HomeMy WebLinkAboutC14-145 Jerry Cheney AGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY,COLORADO AND JERRY CHENEY THIS AGREEMENT("Agreement")is effective as of the 41ay of ,2014 by and between Jerry Cheney a sole proprietor(hereinafter"Contractor")and Eagle County,Colorado,a body corporate and politic (hereinafter"County"). RECITALS WHEREAS,County desires to retain Contractor to assist the Facilities Management Department in the daily maintenance and over sight of the El Jebel Community Center,located at 0020 Eagle County Road,El Jebel,CO 81623 (the"Property");and WHEREAS,Contractor is authorized to do business in the State of Colorado and has the time,skill,expertise,and experience necessary to provide the Services as defined below in paragraph 1 hereof;and WHEREAS,this Agreement shall govern the relationship between Contractor and County in connection with the Services. AGREEMENT NOW,THEREFORE,in consideration of the foregoing and the following promises Contractor and County agree as follows: 1. Services or Work. Contractor agrees to diligently provide all services,labor,personnel and materials necessary to perform and complete the services or work described in Exhibit A and Exhibit A-1 ("Services"or"Work") which exhibits are attached hereto and incorporated herein by reference.The Services shall be performed in accordance with the provisions and conditions of this Agreement. a. Contractor agrees to furnish the Services no later than 7:30 a.m.Monday through Friday each week and in accordance with the schedule established in Exhibit A and Exhibit A-1. If no completion date is specified in the exhibits,then Contractor agrees to furnish the Services in a timely and expeditious manner consistent with the applicable standard of care. By signing below Contractor represents that it has the expertise and personnel necessary to properly and timely perform the Services. b. In the event of any conflict or inconsistency between the terms and conditions set forth in Exhibit A and Exhibit A-land the terms and conditions set forth in this Agreement,the terms and conditions set forth in this Agreement shall prevail. 2. County's Representative. The Facilities Management Department's designee shall be Contractor's contact with respect to this Agreement and performance of the Services. 3. Term of the Agreement. This Agreement shall commence upon the date first written above,and subject to the provisions of paragraph 11 hereof,shall continue in full force and effect for a period of one year. 04' It-5 4. Extension or Modification. This Agreement may be extended for up to three additional one year terms upon written agreement of the parties.Any amendments or modifications shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services in accordance with County's internal policies. Accordingly,no course of conduct or dealings between the parties,nor verbal change orders,express or implied acceptance of alterations or additions to the Services,and no claim that County has been unjustly enriched by any additional services,whether or not there is in fact any such unjust enrichment,shall be the basis of any increase in the compensation payable hereunder.In the event that written authorization and acknowledgment by County for such additional services is not timely executed and issued in strict accordance with this Agreement,Contractor's rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. 5. Compensation. County shall compensate Contractor for the performance of the Services in a sum computed and payable as set forth in Exhibit A-1. The performance of the Services under this Agreement shall not exceed twenty five thousand dollars$25,000. Contractor shall be entitled to bill at overtime rates for work done outside of normal business hours in accordance with the fees established in Exhibit A-1.The Parties agree that the Services to be performed by 7:30 a.m.are deemed to occur during normal business hours and shall not be the basis for overtime. a. Payment will be made for Services satisfactorily performed within thirty(30)days of receipt of a proper and accurate invoice from Contractor. All invoices shall include detail regarding the hours spent,tasks performed,who performed each task and such other detail as County may request. b. If,at any time during the term or after termination or expiration of this Agreement,County reasonably determines that any payment made by County to Contractor was improper because the Services for which payment was made were not performed as set forth in this Agreement,then upon written notice of such determination and request for reimbursement from County,Contractor shall forthwith return such payment(s)to County. Upon termination or expiration of this Agreement,unexpended funds advanced by County,if any,shall forthwith be returned to County. c. 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. d. 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 f o any year,without an appropriation therefor by County in accordance with a budget adopted by the P Y Board of County Commissioners in com p liance 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. Subcontractors. 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 subcontractor agreements for the performance of any of the Services or additional services 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 the subject Project during the performance of this Agreement and no personnel to whom County has an objection,in its reasonable discretion,shall be assigned to the Project. Contractor shall require each subcontractor,as approved by County and to the extent of the Services to be performed by the subcontractor,to be bound to Contractor by the terms of this Agreement,and to assume toward Contractor all the obligations and 2 G:\MAINTENANCE\Service Agreements\El Jebel Maintenance\2014\Jerry Cheney Agreement FINAL.docx responsibilities which Contractor,by this Agreement,assumes toward County.County shall have the right(but not the obligation)to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process.The Contractor shall be responsible for the acts and omissions of its agents,employees and subcontractors. 7. Insurance. Contractor agrees to provide and maintain at Contractor's sole cost and expense,the following insurance coverage with limits of liability not less than those stated below: a. Types of Insurance. i. Workers' Compensation insurance as required by law. ii. Auto coverage with limits of liability not less than$1,000,000 each accident combined bodily injury and property damage liability insurance,including coverage for owned,hired,and non-owned vehicles. iii. Commercial General Liability coverage to include premises and operations, personal/advertising injury,products/completed operations,broad form property damage with limits of liability not less than$1,000,000 per occurrence and$1,000,000 aggregate limits. b. Other Requirements. i. The automobile and commercial general liability coverage shall be endorsed to include Eagle County,its associated or affiliated entities,its successors and assigns,elected officials,employees,agents and volunteers as additional insureds.A certificate of insurance consistent with the foregoing requirements is attached hereto as Exhibit B. ii. Contractor's certificates of insurance shall include subcontractors,if any as additional insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for each subcontractor. iii. The insurance provisions of this Agreement shall survive expiration or termination hereof iv. The parties hereto understand and agree that the County is relying on,and does not waive or intend to waive by any provision of this Agreement,the monetary limitations or rights,immunities and protections provided by the Colorado Governmental Immunity Act,as from time to time amended,or otherwise available to County,its affiliated entities,successors or assigns,its elected officials,employees,agents and volunteers. v. Contractor is not entitled to workers' compensation benefits except as provided by the Contractor,nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Contractor or some other entity. The Contractor is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8. Indemnification. 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 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 3 G:\MAINTENANCE\Service Agreements\E1 Jebel Mamtenance\2014\Jeiry Cheney Agreement FINAL.docx reimburse County for reasonable 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 County is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents(including electronic files)and materials 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. 10. Notice. Any notice required by this Agreement shall be deemed properly delivered when(i)personally delivered,or(ii)when mailed in the United States mail,first class postage prepaid,or(iii)when delivered by FedEx or other comparable courier service,charges prepaid,to the parties at their respective addresses listed below,or(iv) when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date,time and receiving facsimile number for the transmission,or(v)when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this paragraph by giving five(5)days prior written notice of such change to the other party. COUNTY: Eagle County,Colorado Attention:Facilities Management Department 500 Broadway Post Office Box 850 Eagle,CO 81631 Telephone:970-328-8881 Facsimile:970-328-3539 E-Mail:ron.siebert@eaglecounty.us With a copy to: Eagle County Attorney 500 Broadway Post Office Box 850 Eagle,Co 81631 Telephone:970-328-8685 Facsimile: 970-328-8699 E-Mail:atty @eaglecounty.us CONTRACTOR: Jerry Cheney 2496 Hwy 133 Carbondale,CO 81623 Telephone:970-274-0457 Facsimile:970-963-3496 E-Mail:jcheney @sopris.net 11. Termination. County may terminate this Agreement,in whole or in part, at any time and for any reason, with or without cause,and without penalty therefor with seven(7)calendar days'prior written notice to the Contractor. Upon termination of this Agreement,Contractor shall immediately provide County with all documents 4 G:\MAINTENANCE\Service Agreements\El Jebel Maintenance\2014\Jerry Cheney Agreement FINAL.docx as defined in paragraph 9 hereof,in such format as County shall direct and shall return all County owned materials and documents.County shall pay Contractor for Services satisfactorily performed to the date of termination. 12. Venue,Jurisdiction and Applicable Law. Any and all claims,disputes or controversies related to this Agreement,or breach thereof,shall be litigated in the District Court for Eagle County,Colorado,which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 13. Execution by Counterparts;Electronic Signatures. This Agreement may be executed in two or more counterparts,each of which shall be deemed an original,but all of which shall constitute one and the same instrument. The parties approve the use of electronic signatures for execution of this Agreement.Only the following two forms of electronic signatures shall be permitted to bind the parties to this Agreement:(i) Electronic or facsimile delivery of a fully executed copy of the signature page;(ii) the image of the signature of an authorized signer inserted onto PDF format documents. All documents must be properly notarized,if applicable. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act,C.R.S.24-71.3-101 to 121. 14. Other Contract Requirements and Contractor Representations. a. Contractor has familiarized itself with the nature and extent of the Services to be provided hereunder and the Property,and with all local conditions,federal,state and local laws,ordinances,rules and regulations that in any manner affect cost,progress,or performance of the Services. b. Contractor will make,or cause to be made,examinations,investigations,and tests as he deems necessary for the performance of the Services. c. To the extent possible,Contractor has correlated the results of such observations,examinations, investigations,tests,reports,and data with the terms and conditions of this Agreement. d. To the extent possible,Contractor has given County written notice of all conflicts,errors,or discrepancies. e. Contractor shall be responsible for the completeness and accuracy of the Services and shall correct,at its sole expense,all significant errors and omissions in performance of the Services. The fact that the County has accepted or approved the Services shall not relieve Contractor of any of its responsibilities. Contractor shall perform the Services in a skillful,professional and competent manner and in accordance with the standard of care,skill and diligence applicable to contractors performing similar services. Contractor represents and warrants that it has the expertise and personnel necessary to properly perform the Services and shall comply with the highest standards of customer service to the public. Contractor shall provide appropriate supervision to its employees to ensure the Services are performed in accordance with this Agreement.This paragraph shall survive termination of this Agreement. f. Contractor agrees to work in an expeditious manner,within the sound exercise of its judgment and professional standards,in the performance of this Agreement. Time is of the essence with respect to this Agreement. g. This Agreement constitutes an agreement for performance of the Services by Contractor as an independent contractor and not as an employee of County. Nothing contained in this Agreement shall be deemed to create a relationship of employer-employee,master-servant,partnership,joint venture or any other relationship 5 G:\MAINTENANCE\Service Agreements\El Jebel Maintenance\2014\Jerry Cheney Agreement FINAL.docx between County and Contractor except that of independent contractor.Contractor shall have no authority to bind County. h. Contractor represents and warrants that at all times in the performance of the Services,Contractor shall comply with any and all applicable laws,codes,rules and regulations. i. This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding between the parties with respect thereto. j. Contractor shall not assign any portion of this Agreement without the prior written consent of the County. Any attempt to assign this Agreement without such consent shall be void. k. This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted assigns and successors in interest.Enforcement of this Agreement and all rights and obligations hereunder are reserved solely for the parties,and not to any third party. 1. No failure or delay by either party in the exercise of any right hereunder shall constitute a waiver thereof. No waiver of any breach shall be deemed a waiver of any preceding or succeeding breach. m. The invalidity,illegality or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision hereof n. The signatories to this Agreement aver to their knowledge no employee of the County has any personal or beneficial interest whatsoever in the Services or Property described in this Agreement.The Contractor has no beneficial interest,direct or indirect,that would conflict in any manner or degree with the performance of the Services and Contractor shall not employ any person having such known interests. o. 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(i)is a citizen or otherwise lawfully present in the United States pursuant to federal law,(ii)to the extent applicable shall comply with C.R.S.24-76.5-103 prior to the effective date of this Agreement. 15. Prohibitions on Government Contracts. 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 Agreement. By execution of this Agreement, Contractor certifies that it does not knowingly employ or contract with an illegal alien who will perform under this Agreement 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 Agreement. a. Contractor shall not: i. Knowingly employ or contract with an illegal alien to perform Services under this Agreement;or ii. Enter into a subcontract that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under the public contract for services. 6 G:\MAINTENANCE\Service Agreements\El Jebel Maintenance\2014\Jery Cheney Agreement FINAL.docx b. Contractor has confirmed the employment eligibility of all employees who are newly hired for employment to perform Services under this Agreement 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 c. 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. d. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien,Contractor shall be required to: i. Notify the subcontractor and County within three (3) days that 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 Contractor shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. 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). f. If Contractor violates these prohibitions, County may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Contractor shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Contractor violates this provision of this Agreement and County terminates the Agreement for such breach. [REST OF PAGE INTENTIONALLY LEFT BLANK] 7 G:\MAINTENANCE\Service Agreements\El Jebel Maintenance\2014Verry Cheney Agreement FINAL docx IN WITNESS WHEREOF,the parties have executed this Agreement the day and year first set forth above. COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its COUNTY MANAGER By: Montag,Cou y anager CONTRACTOR: JERRY CHENEY,a sole proprietor By: Print Name: J...e.4 � C— C— IIII II 8 (;NAINTENANCE\Scrvice Agreements'EI Jebel Maintnvartce\2014\Jerry Cheney Agreement FINAL.doca 1 EXHIBIT A SERVICES Contractor shall perform the following Services: 1. Contractor agrees to check the building on the Property daily(Monday through Friday)before 7:30 a.m. The building check shall include: a) A security check of doors and check for unauthorized occupants. b) Check condition of meeting rooms,clean if necessary and report findings. c) Check janitorial work,contact contractor if not complete and report findings. d) Check snow removal work,contact contractor if not complete and report findings. 2. Keep grounds at the Property free of litter. 3. Perform routine maintenance and repairs at the Property including,but not limited to,repair minor plumbing problems,change light bulbs,change HVAC filters,hang signs,move furniture and boxes and other duties as requested by County. 4. Contact the Facilities Management Department for larger or specialized needs at the Property. 5. Complete and forward a daily report of findings and activities to County's Representative. 6. Respond to after hour calls concerning alarms,plumbing,etc.as requested by County. 7. Contractor must maintain during the course of the Agreement reliable transportation and tools as well as insurance as required in the Agreement. • EXHIrr 1 G.\MAINTENANCE\Service Agreements`•El Jebel Maintenance\20l4 Jerry Cheney Agreement Ill. it Proposal to Eagle County for Maintenance Services at: El Jebel Community Center 0020 Eagle County Road El Jebel CO 81623 Jerry Cheney, as an Independent Contractor,proposes to provide maintenance services to Eagle County for the El Jebel Community Center as outlined in request for proposal, and other services to be defined later. Contractor to provide labor, tools, transportation and insurance as required at an hourly rate of$45/hr.(includes labor, insurance and mileage)material and supplies to be purchased or supplied by Eagle County. After hours and weekend calls will be billed at a time and half charge. Availability or unavailability for evening and weekend calls will be provided to Bill Beasley with sufficient notice for other arrangements to be made I have worked as a sub contractor for Prince Creek Construction and performed electrical maintenance and other services for the Social Security Administration in Glenwood Springs numerous times. I have managed and maintained a personal rental property in Carbondale the past 2 years. I have no lawsuits,tax liens or potential claims pending at this time. i MI If ► • �....1 OP ID:GH .°``°R°- CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDNYYY) 03/20/14 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. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 970-945-9111 CONTACT NAME: Neil-Garing Agency, Inc. 970-945-2350 OE PO Box 1576 -�/UC.PHNNo.Ext) I FAX (A/C.No): Glenwood Springs,CO 81602 EMAIL Genevieve Haywood PRODUCER CUSTOMER ID B:CHEJE-1 INSURER(S)AFFORDING COVERAGE NAIC B INSURED Jerry Cheney INSURER A:Liberty Mutual Insurance 2496 Highway 133 INSURER B: Carbondale,CO 81623 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE !NCR wvn POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X BKS56035378 03/20/14 03/20/15 DAMAGES(RENTED 300,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY _ $ 1,000,000 — GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY Ti g F7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ _ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I WCYL TU- I I ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yesSCR,describe under OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DE DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Holder is included as Additional Insured under General Liability only and only in respect to ongoing operations performed by the insured on behalf of holder. CERTIFICATE HOLDER _CANCELLATION EAGLEAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County,Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE .DELIVERED IN Facilities Management Dept ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 850 Eagle,CO 81631 AUTHORIZED REPRESENTATIVE I ©1988-2009 ACORD CORPORATI . BIT ACORD 25(2009/09) • The ACORD name and logo are registered marks of ACORD t{ ilt 1 1 i Image Manager Page 1 of 1 A`�o® VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE os►z,2014 ) 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. This form Is used to report coverages provided to a single specific vehicle or equipment.Do not use this form to report liability coverage provided to multiple vehicles under a single policy.Use ACORD 25 for that purpose. PRODUCER CONTACT NAME: TODD FUGATE StateFarnt TODD FUGATE AGENCY 1 p EA, 970-963-5610 I rpm,Nei, 970-963-5607 STATE FARM INSURANCE ADDRESS:' todd.fugate.gOku @ statefarm.corn 590 HIGHWAY 133 PRODUCER ID e: CARBONDALE,CO 81623 INSURER(S)AFFORDING COVERAGE NAIC It INSURED INSURER A:State Farm Mutual Automobile Insurance Company 25178 CHENEY,JERRY&SUSAN INSURER B: 2496 HIGHWAY 133 INSURER C: CARBONDALE,CO 81623-9206 INSURER D: INSURER E: DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE/MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 2005 GMC K2500 PICKUP 1GTHK29U85E129533 DESCRIPTION SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POIJCY(IES)OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S)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 POLICY(IES)DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR AD01 POLICY EFFECTIVE POLICY EXPIRATION LTR NERD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYYYY) DATE(MMIDDIYYYY) UNITS X I VEHICLE LIABILITY COMBINED SINGLE UNIT S • A Y C75 4271-F17-06H 06/17/2013 06/17/2014 BODILY INJURY(Per perm') $ 1,000,000.00 BODILY INJURY(Per accident) S 1000000.00 PROPERTY DAMAGE S 1,000,000.00 GENERAL LIABILITY EACH OCCURENCE S OCCURRENCE GENERAL AGGREGATE S CIAWIS MADE S INSR Lori POLICY EFFECTIVE POLICY EXPIRATION LTR PAYEE TYPE OF INSURANCE POLICY NUMBER DATE(MMNWYYYY) DATE(MMIDD/YYYY) LIMITS J DEDUCTIBLE VEH COLLISION LOSS 0 ACV ❑AGREED ANT S LIMI ❑ ❑STATED NAT S DED VEH COMP u VEH OTC ❑ACV ❑AGREED AMT S LMn ❑ 0 STATED AMT S DED PROPERTY — 0 ACV 0 AGREED AMT S LIMI1 BASIC BROAD ❑RC 0 STATED AMT SPECIAL El S DED REMARKS(INCLUDING SPECIAL CONDITIONS/OTHER COVERAGES)(Attach ACORD 101,Additional Remarks Schedule,K more spec.Is required) ADDITIONAL INTEREST CANCELLATION Select one of the following. 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The eddtiatat interest desalted below has been added to the pofq(ies)listed herein by policy number(s). BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE XA request tray been submibed to add the addbonal interest described Wow to the pokq{es) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ihtotl t e s n by odic nuMa tsl VEHICLE/EOUPMERT INTEREST: I I LEASED I I FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST NAME AND ADDRESS OF ADOITIONAL INTEREST X ADDITIONAL INSURED LOSS PAYEE EAGLE COUNTY,ITS ASSOCIATED OR AFFILIATED ENTITIES, LENDER'S LOSS PAYEE ITS SUCCESSORS AND ASSIGNS,ELECTED OFFICIALS, LOAN I LEASE NUMBER EMPLOYEES,AGENTS AND VOLUNTEERS. AUTHO REPRESENTA / I . ®1997-2010 RD Is RPORAT N.All reserved ACORD 23(2010105) The ACORD name and logo are registered marks of ACO 1004361 142987.2 01-28-201 If tr https://sfnet.opr.statefarm.org/im_core/jsps/pages/imageManager.faces ,