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HomeMy WebLinkAboutC14-227 Paller & Girard, Inc. Agreement AGREEMENT FOR ON-CALL SERVICES
BETWEEN EAGLE COUNTY,COLORADO
AND
PALLER&GIRARD,INC.
THIS AGREEMENT("Agreement")is effective as of the 26th day of May,2014 by and between
n4\�t�6
'Pula jr. c_oc s n (hereinafter"Contractor")and Eagle County,Colorado,a body
corporate and politic(hereinafter"County").
RECITALS
WHEREAS, County desires to contract for on-call or as needed noxious weed control along roads and rights of
ways through Eagle County;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 on-call services or work at the rates set forth in Exhibit A and in accordance
with a formal proposal for each on-call service to be provided by Contractor and approved by County in writing
("Services"or"Work").Exhibit A is 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 in accordance with the schedule established in each
proposal approved by County. If no completion date is specified,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 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 Integrated Pest Management Department's designee(hereinafter"Weed
Manager")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 through the 31" day of October,2014.
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 at the rate of
seventy five dollars($75)per hour,as set forth in Exhibit A. Prior to authorizing Contractor to commence the
performance of Services at any Property or Properties(a"project"),the Weed Manager shall estimate the
approximate number of hours necessary to complete the Services for the project. If Contractor determines it
necessary to exceed the Weed Manager's estimated time for a given project,Contractor shall immediately notify the
Weed Manager and obtain authorization to perform Services beyond the Weed Manager's estimated time. Total
compensation for all Services under this Agreement shall not exceed twenty five thousand dollars$25,000.00.
Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business
hours unless specifically authorized in writing by County.
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 of any 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. 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 perform the Services 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
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Eagle County On-Call General Services final 1/14
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
reimburse County for reasonable attorney fees and costs,legal and other expenses incurred by County in connection
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Eagle County On-Call General Services final 1/14
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:Integrated Pest Management
500 Broadway
Post Office Box 850
Eagle,CO 81631
Telephone:970-328-3553
Facsimile:970-328-8788
E-Mail:scott.griffin @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:
Paller&Girard,Inc
P.O.Box 1085
Eagle,Co 81631
(970)471-0037
Email:tagirard54@gmail.com
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Eagle County On-Call General Services final 1/14
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
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 or Properties,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.
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Eagle County On-Call General Services final 1/14
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
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
6
Eagle County On-Call General Services final 1/14
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.
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]
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Eagle County On-Call General Services final 1/14
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: /..� .r� ■ 1►� 4 -mac
Keith P. Montag, County Ma .:er
CONTRACTOR:PALL6R&GIRARD,INC.
By: G� '�L ` �.rit�i�EJ
Print Name: 1W 9,144S A. G fie 44
Title: �IC,F° — /°/6'S' r--6r=ti'
8
Eagle County On-Call General Services final 1/14
•
EXHIBIT A
SCOPE OF WORK.
Upon acceptance of this proposal the Contractor will be available, upon one week's notice by County, through
the growing season (effective date of contract through Nov 1st 2014)to respond to areas within Eagle County that
the Eagle County Weed Manager has selected. In accordance with instructions provided by the Weed Manager,
Contractor will properly apply at the label recommended rate (or rates directed by the Manager) the herbicides
provide by Eagle County to noxious weeds.. A Colorado Department of Agriculture approved application record
shall be completed daily by the contractor and provided to the Weed Manager by Friday at 5pm of each week that
work is completed. Contractor is responsible for maintaining all required licensing and documents to legally apply
herbicides in Eagle County. Safety signage will only be provided by Eagle County Weed and Pest for secondary
road and Rail Road staging areas. River and or ditch water are not to be used when mixing herbicides for Eagle
County, only clear and clean water shall be used for product mixing and will be provided by contractor. Prior to
operations the contractor shall provide a signed document stating the date,time and percentages of output for each
piece of equipment they intend to use that show proper calibration per the Colorado Department of Agriculture
guidelines.A copy of Current and valid Colorado Department of Agriculture or compact state issued license must be
provided prior to operations.
Contractors shall maintain cellular contact capabilities with the County Weed Manager during any spraying
operations conducted for the County unless previously discussed and agreed upon.
Contractor will be applying herbicides to roadside and railroad right of way noxious weeds throughout
Eagle County on uneven and potentially hazardous terrain at the rate of$75.00 per hour. The areas of
concentration will be varied and selected on an as needed basis for weed control along US Highway 6
from mile marker 133 to mile marker 171, Highway 131 from Wolcott to State Bridge, Highway 24 from
the Dowd junction interchange at I-70 to mile marker 162 and the UPRR right of ways from Gypsum
through Camp Hale.Contractor will be responsible for the proper application of herbicides to designated
noxious weeds per the label requirements and or as directed by the County weed manager.
Contractor is responsible for providing:
1. Modern and recently calibrated equipment in good working condition
2. Clean water for chemical preparation and mixing
3. Daily activity reports and weekly application sheets
9
Eagle County On-Call General Services final 1/14
•
•
EXHIBIT B
INSURANCE CERTIFICATES
10
Eagle County On-Call General Services final 1/14
PALLE-1 OP ID: RC
C4SPRCTE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
05/22/2014
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 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 CONTACT
Buren Insurance Group,Inc-4 NAME Justin Buren
585 South Front St Suite 200 HO NN, Ext):614-942-1226 FAX
(NC,No): 614-942-1227
Columbus,OH 43215 E-MAIL
Justin Buren ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:CNA Insurance Company 35289
-
INSURED Paller&Girard Inc INSURER B:
PO Box 1058
Eagle,CO 81631 INSURER C:
INSURER D:
INSURER E:
_INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY 2077558149 03/22/2014 03/22/2015 DAMAGE TO RENTED
PREMISES(Ea occurrence) $ 100,000
CLAIMS-MADE X OCCUR MED EXP(Anyone person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY PECOT- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
(Ea accident) _ $
A X ANY AUTO 2077558197 03/22/2014 03/22/2015 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS JPER ACCIDENT) $ _
UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $
EXCESS LIAB • CLAIMS-MADE
AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required)
Eagle County Government is listed as an Additional Insured
CERTIFICATE HOLDER CANCELLATION
EAGLECO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Eagle County Government ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 239
500 Broadway AUTHORIZED REPRESENTATIVE
Eagle,CO 81631
©1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD