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HomeMy WebLinkAboutC13-188 R&H MechanicalAGREEMENT BETWEEN EAGLE COUNTY AND R &H MECHANICAL
THIS AGREEMENT is made this Z-t day of -S�) t4F— , 2013, by and between Eagle County
( "County "), and, R &H Mechanical ( "Contractor "), a limited liability company with a principal place of
business at 825A Chambers Ave, Eagle, Colorado, 81631.
WHEREAS, County desires to install cooling equipment at the Miller Ranch Community Center (the
"Facility ").
WHEREAS, Contractor is authorized to do business in the State of Colorado, has experience and expertise
necessary to provide said equipment, 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 materials, equipment and 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 procure the materials and equipment ( "Equipment ") and provide all services, labor,
personnel and materials to perform and complete the procurement and installation services set forth in
Exhibit A (hereinafter "Services" or "Work ") which is attached hereto and incorporated by this reference.
Contractor and will use its expertise and skill to perform the Services. In the event of any conflict between
the contents of this Agreement and Exhibit A, this Agreement shall control.
1.2 County shall have the right to inspect all Equipment prior to acceptance. Inspection and acceptance shall not
be unreasonably delayed or refused. In the event County does not accept the Equipment for any reason in its
sole discretion, then Vendor shall upon County's request and at no charge or cost to County i) take the
Equipment back, ii) exchange, or iii) repair the Equipment.
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. All guarantees or warranties shall survive
termination.
3.2 The term of this Agreement may be extended or modified and the scope of services may be changed
upon a written amendment to this Agreement signed by both parties.
ARTICLE 4 — COMPENSATION
4.1 For the Services to be provided hereunder, County will pay Contractor the amounts provided in Exhibit
A. The maximum amount of compensation under this Agreement shall not exceed Twenty seven thousand one
,� %2 -1f 1
hundred sixty eight and 00 /100 dollars ($27,168.00) without a signed amendment to the Agreement.
4.2 Payment will be made for Equipment satisfactorily delivered and accepted and Services satisfactorily
performed as specified in Exhibit A within thirty (30) days of receipt of a proper and accurate invoice from
Contractor respecting the same. 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.
4.5 The signatories to this Agreement aver to their knowledge, no employee of the County has any personal
or beneficial interest whatsoever in the service or property described in this Agreement. The Contractor has no
interest and shall not acquire any interest, direct or indirect, that would conflict in any matter or degree with the
performance of Contractor's services and Contractor shall not employ any person having such known interests.
ARTICLE 5— CONTRACTOR'S REPRESENTATIONS /WARRANTIES
In order to induce County to enter into this Agreement, Contractor makes the following representations:
5.1 Contractor shall deliver the Equipment and perform the Services no later than 30 days from the date
contract is executed.
5.2 Contractor has familiarized itself with the intended purpose and use of the Equipment, 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.
5.3 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 Contractor's providing similar Equipment and Services. 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.
5.7 In addition to any specific guarantees required by this Agreement and any other documents related to
this Agreement, Contractor promises the Equipment will be new and promises to perform the Work in a
workmanlike manner and guarantees all Work against defects in materials or workmanship for a period of one
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(1) year from date the Work is completed, or such longer period as may be provided by law or as may be
included in the plans and specifications.
5.8 All guarantees and warranties of Equipment and other materials furnished to Contractor or
subcontractors by any manufacturer or supplier are for the benefit of County. If any manufacturer or supplier of
any Equipment or materials furnishes a guarantee or warrantee for a period longer than one (1) year from the
date the Work is completed, Contractor's guarantee shall extend for a like period as to such Equipment and
materials.
5.9 Contractor warrants that title to all Work, Equipment and materials will pass to County either by
incorporation into the Facility or upon the receipt of by Contractor of payment from County (whichever occurs
first) free and clear of all liens, claims, security interests or encumbrances. Contractor further warrants that
Contractor (or any other person performing Work covered by this Agreement) purchased all materials and /or
Equipment free and clear of all liens, claims, security interests or encumbrances.
5.10 Contractor assumes all risk of loss with respect to the Equipment until title to the Equipment passes
from Contractor to County, at which time County shall assume all risk of loss with respect to the Equipment.
Notwithstanding anything to the contrary herein, for purposes of this Section 5.10 title shall pass to County after
Contractor has installed the Equipment and Owner has inspected and approved the Equipment as installed.
5.11 Within a reasonable time after receipt of written notice, Contractor shall correct at its own expense,
without cost to County, and without interruption to County's occupancy:
a) Any defects in materials or workmanship which existed prior to or during the period of any
guarantee or warranty provided in this Agreement; and
b) Any damage to other Work or property caused by such defects or the repairing of such defects.
5.12 Guarantees and warranties shall not be construed to modify or limit any rights or actions County may
otherwise have against Contractor in law or in equity.
5.13 Warranties required by this Agreement shall commence on the date of completion of the Work and
acceptance of the Equipment by County and shall terminate one (1) year after such date or such longer period as
may be agreed to by the parties or as may be required by applicable law.
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 and B. 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
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.
3
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 tc
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
to establish that the subcontractor has not knowingly employed or contracted with an illegal
alien.
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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 The Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under
penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to
federal law, (b) to the extent applicable shall comply with the provisions of C.R.S. 24- 76.5 -101 et. seq., and (c)
has produced one form of identification required by C.R.S. 24- 76.5 -103 prior to the effective date of this
Agreement.
7.6 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.
7.7 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 parry 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
5
the extent that the County is solely liable to such third party for such claims without regard to the involvement
of the Contractor.
ARTICLE 10 - OWNERSHIP OF DOCUMENTS AND MATERIALS:
10.1 All documents (including electronic files) and flooring 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: R &H Mechanical, LLC
P.O. Box 810
Eagle, Colorado 81631
(970) 328 -2699 (p)
(970 328 -0234 (f)
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
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,
111
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
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 B.
ASIGNATURE PAGE TO FOLLOW //
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above
written.
ATTEST:
Clerk to the Bg,
y
. P!
COUNTY OF EAGLE, STATE OF
COLORADO, by its Board of County Commissioners
By: n A
Sara J. Fisher, airman
LIM
CONTRACTOR:
R &H MECHANICAL, LLC
By:
Title: 72 PZ tC;,A 1S, l AC�4
CONTRACTOR IS REQUIRED TO SAVE ITS SIGNATURE NOTARIZED
STATE OF di 1Cr tBC )
ss.
COUNTY OF _ L- t ' )
The foregoing instrument was acknowledged before me by L'`A�.ZLt ; r _ � � , of
f i-F° cr this _ day of _,-2013.
Nampo&
rrP 7 _ a4-t& Pro -d {.t } diA/ Ca4v Cotuit 0 vi;'
POi.�BOX 810,0825A CHAMBERS AVE, EAGLE, Co 81631
PHONE: (970) 328 -2699 FAX (970) 328 -0234
Proposal Submitted to:
Date:
Prepared By:
Eagle County — Eric Boley & Jan Miller
June 6, 2013
Brent Wilson
Street:
Job Name:
3289 Cooley Mesa Road
Miller Ranch Child Care & Community Ctr. Splits
City, State and Zip Code:
Job Location:
Gypsum, CO 81637
25 Mill Loft, Miller Ranch, Edwards
Phone:
Mobile:
Contact:
Email:
970.328.8889
970.445.7718
Eric Boley & Jan Miller
i4p.milleri u;eaplecac�ntv.us
Payment to be made as follows: DRAW UPON COMPLETION OF EACH PHASE.
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from
spmilleations below involving extra costs will be executed only upon written orders, and will became an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays beyond our control. Owner to carry fire tomado and other necessary insurance. Our workers are Fully covered by
Workman's Compensation Insurance.
Please awe this proposal is valid foe 30 days. Acceptance past the date of this proposal shall be subject to additional negotiation and pricing.
We hereby submit specifications and estimates per sizing teceived June 16,2012:
New Mitsubishi Air Conditioning System
• Provide & Install (1) MXZ4B36NA -1 & (1)1 X=B20NA -1 Mitsubishi Outdoor Heat Pump(s) Note: (7-day lead time).
• Provide & Install (5) indoor SLZKA09NA 24 "x24" Indoor Cassette Fan Coils. Note: (7-day lead time).
• Provide & Install (1) indoor SLZKAI5NA 24 "x24" Indoor Cassette Fan Coils. Note: (7 -day lead time).
• Provide & Install refrigerant linesets from outdoor unit to indoor fan coils.
• Pressure Test linesets with Nitrogen and Charge System with R4I OA Refrigerant.
• Install Condensate lines from indoor units to nearest drain receptacle at nearest sink
• (6) remote controlled thermostats, walk through, startup and testing of equipment.
• Eagle County Mechanical Permit.
• After hours and weekend labor. Manufach= (5) year parts & (7) year compressor Warranty.
• System control wiring, startup & owner walk-through.
• Labor, materials & tax.
Total: $ 27,168.°—°
Exclusions: High Voltage Electrical Wiring & Disconnects, Engineered Drawings, Roof Patching, Gable Access Hatches, Drywall
Painting & Patching. Thank yaU
Acceptance of Proposal — The above Signature: Date:
(Client)
prices, specifications and conditions are satisfactory and
are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above. Signature: M&W W4 M6 Date: 6161013
(R & H Mechanical) EXHIBIT
Page 1 of 1 r 2k 41 U
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DATE IMM(DOMYY)
CERTIFICATE OF LIABILITY INSURANCE 04112/13
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 pollcy(ies) must 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 970 -945 -9111 NAME OT Sbanti Cartmell, CIC
Neil »Caring Agency, Inc. 970- 945 -2350 PHONE 970 945 9'111 FAX �rrr 970- 945 -2350
Glenwood Box 1876 JAM %o _ ..
JimnwOod Springs, CO 81602 ADDRESS: SCattmell�n rin..com
Jim Nation, C1C � PROCiOic€R
PMSTOMERIP
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INSURED R & H Mechanical, LLC INSURER A: Cincinnati Insurance Company 128665
PO BOX 810 INSURER 13: Pinnacol Assurance
Eagle, CO 81631 INSURER C: One Beacon Insurance
INSURER 0,
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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 DESCRIBER HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRi w.. ..._..,, .... AO SUB" �w�« .w, -.a Pci►cYEFP- -PbLkCYElIP .-
TR TYPE OF INSURANCE POLICY NUMBER S§ MMIDUtYYYY MWDDlYYYY LIMITS
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$ 1,400,0
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CLAIMS -MADE X? OCCUR
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$ 1,000104
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GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGO
$ 2,000,E
$ 2,000,00
POLICY IF X- i PRO- µ LOC
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ALL OWNED AUTOS
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
Certificate holder is included as Additional Insured with regard to General
tit Contract
Liability 8, ongoing operations of the insured per Blanket Per
Endorsement
rC" t ^1 M r'lAAIr"CI I A*rintti
EAGCOU6
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Eagle County Government
Facilities Management Dept -
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 850
AUTHORIZED REPRESENTATWE
Eagle, CO 81631
tfJ 7atstl -GUU`J At4llttu t.uttr a.
ACORD 25 (2049109) The ACORD name and logo are registered marks of ACORD EXHIBIT