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HomeMy WebLinkAboutC13-143 Western Lands, Inc. Agreement AGREEMENT BETWEEN EAGLE COUNTY AND WESTERN LANDS, LLC 1a,V1 THIS AGREEMENT ( "Agreement ") dated as of this day of s , 2013 is between the County of Eagle, State of Colorado, a body corporate and politic, by and through its Board of County Commissioners or County Manager with a mailing address of 500 Broadway, Post Office Box 660, Eagle CO 81631 ( "County "), and Western Lands, LLC, a Colorado limited liability company, with a mailing address of 11679 S. Breeze Grass Way, Parker, CO 80134 ( "Consultant "). WHEREAS, the County desires to develop a site plan, cross section details and a cost estimate for the design of phase two of the Eagle River Preserve, located in Edwards, Colorado (the "Preserve "); WHEREAS, Consultant is authorized to do business in the State of Colorado, has experience and expertise necessary to provide said services to the County; and WHEREAS, the County wishes to hire Consultant to perform the services outlined in Article 1 hereunder; and WHEREAS, the County and Consultant intend by this Agreement to set forth the scope of the responsibilities of Consultant in connection with the services and related terms and conditions to govern the relationship between Consultant and County in connection with this Agreement. NOW THEREFORE, based upon the representations by Consultant set forth in the foregoing recitals, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, including the promises set forth herein, the parties agree to the following: ARTICLE 1— WORK 1.1 Consultant shall furnish all materials and labor necessary for completion of the scope of work (Tasks 1 — 4) identified in Consultant's proposal dated January 27, 2013, attached hereto as Exhibit "A," and hereby incorporated by this reference (the "Services" or the "Work "). If no completion date is specified in Exhibit A, Consultant agrees to furnish the Services in a timely and expeditious manner consistent with the applicable professional standard of care. In the event of any conflict or inconsistency between the terms and conditions set forth in Exhibit A and the terms and conditions set forth in this Agreement, the terms and conditions set forth in this Agreement shall prevail. ARTICLE 2 — TERM OF AGREEMENT 2.1 This Agreement shall commence upon execution of this Agreement by both parties, and, subject to the provisions of Article 10 hereof, shall continue in full force and effect until the Services are satisfactorily completed in accordance with the terms of this Agreement. ARTICLE 3 — COMPENSATION 3.1 For the services satisfactorily performed in accordance with this Agreement, County will /K`. 1 odo-r-0 , pay Consultant according to the fee schedule set forth in Exhibit A. The maximum amount of compensation under this Agreement shall not exceed six thousand dollars ($6,000.00) without an executed amendment to this Agreement. Said amount shall include all of Consultant's expenses relating to services performed pursuant to this Agreement, including but not limited to printing costs, mileage, GPS and other miscellaneous project costs. Mileage will be reimbursed at the Federal Government allowable rate for 2013. The County must approve in writing any additional services under this Agreement ( "Additional Services ") and the fees therefor prior to the commencement of such any such Additional Services. The fees for approved Additional Services shall be as set forth in an executed amendment to this Agreement. 3.2 Consultant must submit invoices by the fifth business day of each month. Payment will be made for Services satisfactorily performed will be made within thirty (30) days of receipt of a proper and accurate invoice from Consultant respecting the Services. The invoice shall include a description of services performed and a detailed breakdown of all reimbursable expenses. Upon request, Consultant shall provide the County with such other supporting information as the County may request. 3.3 All invoices must be email, mail or delivered in- person to the following address to ensure proper payment: Cliff Simonton Eagle County Planning Department PO Box 179 500 Broadway Eagle, CO 81631 Clifford. Simonton @eaglecounty. us 3.4 The County will not withhold any taxes from monies paid to the Consultant hereunder and Consultant 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. 3.5 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 Consultant in excess of the amount for any work done without the written approval in accordance with a budget adopted by the Eagle County Board of County Commissioners 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 4— CONSULTANT'S REPRESENTATIONS In order to induce the County to enter into this Agreement, Consultant makes the following representations: 4.1 Consultant has familiarized itself with the nature and extent of the Services to be provided hereunder, the Eagle River Preserve, and with all local conditions, and federal, state, 2 and local laws, ordinances, rules and regulations that in any manner affect cost, progress, or performance of the Services. 4.2 Consultant will make, or cause to be made, examinations, investigations, and tests as it deems necessary for the performance of the Services. 4.3 To the extent possible, Consultant has correlated the results of all such observations, examinations, investigations, tests, reports, and data with the terms and conditions of this Agreement. 4.4 To the extent possible Consultant, has given the County written notice of all conflicts, errors, or discrepancies that he has discovered in the Agreement. 4.5 Consultant shall be responsible for the completeness and accuracy of the Services performed, including but, not limited to, the completion and accuracy of the documentation described in Exhibit A hereto and all supporting data and other documents prepared or compiled in performance of the Services. Consultant shall correct, at its sole expense, all significant errors and omissions therein. The fact that the County has accepted or approved the Services shall not relieve Consultant of any of its responsibilities. Consultant shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to Consultants, with respect to similar services, in this area at this time. Further, in rendering the Services, Consultant shall comply with the highest standards of customer service to the public. Consultant shall provide appropriate supervision of its employees to ensure the Services are performed in accordance with this Agreement. 4.6 Consultant shall coordinate all Work with the Eagle County Planning Director or his designee and shall comply with any and all rules and regulations while working on public or County property. ARTICLE 5 — ENTIRE AGREEMENT 5.1 This Agreement and Exhibits A and B (the "Contract Documents ") represent the entire Agreement between the parties hereto. There are no Contract Documents other than this Agreement and Exhibits A and B. The Agreement may only be altered, amended, or repealed in writing. ARTICLE 6 — MISCELLANEOUS 6.1 The parties to this Agreement recognize that the Services to be provided pursuant to this Agreement are professional in nature and that in entering into this Agreement the County is relying upon the professional services and reputation of Consultant. Therefore, Consultant may not assign its interest in this Agreement, including the assignment of any rights or delegation of any obligations provided therein, without the prior written consent of the County, which consent the County may withhold in its sole discretion. Unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Agreement. 3 /0?-, 6.2 Subject to Section 6.1, this Agreement shall be binding on and inure to the benefit of the parties hereto, and their respective successors and assigns, and shall not be deemed to be for the benefit of or enforceable by any third party. 6.3 Notwithstanding anything to the contrary contained in this Agreement, Eagle County shall have no obligations under this Agreement after, nor shall any payments be made to Consultant in respect of any period after December 31 of each year without an appropriation therefor 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). 6.4 Provision Mandated by C.R.S. § 8- 17.5 -101 et seq. PROHIBITIONS ON PUBLIC CONTRACT FOR SERVICES 6.4.1 If Consultant has any employees or subcontractors, Consultant 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 Agreement, Consultant certifies that it does not knowingly employ or contract with an illegal alien who will perform under this Agreement and that Consultant 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 Agreement. 6.4.2 Consultant 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 Consultant that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under the public contract for services. 6.4.3 Consultant 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_ 1 185221678150. shtm 6.4.4 The Consultant 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. 6.4.5 If the Consultant obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien, the Consultant shall be required to: 4 (i) Notify the subcontractor and the County within three days that the Consultant 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 Consultant shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. 6.4.6 The Consultant 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). 6.4.7 If a Consultant violates these prohibitions, the County may terminate this Agreement for a breach of the contract. If this Agreement is so terminated specifically for a breach of this provision of this Agreement, the Consultant shall be liable for actual and consequential damages to the County as required by law. 6.4.8 The County will notify the office of the Colorado Secretary of State if Consultant violates this provision of this Agreement and the County terminates this Agreement for such breach. 6.5 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. 6.6 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. ARTICLE 7 - JURISDICTION AND CONFIDENTIALITY: 7.1 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. 7.2 The Consultant and the County acknowledge that, during the term of this Agreement and in the course of the Consultant rendering the Services, the Consultant may acquire knowledge of the business operations of the County and the Consultant shall not disclose, use, publish or otherwise reveal, either directly or through another, to any person, firm or corporation, any knowledge, information or facts concerning any of the past or then business operations, pricing or other data of the County and shall retain all knowledge and information which it has acquired as the result of this Agreement in trust in a fiduciary capacity for the sole benefit of the County, successors and assigns during the term of this Agreement and for a period of five (5) years following the termination of this Agreement. ARTICLE 8 - INDEMNIFICATION: 8.1 The Consultant shall, to the fullest extent permitted by law, indemnify and hold harmless the County and any of its officers, agents and employees against any losses, claims, damages or liabilities for which the 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 Consultant hereunder; and Consultant shall reimburse the County for any and all legal and other expenses incurred by the 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 claim without regard to the involvement of the Consultant. ARTICLE 9 - OWNERSHIP OF DOCUMENTS AND MATERIALS: 9.1 All documents (including electronic files) 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 the County before final payment is made to Consultant or upon earlier termination of this Agreement. ARTICLE 10 - TERMINATION: 10.1 Either party may terminate this Agreement upon thirty (30) days written notice to the other, for any reason, and without penalty. Any such termination shall be effected by delivery of a written notice of termination specifying the date upon which termination becomes effective. In the event this Agreement is terminated, Consultant shall be compensated for all Services satisfactorily completed up to the date of termination and Consultant shall provide the County with all task items and documents paid for by the County. ARTICLE 11 — NOTICE 11.1 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 Attorney P.O. Box 850 Eagle, Colorado 81631 (970) 328 -8685 (p) (970) 328 -8699 (f) �L� 6 The Consultant: Western Lands, LLC Tom Roberts - President 11679 S. Breeze Grass Way Parker, CO 80134 720 - 936 -9973 120 -1q1 - 11'3 (0 11.2 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 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 12 — INDEPENDENT CONSULTANT 12.1 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 Consultant or County and Consultant's employees. Consultant and its employees shall be, and shall perform as, independent contractors. No officer, agent, subcontractor, employee, or servant of Consultant shall be, or shall be deemed to be, the employee, agent or servant of County. Consultant shall be solely and entirely responsible for the means and methods to carry out the Services under this Agreement and for Consultant's acts and for the acts of its officers, agents, employees, and servants during the performance of this agreement. Neither Consultant 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 13 — INSURANCE REQUIREMENTS 13.1 At all times during the term of this Agreement, Consultant shall maintain insurance on its own behalf in the following minimum amounts: Worker's Compensation benefits, disability benefits, and other similar employee benefit acts, with coverage and in amounts as required by the laws of the State of Colorado, if applicable; 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. Comprehensive liability and property damage insurance issued to and covering Consultant and any subcontractors 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 13.2 Consultant shall purchase and maintain such insurance as required above and shall provide certificates of insurance in a form acceptable to County upon execution of this Agreement. Insurance certificates shall be attached hereto as Exhibit `B" and incorporated herein by this reference. / /SIGNATURE PAGE TO FOLLOW // 8 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written. COUNTY OF EAGLE, STATE OF COLORADO By and through its County Manager Keith Montag, County M. ► : ger WESTERN L DS, LLC By: Title: reir,'1 STATE OF COLORADO ) 1 ) ss. COUNTY OF I.JD / 5 ) The foregoing instrument was acknowledged before me by ( q 5 ( 12.'49 h e csit5 as Ryes i elevrf of Western Lands, LLC, this / 7! day of 4 pf i I , 2013. My commission expires: 1 Notary Public B RUCE L. HARPER S TATE OF C L O RAD M y C ommission mission EXA +res 10/3 9 WESTERN LANDS EXHIBIT RANCH RESTORATION SERVICES January 27, 2013 888 Eagle River Preserve Phase 2 Design Introduction Phase 2 of the Eagle River Preserve is located to the west of the main entrance to the property and includes approximately 20 -acres of land that has been previously graded and seeded. A small stream originates from the splitter box at this entrance and takes a portion of the flow from the irrigation ditch to the west and through the site. The water from the stream enters several shallow pond areas that were graded by previous contractors. The intent of this portion of this project is to provide a site plan, cross section details, and a cost estimate for the new trail system, low profile boardwalk, bird watching blind, stream, ponds, and wetland areas as well as any planting areas. This will not include the development of full construction documents, but a starting point to use for project fund raising. We will use the existing layouts of the stream and pond areas to the extent possible, but make minor adjustments to minimize water loss, stabilize the soil, and to enhance the aesthetics and function of the system. Scope of Work Task 1 — Data Gathering and Site Design — Western Lands will use the survey provided by the County to field verify the existing features and to layout the final locations of proposed elements such as the trails, boardwalk, streams, wetlands, pond edges, bird watching blind, and planting areas. The information gathered on site will be used to finalize a base map for use in the design phases and to generate accurate cost estimates. Deliverables: 1. One site visit 2. One project coordination meeting with the County Task 2 — Site Plan and Cross Section Details — With the information obtained in Task 1, Western Lands will develop a site plan that will indicate the final proposed trail system with connections to the existing trails, pedestrian bridge crossings, low profile boardwalk areas, and bird watching blind. Also shown will be a proposed stream layout, pond locations, wetlands, and planting areas. Western Lands will also develop cross section details that indicate the design intent and materials used to achieve the final built product. These will include the trail, boardwalk, bird blind, stream channel (with and without liner), the lined ponds, waterfall features, and planting details. Deliverables: 1. Design layout for the elements in Phase 2 2. Cross section details Task 3 — Cost Estimate — Based on the design elements indicated on the plans, Western Lands will develop an accurate cost estimate for the project. We will base this estimate on the best available costs for materials, labor, and equipment. Deliverables: 1. Cost estimate for Phase 2 www.western- lauds.com 11679 S. BREEZE GRASS WAY P. 720.936 9973 PARKER. COLORADO 60134 L 720.294 1183 Agreement Qualifications Assumptions - If appropriate, the client shall provide to Western Lands the following information or services as required for performance of the work. Western Lands assumes no responsibility for the accuracy of such information or services, and shall not be liable for errors or omissions therein. Should Western Lands be required to provide services in obtaining or coordinating compilation of this information, such services shall be billed as Additional Services. If this information is not available and the County does not intend to have this information completed, then Western Lands will proceed to the best of our ability without this information. In order to begin work, we may require the following information: 1. Topographic Survey Exclusions - All specific deliverables for this project are identified within the Scope of Work portion of this agreement. The following information is not a part of the agreement and would be proposed under a separate agreement if required. Should Western Lands be required to provide services in obtaining or coordinating compilation of this information, such services shall be billed as Additional Services. i. Civil Engineering Terms and Conditions Standard Terms 1. Western Lands will invoice work monthly based on the fee schedule indicated herein with any requested additional work billed at the standard hourly rates indicated below. 2. - ..' - - Iviiiiegeoviliabeesinisesesittle."- T.. ] ».. »t n .... »....... »..a »77...,., »l,h .•stn , - - 4 . . . . 5. Tasks will by billed by hours spent and may be less or more than the fee for each task. Services and fees will not exceed the total contract amount unless agreed upon as additional services. 6. .. • • • • - e • - - -- _. ,f Specific Terms 1. Revisions exceeding Minor Revisions or additional tasks requested by the owner will be billed at the Standard Hourly rates in addition to the fixed fees, or a specific fee will be authorized for the additional work prior to commencement. 2. . _ _ • •..... - 3. Any additional meetings or public hearings not identified in this proposal will be considered additional services. Standard Hourly Rates Senior Landscape Architect $ioo.00 /Hour Staff Landscape Architect $65.00 - $80.00 /Hour Clerical $4o.00 /Hour Fee Schedule — The following indicates the estimated time to complete each task. Expenses will be billed in addition to the hourly fees and will be at "cost ". It is anticipated that these expenses will be approximately $650. Task i — Data Gathering / Site Design 6 hours $600 Task 2 - Site Plan / Cross Section Details 4o hours $4,000 Task 3 — Cost Estimate 6 hours $600 Expenses (Mileage, Plots, GPS, Copies) Cost TOTAL 52 hours $5,200 Acceptance - Western Lands shall provide the services described within the Scope of Work per the Fee Schedule as identified in this proposal. .: • , • _ . . If the conditions of this contract are acceptable, please sign and return a copy for our files. We look forward to working with you on this project. Sincerely, Thomas Roberts — President Western Lands, LLC Aettritimeeletipmehaime Name Title Date DIVIDER PAGE Producer No: 65880 SAN: 59241010000000 Pol Eff Dt: 03 -23 -2013 Office: 99 Date Printed: 04 -08 -2013 Time Printed: 15:19:22 Trans Eff Dt: 04 -09 -2013 Insured Name: WESTERN LANDS, LLC Policy No: 9100038192 Trans Seq No: 003 Trans Type: Certificate Only Oper Init: A155616 Company Abbr: GK Release Version: 13.04 User - Selected Sets Copies Printer CERTIFICATES 01 Don't print EXHIBIT CCORD DATE(MM / DC( YY) ,...� CERTIFICATE OF LIABILITY INSURANCE 4/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTFCT THOMAS ROBERTS NAME: PRODUCER AC No.Fxt: (720) 936 -9973 1 Q . Jona the n Bryan Email Ore Geico Boulevard. Address: THOMASROBERTS149 @MSN.COM Fredericksburg, VA 224:2 INSURERS AFFORDING COVERAGE NAIC # 6588C INSURER A: rGCVFRNt15N'1 EV121,0 Ehi 1NSURANCh. COMPANY 22063 INSURED INSURER B: WESTERN -ANDS, L -C - 1679 S BREEZE GRASS ttiAY INSURER C: [' RKER CO 80134 -3099 - INSURER D: INSURER E: INSURER F: COVERAGES TH E POLICIES OF INSURANCE U STE BELOW HAVE BEEN ISSUED TO THE IN SUFED NAMED ABOVE FORTH E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY FEQUI REMENT, TERM OR CON DITI ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI N, TH E INSURANCE AFFORD ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC LUSION S AND CONDI TION S OF SUCH POLICIES. AGGFEGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L SUBR POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE pOUCY NUMBER LF1'A LTR INSRD WVD DATE (MM/ DD/ YY) DATE (MM/ DD/ YY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES (Ea occurence) CLAIMS MADE 1 OCCUR MED. EXPENSE (My one person) $ PERSONAL & ADV. INJURY $ GENERAL AGGREGATE $ PRODUCTS — COMP/ CPAGG. $ GEN'L AGGREGATE OMIT APPLIES PER: n POLICY n PROJECT n LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,003,000 (Ea accident) _ BODILY INJURY A ANY AUTO 910D0381 3;23/2013 3/2312014 $ (Per person) ALL OWNED X SCHEDULED BODILY INJURY AUTOS AUTOS (Per accident) HIRED AUTOS NON -OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED (RETENTION $ $ WORKERS' COMPENSATION AND EMPLOYERS' I WC STATU- I OTH- LIABILITY Y I N _ TORY LIMITS ER ANY PROPRIETOR/ PARTNER/ EXECUTIVE NI A E.L. EACH ACCIDENT $ . OFFICER/ MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below E.L. DISEASE -EACH EMPLOYEE $ D ESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS EAGLE COUNTY COLORADO IS NAMED AS AN ADDITIONAL INSURED 1998 TOYOTA 4 RUNNER UTILITY VTN: ?T3HN87R6N0173106 CERTIFICATE HOLDER CANCELLATION EAGLE COUNTY COLORADO SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE PO BOX 850 EXPI RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EAGLE, CO 81631 - 0850 ACCORDANCE WITH THEPOUCYPROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION.AIl rights reserved. ACORD 25 (2010! 05) The ACORD name and logo are registered marks of ACORD A ICORL I D ATE(MM /DD /YY) CERTIFICATE OF LIABILITY INSURANCE I 4/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTFGT THOMAS ROBERTS NAME: PRODUCER A C NE PRODUCER (720) 936 -9973 I Fax AI Jonathan Bryan Email One Geico Boulevard. Address: THOMASROBERTS14 9 @MSN. COM Fredericksburg, VA 224.2 INSURERS AFFORDING COVERAGE NAIC # 6588C INSURER A: GCVERNI'ILN'1' EM=LCYEES 1NSURANCE COIAFANY 22063 INSURED INSURER B: WESTERN = AIDS, LEO _1679 S BREEZE GRASS WAY INSURER C: PARKER CO 81134 - 3099 INSURER D: INSURER E: INSURER F: COVERAGES TH E POLICIES OF INSURANCE U STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERN OR CON D ITI ON OF ANY CONTRACT OR OTHER DOCUM EN T WITH RES PEC T TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAJ N, THE INSURANCE AFFORD EDBYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS, BCC LUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L SUER POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURPNCE POLICY NUMBER LIMITS LTR INSRD WVD DATE (MM/ DD1YY) _DATE (M M/ DD/ YY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurence) CLAIMS MADE I OCCUR MED. EICPENSE (Any one person) $ - PERSONAL & ADV. INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /CPAGG. $ GENII AGGREGATE LIMIT APPLIES PER: - I POLICY n PROJECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ L001,002 (Ea accident) A ANY AUTO ��_ -�1'1 3;23/2013 3%2 BODILY INJURY ;lil(!p3.1" (Per person) ALL OWNED x SCHEDULED BODILY INJURY AUTOS _ AUTOS (Per accident) HIRED AUTOS NON -OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA ?JAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED !RETENTION $ $ WORKERS' COMPENSATION AND EMPLOYERS' I WC STATU 0TH - LIABIUTY Y 1 N TORY LIMITS I ER ANY PROPRIETOR/ PARTNER(EXECUTIVE N / A E.L. EACH ACCIDENT $ OFFICER/ MEMBER OCCLUDED? E.L. DISEASE -POLICY LIMIT $ If yes, describe under _ SPECIAL PROVISIONS below E.L. DISEASE - EACH EMPLOYEE $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS EAGLE COUNTY COLORADO IS NAMED AS AN ADDITIONAL INSURED 1998 TOYOTA 4 RUNNER UTILITY VTN: JT3HN87R6W017310 6 CERTIFICATE HOLDER CANCELLATION EAGLE COUNTY COLORADO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PO BOX 850 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EAGLE, CO 81631 - 0850 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION.AII rights reserved. ACORD 25 (2010/ 05) The ACORD name and logo are registered marks of ACORD A CORD • DATE {MU/ DD /YY) CERTIFICATE OF LIABILITY INSURANCE 9/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT THOMAS ROBERTS NAME: F PRODUCER PHONE NE No. (720) 936 -9973 f Fax Nn) Jonathon Bryan Email One Geico Boulevard. Address: THOMASROBERTS149@MSN.COM Fredericksburg, VA 224L2 INSURERS AFFORDING COVERAGE NAIC # 6588C INSURER A: 'JO VERNt'L- N'1' ENl_ LCYEE'0 INSURANCE COMPANY 22063 INSURED INSURER B: WESTERN -ANDS, LIC _1679 0 BREEZE CRASS WAY INSURER C: PARKER CO 8134 -3019 INSURER D: INSURER E: INSURER F: COVERAGES TH E POLICIES OF INSURANCE U STED BELOW HAVE BEEN ISSUED TO THE IN SURED NAMED ABOVE FORTH E POLICY PERIOD INDICATED. NOTWITHSTAN DING ANY REQUIREMENT, TERM OR CON DITI ON OF AN Y CO NTRACT OR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HERBN IS SUBJECT TO ALL THETERMS, EXCLU SONS AND CONDITIONSOF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD'L SUER POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD WVD DATE (MM/ DDI YY) DATE (MM/ DDfre) GENERAL LIABILITY EACH OCCURRENCE _ $ _ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES (Ea occurence) CLAIMS MADE OCCUR MED. IDPENSE (My one person) $ PERSONAL & ADV. INJURY $ GENERAL AGGREGATE $ PRODUCTS- COMP /CPAGG. $ GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY n PROJECT n LOC AUTOMOBILE LI ABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 (Ea accident) _ _ A BODILY INJURY ANY AUTO 9100u:iF3_92 -00 3/23/2013 %2 +.%2019 {Per person) ALL OWNED X SCHEDULED BODILY INJURY AUTOS _ AUTOS (Per accident) HIRED AUTOS NON -OWNED PROPERTY DAMAGE $ AUTOS (Per accident) — $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED ,RETENTION $ $ WORKERS' COMPENSATION AND EMPLOYERS' WC STATU- I I OTH LIABILITY Y! N TORY LIMITS ER ANY PROPRIETOR/ PARTNER / EXECUTIVE N I A E.L. EACH ACCIDENT $ OFFICER/ MEMBER EXCLUDED? DISEASE - POLICY LIMIT If yes, describe under E.L. $ SPECIAL PROVISIONS below E.L. DISEASE -EACH EMPLOYEE $ DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS EAGLE COUNTY COLORADO IS NAMED AS AN ADDITIONAL INSURED 1998 TOYOTA 4 RUNNER UTILITY VIN: ?T3HN87R6W0173106 CERTIFICATE HOLDER CANCELLATION EAGLE COUNTY COLORADO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PO BOX 850 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EAGLE, CO 81631 - 0850 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988.2010 ACORD CORPORATION.AII rights reserved. ACORD 25 (2010/ 05) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2010/05) Colorado Workforce by the Colo. Dept. of Labor and Employment 4/16/13 10:58 PM lc t Labor & Employment What's New? Workers' Compensation Coverage Rejection This screen allows interested parties to search for evidence of rejection of Workers' Compensation coverage by sole proprietors, and /or Contact Information partners performing construction work as well as coporate officers, members of an LLC who are also at least 10% owners of the business Workers' and participate in the daily operations and /or management of the business. Compensation Act Disclaimer The information provided here is from data submitted to the Colorado Division of Workers Compensation (DOWC). There may be errors and/or discrepancies with this Rules of Procedure information due to causes outside the control of the DOWC. Therefore, DOWC does not guarantee the accuracy of this information. tf your search does not produce a result, this does not necessarily mean that a rejection of coverage has not been filed. Rejection Corms received by DOWC become effective the day after all required Medical Treatment information is received, but processing may take several days. Guidelines For additional information or assistance with verifying rejection of Workers' Compensation coverage, please contact Customer Service at (303) 318 -8700 in the metro area or (888) 390 -7936. Official Forms Search Terms Publications Enter a full or partial legal name or trade name of the business you are seeking in the appropriate box below Interpretive Bulletins Business Legal Name western lands, Ilc Search Lists Business Trade Name Clear EDI /Online Filing Selected Employers - Click on the Green Triangle to See Search Results Employers' Insurance Business Legal Name Business Trade Name Coverage Verification Do I Need Insurance? I Western Lands, LLC Looking For Insurance? Dispute Resolution Rejections for Western Lands, LLC Other Agencies — - - -- Last Name First Name Middle Name Date Rejection Recd Date Rescind Rec'd Statistics [Roberts Thomas Clark 4/2/2013 En Espanol Contact the Webmaster Return to Home Page http: / /www.coworkforce.com /dwc/ CERejectionLists /rejectcompliance.aspx Page 1 of 1