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HomeMy WebLinkAboutC12-119 Taft Engineering, Inc. Agreement AGREEMENT BETWEEN EAGLE COUNTY AND TAFT ENGINEERING, INC.
THIS AGREEMENT is made this day of M , 2012, by and between Eagle County
( "County "), and, Taft Engineering, Inc. ( "Contractor "), a Colorado corporation with a principal place of
business at 9800 E. Easter Ave, Suite 130, Centennial, Colorado 80112.
WHEREAS, County desires to contract for preventive maintenance for the boilers and water heaters at the
Justice Center located at 885 Chambers and boilers at the Eagle County Building located at 550 Broadway,
Eagle, Colorado 81632 (the "Facility ").
WHEREAS, Contractor is authorized to do business in the State of Colorado, has experience and expertise
necessary to provide said product and /or services to County; and
WHEREAS, County and Contractor intend by this Agreement to set forth the scope of the responsibilities of
Contractor in connection with the services and related terms and conditions to govern the relationship between
Contractor and County in connection with this Agreement.
NOW, THEREFORE, in consideration of the foregoing premises and the following promises, County and
Contractor agree as follows:
ARTICLE 1— WORK
1.1 Contractor agrees to provide all services, labor, personnel and materials to perform and complete the
services set forth in Exhibit A and B (hereinafter "Services" or "Work ") which is attached hereto and
incorporated by this reference. Contractor will use its expertise, skill to perform the Services. In the event of
any conflict between the contents of this Agreement and Exhibit A and B, this Agreement shall control.
ARTICLE 2 — COUNTY'S REPRESENTATIVE
2.1 The Facilities Management Department designee, shall be Contractor's contact with respect to this
Agreement and the performance of the Services.
ARTICLE 3 — TERM OF AGREEMENT
3.1 This Agreement shall commence upon execution of this Agreement by both parties, and, subject to the
provisions of Article 11 hereof, shall continue in full force and effect until the Services are satisfactorily
completed in accordance with the terms of this Agreement.
ARTICLE 4 — COMPENSATION
4.1 For the Services to be provided hereunder, County will pay Contractor three thousand eight hundred
twenty five dollars ($3,825.00). This includes one thousand nine hundred seventy five dollars ($1,975.00)
for the Justice Center, Exhibit A, and one thousand eight hundred fifty dollars ($1,850.00) for the Eagle
County Building, Exhibit B. In the event Contractor and County agree upon the need for additional
maintenance or repair services beyond the services described in Exhibit A and B, those services shall be billed
at a rate of $95 per hour, plus material costs. Total compensation under this Agreement shall not exceed six
thousand three hundred twenty five dollars ($6,325.00) without a written amendment to this Agreement. In
the event of any conflict between the contents of this Agreement and Exhibit A and B, this Agreement shall
control.
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4.2 Payment will be made for Services satisfactorily performed within thirty (30) days of receipt of a proper
and accurate invoice from Contractor respecting the Services. The invoice shall include a description of
services performed. Upon request, Contractor shall provide County with such other supporting information as
County may request.
4.3 County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees
to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant
to the terms of this Agreement.
4.4 Notwithstanding anything to the contrary contained in this Agreement, no charges shall be made to the
County nor shall any payment be made to the Contractor in excess of the amount for any Services done without
the written approval in accordance with a budget adopted by the Board in accordance with provisions of the
Colorado Revised Statutes. Moreover, the parties agree that the County is a governmental entity and that all
obligations beyond the current fiscal year are subject to funds being budgeted and appropriated.
ARTICLE 5— CONTRACTOR'S REPRESENTATIONS
In order to induce County to enter into this Agreement, Contractor makes the following representations:
5.1 Contractor has familiarized itself with the nature and extent of the Services to be provided hereunder,
the Facility, and with all local conditions, and federal, state, and local laws, ordinances, rules and regulations
that in any manner affect cost, progress, or performance of the Services.
5.2 Contractor will make, or cause to be made, examinations, investigations, and tests as he deems
necessary for the performance of the Services.
5.4 To the extent possible, Contractor has correlated the results of all such observations, examinations,
investigations, tests, reports, and data with the terms and conditions of this Agreement.
5.5 To the extent possible Contractor, has given County written notice of all conflicts, errors, or
discrepancies that he has discovered in the Agreement.
5.6 Contractor will be responsible for provision of the Services and shall perform the Services in a skillful,
professional and competent manner and in accordance with the standard of care, skill and diligence applicable
to boiler and water heater maintenance and service. Further, in rendering the Services, Contractor shall comply
with the highest standards of customer service to the public. Contractor shall provide appropriate supervision of
its employees to ensure the Services are performed in accordance with this Agreement.
ARTICLE 6 — ENTIRE AGREEMENT
6.1 This Agreement represents the entire Agreement between the parties hereto. There are no Contract
Documents other than this Agreement and Exhibits A, B and C. The Agreement may only be altered, amended,
or repealed in writing.
ARTICLE 7 — MISCELLANEOUS
7.1 No assignment by a party hereto of any rights under, or interests in the Agreement will be binding on
another party hereto without the written consent of the party sought to be bound; and specifically, but without
limitation, moneys that may become due and moneys that are due may not be assigned without such consent
(except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to
the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from
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any duty or responsibility under the Agreement.
7.2 County and Contractor each binds itself, its partners, successors, assigns and legal representatives to the
other party hereto, in respect to all covenants, agreements, and obligations contained in this Agreement.
7.3 Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations
under this Agreement after, nor shall any payments be made to Contractor in respect of any period after
December 31 without an appropriation therefore by County in accordance with a budget adopted by the Board
of County Commissioners in compliance with Article 25, Title 30 of the Colorado Revised Statutes, the Local
Government Budget Law (C.R.S. § 29 -1 -101 et seq.) and the TABOR Amendment (Colorado Constitution,
Article X, Sec. 20).
7.4 Provision Mandated by C.R.S. § 8- 17.5 -101 et seq. PROHIBITIONS ON PUBLIC CONTRACT FOR
SERVICES
7.4.1 If Contractor has any employees or subcontractors, Contractor shall comply with C.R.S. § 8- 17.5 -101, et
seq., regarding Illegal Aliens — Public Contracts for Services, and this Contract. By execution of this Contract,
Contractor certifies that it does not knowingly employ or contract with an illegal alien who will perform under
this Contract and that Contractor will participate in the E -verify Program or other Department of Labor and
Employment program ( "Department Program ") in order to confirm the eligibility of all employees who are
newly hired for employment to perform Services under this Contract.
7.4.2 Contractor shall not:
(i) Knowingly employ or contract with an illegal alien to perform work under this contract for
services; or
(ii) Enter into a contract with a subcontractor that fails to certify to the Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under
the public contract for services.
7.4.3 Contractor has confirmed the employment eligibility of all employees who are newly hired for
employment to perform work under this Contract through participation in the E -verify Program or Department
Program, as administered by the United States Department of Homeland Security. Information on applying for
the E -verify program can be found at:
http://www.dhs.gov/xprevprot/programs/gc_1185221678150.shtm
7.4.4 The Contractor shall not use either the E -verify program or other Department Program procedures to
undertake pre - employment screening of job applicants while the public contract for services is being performed.
7.4.5 If the Contractor obtains actual knowledge that a subcontractor performing work under the public
contract for services knowingly employs or contracts with an illegal alien, the Contractor shall be required to:
(i) Notify the subcontractor and the County within three days that the Contractor has actual
knowledge that the subcontractor is employing or contracting with an illegal alien; and
(ii) Terminate the subcontract with the subcontractor if within three days of receiving the notice
required pursuant to subparagraph (i) of the paragraph (D) the subcontractor does not stop
employing or contracting with the illegal alien; except that the Contractor shall not terminate the
contract with the subcontractor if during such three days the subcontractor provides information
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to establish that the subcontractor has not knowingly employed or contracted with an illegal
alien.
7.4.6 The Contractor shall comply with any reasonable request by the Department of Labor and Employment
made in the course of an investigation that the department is undertaking pursuant to its authority established in
C.R.S. § 8- 17.5- 102(5).
7.4.7 If a Contractor violates these prohibitions, the County may terminate the contract for a breach of the
contract. If the contract is so terminated specifically for a breach of this provision of this Contract, the
Contractor shall be liable for actual and consequential damages to the County as required by law.
7.4.8 The County will notify the office of the Colorado Secretary of State if Contractor violates this provision
of this Contract and the County terminates the Contract for such breach.
7.5 Invalidity or unenforceability of any provision of this Agreement shall not affect the other provisions
hereof, and this Agreement shall be construed as if such invalid or unenforceable provision was omitted.
7.6 Contractor acknowledges that County has entered into this Agreement in reliance upon the particular
reputation and expertise of Contractor. Contractor shall not enter into any sub - consultant or sub - contractor
agreements for the performance of any of the Services or without County's prior written consent, which
may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to
approve all personnel assigned to perform the Work and no personnel to whom County has an objection, in
its reasonable discretion, shall be assigned. Contractor shall require each sub - consultant or sub - contractor,
as approved by County and to the extent of the Services to be performed by the sub - consultant or sub-
contractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all
the obligations and responsibilities which Contractor, by this Agreement, assumes toward County.
ARTICLE 8 - JURISDICTION AND VENUE:
8.1 This Agreement shall be interpreted in accordance with the laws of the State of Colorado and the parties
hereby agree to submit to the jurisdiction of the courts thereof. Venue shall be in the Fifth Judicial District for
the State of Colorado.
8.2 In the event of litigation between the parties hereto regarding the interpretation of this Agreement, or the
obligations, duties or rights of the parties hereunder, or if suit otherwise is brought to recover damages for
breach of this Agreement, or an action be brought for injunction or specific performance, then and in such
events, the prevailing party shall recover all reasonable costs incurred with regard to such litigation, including
reasonable attorney's fees.
ARTICLE 9 - INDEMNIFICATION:
9.1 The Contractor shall indemnify and hold harmless County and any of its officers, agents and employees
against any losses, claims, damages or liabilities for which County or any of its officers, agents, or employees
may become subject to, insofar as any such losses, claims, damages or liabilities arise out of, directly or
indirectly, this Agreement, or are based upon any performance or nonperformance by Contractor or any of its
subcontractors hereunder; and Contractor shall reimburse County for any and all attorney fees and costs, legal
and other expenses incurred by County in connection with investigating or defending any such loss, claim,
damage, liability or action. This indemnification shall not apply to claims by third parties against the County to
the extent that the County is solely liable to such third party for such claims without regard to the involvement
of the Contractor.
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ARTICLE 10 - OWNERSHIP OF DOCUMENTS AND MATERIALS:
10.1 All documents (including electronic files) and materials which are obtained during, purchased or
prepared in the performance of the Services shall remain the property of the County and are to be delivered to
County before final payment is made to Contractor or upon earlier termination of this Agreement.
ARTICLE 11 - TERMINATION:
11.1 County may terminate this Agreement, in whole or in part, for any reason, at any time, with or without
cause. Any such termination shall be effected by delivery to Contractor of a written notice of termination
specifying the date upon which termination becomes effective. In such event, Contractor shall be compensated
for all Services satisfactorily completed up to the date of termination for such Services.
ARTICLE 12 — NOTICE
12.1 Any notice required under this Agreement shall be personally delivered, mailed in the United States
mail, first class postage prepaid, or sent via facsimile provided an original is also promptly delivered to the
appropriate party at the following addresses:
The County: Eagle County Facilities Management
P.O. Box 850
Eagle, Colorado 81631
(970) 328 -8786 (p)
(970) 328 -8899 (f)
and a copy to: Eagle County Attorney
P.O. Box 850
Eagle, Colorado 81631
(970)328 -8685 (p)
(970) 328 -8699 (f)
The Contractor: Taft Engineering, Inc.
9800 E. Easter Ave., Suite 130
Centennial, Colorado 80112
(303) 753 -4584 (p)
(303) 941 -1199
12.2 Notices shall be deemed given on the date of delivery; on the date a FAX is transmitted and confirmed
received or, if transmitted after normal business hours, on the next business day after transmission, provided
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that a paper copy is mailed the same date; or three days after the date of deposit, first class postage prepaid, in
an official depositary of the U.S. Postal Service.
ARTICLE 13 — INDEPENDENT CONTRACTOR
13.1 It is expressly acknowledged and understood by the parties hereto that nothing contained in this
Agreement shall result in, or be construed as establishing, an employment relationship between County and
Contractor or County and Contractor's employees. Contractor and its employees shall be, and shall perform as,
independent contractors. No officer, agent, subcontractor, employee, or servant of Contractor shall be, or shall
be deemed to be, the employee, agent or servant of County. Contractor shall be solely and entirely responsible
for the means and methods to carry out the Services under this Agreement and for Contractor's acts and for the
5
acts of its officers, agents, employees, and servants during the performance of this Agreement. Neither
Contractor nor its officers, agents, subcontractors, employees or servants may represent, act, purport to act or be
deemed the agent, representative, employee or servant of County.
ARTICLE 14 — INSURANCE REQUIREMENTS
14.1 At all times during the term of this Agreement, Contractor shall maintain insurance on its own behalf in
the following minimum amounts:
14.1.1 Workmen's Compensation, disability benefits, and other similar employee benefit acts, with coverage
and in amounts as required by the laws of the State of Colorado.
14.1.2 Comprehensive Automobile Insurance shall be carried in the amount of $1,000,000 for bodily injury and
$1,000,000 for property damage, each occurrence. All liability and property damage insurance required
hereunder shall be Comprehensive General and Automobile Bodily Injury and Property Damage form of policy.
14.1.3 Comprehensive liability and property damage insurance issued to and covering Contractor and any
subcontractor with respect to all Work performed under this Agreement and shall also name County as an
additional insured, in the following minimum amounts:
Bodily Injury Liability:
Each Person: $1,000,000
Each Accident or Occurrence: $1,000,000
Property Damage Liability:
Each Accident or Occurrence: $1,000,000
14.2 Contractor shall purchase and maintain such insurance as required above and the certificate of insurance
is attached hereto as Exhibit C.
/ /SIGNATURE PAGE TO FOLLOW //
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above
written.
COUNTY OF EAGLE, STATE OF
COLORADO, by its County Manager
AV
By: - "�
Keith Montag
CONTRACTOR:
TAFT ENGINEERING, IN
r By: /
y.
Title: — Or aie--
CONTRACTOR IS REQUIRED TO HAVE ITS SIGNATURE NOTARIZED
STATE OF A16RIAC .L> _)
) ss.
COUNTY OF ' ' e )
The foregoing instrument was acknowledged before me by TrCt.C, UD►�ea)C , of
i►. �_ �r,� - ;. ..� , this ) day of , 2012.
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My co r fission expires: 11- 141-1V
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f.,/ Public
7
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ENGINEERING Manufacturers' Representative for High Efficiency HVAC &Plumbing Products
Quote: 020612PMCH -1 Date: 02 /06/12
Facility: Eagle County Justice Center
885 Chambers
Eagle, CO 81631
Attn: Eric Boley
We are pleased to provide pricing to perform annual style maintenance on the three Aerco BMK2.0(STD)
boilers and two Aerco KC1000 water heaters that serve the above mentioned facility, serial numbers
listed below.
Serial Numbers: G- 09- 0456,G- 09- 0594,G -09 -0595 & G- 09- 0450,G -09 -0451
Includes:
• New igniters & flame rods
• Combustion analysis and calibration as required
• Inspection and tightening of all electrical connections
• Inspection and cleaning of condensate traps and associated drain lines
• Testing of safety devices
Excludes: Repairs or parts to make any repairs other than the above mentioned
Pricing For The Above: $1,975.00 (One thousand nine hundred seventy five and No /100) Net Plus Tax
Due Upon Completion.
In the event of non - payment of all or part of the amount due to Taft Engineering LLC, Taft Engineering LLC shall be entitled to
payment of its attorney's fees and costs incurred in the collection process, together with interest at the rate of 1.5% per month from and after
the payment date is due. It is expressly agreed that any property furnished by Taft Engineering, shall be and remains personal property, and the
ownership and title to same, is herby retained by Taft Engineering and shall not pass to the purchaser, until total charges for labor, service,
materials and equipment have been paid. Fax signature shall operate the same as original documents. These terms are applicable to all initial
work and subsequent work. All work shall be completed in a workmanlike manner according to industry standard practices. All material is
guaranteed to be as specified. This proposal may be withdrawn by Taft Engineering if not accepted within thirty days.
Accepted For The Owner
BY:
EXHIBIT
1 "A n
9800 E. Easter Avenue, Suite 130 • Centennial, CO 80112 • Ph. 303- 753 -4584 • Fax: 720 -941 -1 199 • wwo, raft- engineerrng.con-I
r: .. 4 Manufacturers' Representative for High Efficiency HVAC & Plumbing Products
ENGINEERING
Quote: 020612PMCH -2 Date: 02 /06/12
Facility: Eagle County Government
550 Broadway
Eagle, CO 81631
Attn: Eric Bo ley
We are pleased to provide pricing to perform biannual style maintenance on the two Aerco BMK1.5LN
boilers that serve the above mentioned facility, serial numbers listed below.
Serial Numbers: G -09 -0282 & G -09 -0283
Includes:
• New igniters & flame rods
• Remove clean and inspect burner, reinstall with new gaskets
• Inspect exhaust manifold and clean as necessary
• Combustion analysis and calibration as required
• Inspection and tightening of all electrical connections
• Inspection and cleaning of condensate traps and associated drain lines
• Testing of safety devices
Excludes: Repairs or parts to make any repairs other than the above mentioned
Pricing For The Above: $1,850.00 (One thousand eight hundred fifty and No /100) Net Plus Tax Due
Upon Completion.
In the event of non - payment of all or part of the amount due to Taft Engineering LLC, Taft Engineering LLC shall be entitled to
payment of its attorney's fees and costs incurred in the collection process, together with interest at the rate of 1.5% per month from and after
the payment date is due. It is expressly agreed that any property furnished by Taft Engineering, shall be and remains personal property, and the ,
ownership and title to same, is herby retained by Taft Engineering and shall not pass to the purchaser, until total charges for labor, service,
materials and equipment have been paid. Fax signature shall operate the same as original documents. These terms are applicable to all initial
work and subsequent work. All work shall be completed in a workmanlike manner according to industry standard practices. All material is
guaranteed to be as specified. This proposal may be withdrawn by Taft Engineering if not accepted within thirty days.
Accepted For The Owner
BY:
. EXHIBIT
1 0 5 ,
9800 E. Easter Avenue, Suite 130 • Centennial, CO 80112 • Ph: 303- 753 -4584 • Fax: 720 - 941 -1199 • www.taft- engineering. corn
• A�� �
( „y CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMIDD/YYYY)
2/14/2012
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 1S 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 CONTACT COWeet Centennial
NAME:
CQWeet Centennial Insurance E, 0 „ * ,, (303)400 - 4567 I WC.NeI:
6515 So. Riviera Way ADDRess
INSURERS) AFFORDING COVERAGE NAIC Ir
Aurora CO 80016 INSURER A :S10Dloyere Mutual Casualty Co. 21415
INSURED INSURER e :United Financial Casualty 11770
TAFT ENGINRRRXNG,INC. INSURER C :Swint eon Insurance
PO BOX 3153 INSURER D:P innacol Assurance 41190
INSURER E :
> NGLEWOOD CO 80155-3153 INSURER F :
COVERAGES CERTIFICATE NUMBER:11 -12 REVISED MASTER _ 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.
Mgr TYPE OF INSURANCE s R POLICY NUMBER POLICY Inw EFF - POLICY - UP INTT
jolt Q(rmrY1 l�Y�plyyyYl LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100, 000
PRE7�eSE3- (r:A.QepRrene*) $ _
A I CI,ILIS.MADE OCCUR 4D52699 0/14/2011 0/14/2012
MD 00 (Any one_ . an} $ 5,000
PERSONAL AADV INJURY $ 1, 000, 000
QE►JERAL AGGREGATE ,$ 2,000,000
—
� GEN'L AGGREGATE MET APPLIES PER: PRODUCTS .COMPVPAGG $ 2,000,000
FPOLICY N 11 LOC $
AUTOMOBILE LIABILITY (Ea OMBINNED M tI W � s 1,000,000
B ANY AUTO BODILY INJURY (Par person) $
-
ALL OWNED X S 03559658 -6 12/6/2011 12/6/2012 Ropily INJURY(PrroccideM) $
X HIRED AUTOS S WNED PRoPEATY Par accider$1
DAMAGE $
Uninsured mopflr4t eornbirwl 5 1,000,000
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000
c EXCE0SLIAB CLAIMS -MADE AGGREGATE S 2,000,000
DEC 1 X I RETENTIONS 10,000 X0A8171711 8/14/201i 0/14/2012 $
D WORKERS CQMPEN$ATION - ^
X I $iATU J 1 la ,
AND EMPLOYER$ LIABILITY Y J N L efJ S
ANY PROPRIET0FuPARTNER,EXECUTiVE E. EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED? n E.L. NIA 4080614 5/1/2011 5 {1/2012
(Mandator' In NH) EL. DISEASE - EA EMPLOYEE, $ 1, 000, 000
If yyeas, dee cr(be und
DESCRFTION OF O PERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEI4CLES (Atlsch ACORD 101. AtltBtlanal Remarks Schedule, R more spice Is rewired)
COLORADO SPRINGS SCHOOL DISTRICT NO. 11 IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS INSURKD *8 Gs1ERAL
LIABILITY COVERAGE AS PER FORM CG7482 (1-08) . RE: JACK SWYGERT ANNOSPACB ACADB6IY. THIS TNBIIRANC3 T8
PRIMARY AND NON - CONTRIBUTORY.
CERTIFICATE HOLDER CANCELLATION
g . etepheneed11. org SHOULD ANY OF THE ABOVE DESCRIBED POLIC ; . :.i ( , r
THE EXPIRATION DATE THEREOF, NOTICE
COLORADO SPRINGS SCHOOL DISTRICT 11 ACCORDANCE WITH THE POLICY PROVISIONS. `' G If
ATTN: KATT STEPHENS
5240 GEIGER BLVD AUTHORIZED [terns T TTATIlfe
COLORADO SPRINGS, CO 80915
James Roam/AMA
ACORD 25 (2010105) Ci 1988 -2010 ACORD CORPORATION. All rights reserved.