EquipmentExhibit B- Amendment #1Method and Conditions Precedent to Payment1. The State shall pay the Contractor an amount not to exceed the Form P-37, Block 1.8, Price Limitationfor the services provided by the Contractor pursuant to Exhibit A, Scope of Services.2. This Agreement is funded with:2.1. General funds.2.2. Federal funds from the Social Security Act, Section 1923, Payment for Inpatient Hospital ServicesFurnished by Disproportionate Share Hospitals.2.3. Other Funds from Interagency and Agency Income.3. The Contractor agrees to provide the services in Exhibit A, Scope of Service in compliance with fundingrequirements. Failure to meet the scope of services may jeopardize the Contractor's current and/orfuture funding.4. Payment for services shall be made as follows:4.1. The Contractor shall submit invoices in a form satisfactory to the State for services specified inExhibit A, Scope of Services, as follows, upon Governor and Executive Council approval of theagreement:4.2. Standard invoices for quarterly Preventative Maintenance:4.2.1. The Contractor shall invoice the Department on a quarterly basis for preventativemaintenance services.4.2.2. The Contractor shall invoice the Department on a monthly basis for any repairs performedoutside of the preventative maintenance scope.4.3. Invoices for Repairs and Emergency Calls:4.3.1. The Contractor shall provide a written estimate for the cost of repairs in excess of onethousand dollars and zero cents ( 1 ,000.00) to the Department for approval prior tocompletion of repairs.4.3.2. The Contractor shall include a written summary of the work performed and materials used.4.3.3. The Contractor shall include a detailed summary of parts and labor.4.3.4. Emergency calls during regular business hours shall be charged at a rate of one hundrednineteen dollars and zero cents ( 119.00) per hour.4.3.5. Emergency calls outside of regular business hours shall be charged at a rate of onehundred seventy-eight dollars and zero cents ( 178.00) per hour.4.3.6. A Travel Fee will be charged at a rate of one hundred thirty-two dollars and zero cents( 132.00) per service call.11W Food Equipment Group LLCSS-2018-NHH-08-KITCHRev. 01/08/19Exhibit B- Amendment #1Page 1 of 2ContractorInitials Date S-t./ -/1
New Hampshire Department of Health and Human ServicesMaintenance and Repair of Commercial Kitchen EquipmentExhibit B- Amendment #14.4. The State shall make payment to the Contractor within thirty (30) days of receipt of each invoice,subsequent to approval of the submitted invoice and if sufficient funds are available. TheContractor shall keep detailed records of their activities related to DHHS-funded programs andservices.4.5. The final invoice shall be due to the State no later than forty (40) days after the contract Form P37, Block 1.7 Completion Date.4.6. Invoices must be submitted to:New Hampshire Hospital - Office of Financial ServicesDepartment of Health and Human Services36 Clinton StreetConcord, NH 033015. Review of the State Disallowance Costs: At any time during the performance of the Services, the Statemay review all Project Costs incurred by the Contractor and all payments made to date. Upon suchreview, the State shall disallow any items of expenses that are determined not allowable or aredetermined to be in excess of actual expenditures and shall, by written notice, specify the disallowedexpenditures, inform the Contractor of any such disallowance.6. Payments may be withheld pending receipt of required reports or documentation as identified in ExhibitA, Scope of Services and in this Exhibit B - Amendment #1.7. Notwithstanding anything to the contrary herein, the Contractor agrees that funding under this Contractmay be withheld, in whole or in part, in the event of noncompliance with any State or Federal law, ruleor regulation applicable to the services provided, or if the said services have not been completed inaccordance with the terms and conditions of this Agreement.8. Notwithstanding paragraph 18 of the General Provisions P-37, changes limited to adjusting amountsbetween budget line items, related items, amendments of related budget exhibits within the pricelimitation, and to adjusting encumbrances between State Fiscal Years, may be made by writtenagreement of both parties and may be made without obtaining approval of the Governor and ExecutiveCouncil.llW Food Equipment Group LLCSS-2018-NHH-08-KITCHRev. 01/08/19Exhibit B - Amendment #1Page 2 of 2Contractor InitialsDateMs-t.f-fCj
State of New HampshireDepartment of StateCERTIFICATEI, William M. Gardner, Secretary of State of the State of New Hampshire, do hereby certify that ITW FOOD EQUIPMENTGROUP LLC is a Delaware Limited Liability Company registered to transact business in New Hampshire on February 19, 2002. Ifurther certify that all fees and documents required by the Secretary of State's office have been received and is in good standing asfar as this office is concerned.Business ID: 397257Certificate Number : 0004522224IN TESTIMONY WHEREOF,I hereto set my hand and cause to be affixedthe Seal of the State of New Hampshire,this 28th day of May A.D. 2019. William M. GardnerSecretary of State
CERTIFICATE OF VOTE/AUTHORITYI, Brenda F. Wilson of ITW Food Equipment Group LLC do hereby certify that:1. I am the Assistant Secretary of ITW Food Equipment Group LLC:This Limited Liability Company may enter into any and all contracts, amendments, renewals,revisions or modifications thereto, with the State of New Hampshire, acting through itsDepartment of Health and Human Services.RESOLVED: That the Branch Manager is hereby authorized on behalf of this company to enterinto said contracts with the State, and to execute any and all documents, agreements, and otherinstruments, and any amendments, revisions, or modifications thereto, as he/she may deemnecessary, desirable or appropriate, and Debbie Alves is the duly elected Branch Manager ofthe Limited Liability Company.2. The foregoing resolutions have not been amended or revoked and remain in full force and effectas of this 5th day of June, 2019.IN WITNESS WHEREOF, I have hereunto set my hand as the Assistant Secretary of thecompany this 5th day of June, 2019.1!Jtt11 dtL {l)d nUBrenda F. WilsonAsst. SecretaryITW Food Equipment Group LLCSTATEOFOh;oCOUNTYOFffi,Am'q,before the undersigned officer, personally appeared the person identifiedOn -:kttJ e. S d.O/directly above, or satisfactorily proven to be the person whose name is signed above, andacknowledged that s/he executed this document in the capacity indicated above.i:v() i. Signature of Notary or Justice of the PeaceNotary Sealf'fo-1-aev f u L/cm tfe of Notary or Justice of PeaceMy Commission Expires:J (; 7 (ao J-1IIw:tallADENOI'ARY fltiU · OHIOtit COIIIISSKIC EliPI S 03-17·21R1RECORDED .,. aum
ICERTIFICATE OF LIABILITY INSURANCEDATE (MM/DDIYYYY)06/03/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( ), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).CONTACTPRODUCERNAME:MARSH USA INC.I {AteFAX:;:)g N o. Extl:Nol:540 W. MADISONE-MAILCHICAGO, IL 60661ADDRESS:Attn: ITW.CertRequest@Marsh.com or Fax: 212-948-0300INSURE AFFORDING ER A : Zurich American Insurance CompanyINSURED40142INSURER B: American Zurich Insurance Com ll ai}YILLINOIS TOOL WORKS INCINSURERC:ITW FOOD EQUIPMENT GROUP LLCATTN: VICKI LADEINSURERD:701 S. RIDGE AVENUEINSURERE:TROY, OH ERAGESCERTIFICATE NUMBERREVISION NUMBER: 2THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.ADDL SUBRINSRTYPE OF INSURANCELIMITS.INSO ·wvnPOLICY NUMBERil;m-J% 1 11;gMg LTRA X COMMERCIAL GENERAL LIABILITY11/01/201911/01/2018GLO 9441382-043,000,000 EACH OCCURRENCEc--DAMAGE TO RENTED500,000 CLAIMS-MADEOCCURPREMISES (Ea occurrence)10,000SIR 1,000,000 MED EXP (Any one person)xr--00 'LAGGREGATE LIMIT APPLIES PER:POLICY DPROJECT DLOGIA 2,000,000GENERAL AGGREGATE 4,000,000PRODUCTS- COMP/OP AGGPRODUCTS- OCCUR 4,000,0004,000,000 g;'d INGLE LIMIT 3,000,000BODILY INJURY (Per person) PERSONAL & ADV INJURYOTHER:AUTOMOBILE LIABILITYBAP 9373447-1511/01/201811/01/2019XANYAUTOr-- OWNEDONLYr-- AUTOSHIREDr-- AUTOS ONLYr--UMBRELLA LIABEXCESS LIAB,-- SCHEDULEDAUTOSNON-OWNEDr-- AUTOS ONLYBODILY INJURY (Per accident) iP ? c de gAMAGEHOCCURCLAIMS-MADElWC 9373451-16 (AOS Ded)y 1N0 EACH OCCURRENCE N/AIwe 9373452-16 (Retro- WI, MA)11/01/ 01811/01/201911/01/201811/01/2019l IOTHX ffTuTEERE.L. EACH ACCIDENTII500,000 AGGREGATEI IRETENTION OEDB IWORKERSCOMPENSATIONAND EMPLOYERS' LIABILITYA ANYPROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH)If yes, describe underDESCRIPTION OF OPERATIONS below COMP/COLL DED 1,000,000E.L DISEASE- EA EMPLOYEE 1,000,000 1,000,000E.L. DISEASE- POLICY LIMITIIDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)ITW FOOD EQUIPMENT GROUP LLC INCLUDES THE FOLLOWING AS INSUREDS: HOBART (SUCCESSOR TO HOBART CORPORATION), HOBART SERVICE, HOBART BAKERY SYSTEMS, BAXTERMANUFACTURING, TRAULSEN, ITW REFRIGERATION, VULCAN FOOD EQUIPMENT GROUP (FKA VULCAN-HART), AVERY BERKEL, BERKEL, CRIMSCO, GAYLORD INDUSTRIES, KAIRAK, SOMAT,STERO, WITT CO FOODSERVICE EQUIPMENT, WOLF, PEERLESS FOOD EQUIPMENT.DOES NOT INCLUDE INDEPENDENT CONTRACTORS D/B/A HOBART SALES & SERVICE.INSURANCE COVERAGE IS SUBJECT TO POLICY EXCLUSIONS, POLICY TERMS AND CONDITIONS.III----CANCELLATIONCERTIFICATE HOLDERSTATE OF NEW HAMPSHIREDEPARTMENT OF HEALTH AND HUMAN SERVICES129 PLEASANT ST.CONCORD, NH 03301SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.AUTHORIZED REPRESENTATIVEof Marsh USA Inc.Manashi Mukherjee VUJoOk.L 1988-2016 ACORD CORPORATION. All rights res
1 Salvajor Food Waste Disposer Exhibit A-1 - Amendment #1 Kitchen Equipment List VSX5 N/A N/A N/A N/A 200 1 lnsinger 1 Rack Dishwasher (Hot Water) Commander 18-4 1 Metro Warmer Cabinet 1 Ceilware Gas Fryer ITW Food Equipment Group LLC/Hobart 55-2018-NHH-08-KITCH Rev. 01/08/19 C175 N/
