No preview available
HomeMy WebLinkAboutC15-328 Regents of The University of Colorado - Health Links AGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY, COLORADO AND REGENTS OF THE UNIVERSITY OF COLORADO (HEALTH LINKS COLORADO) THIS AGREEMENT("Agreement")is effective as of the 44-h day of Jay,2015 by and between Regents of the University of Colorado,a body corporate,on behalf of the University of Colorado Denver, a public institution of higher education created under the Constitution and the Law of the State of Colorado(hereinafter"Contractor")and Eagle County,Colorado, a body corporate and politic (hereinafter"County"). RECITALS WHEREAS,the County,through its Department of Health and Human Services("HHS")works to promote the health, safety and welfare of County residents of all ages; and WHEREAS,the County uses outside providers and professionals to enhance the ability of County to promote such health, safety and welfare; and WHEREAS,Health Links Colorado is a nonprofit initiative from the Center for Worker Health and Environment within the Colorado School of Public Health; and WHEREAS,the County will enter in to a collaboration with Health Links Colorado,through the Contractor,to engage employers across Pitkin,Eagle, Summit,Grant and Jackson Counties(Economic Development Region 12)to promote wellness and safety programs in the workplace with the intent to improve overall health and wellbeing across residents,workers, families and the community. This collaboration and regional work is through the Colorado Department of Public Health and Environment's Cancer, Cardiovascular,and Pulmonary Disease Grants Program. The services will occur throughout Economic Development Region 12,and will be coordinated from Health Links' offices located at 13199 East Montview Blvd., Suite 200,Aurora,CO 80045; 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("Services"or "Work")which is attached hereto and incorporated herein by reference.The Services shall be performed in accordance with the provisions and conditions of this Agreement. C►S -3 a. Contractor agrees to furnish the Services no later than June 30,2016 and in accordance with the schedule established in Exhibit A. If no completion date is specified in Exhibit A,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 Public Health and Environment 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 through the 30th day of June,2016. 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. The performance of the Services under this Agreement shall not exceed$92,000. 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. For reimbursement Contractor must submit invoices quarterly. Invoices shall include a description of the Services performed. If County is not satisfied with the completeness of a submitted invoice, County may request Contractor to either revise the invoice or provide additional information. 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. All invoices must be mailed or delivered in-person to the following address to ensure proper payment. Invoices sent by fax or e-mail will not be accepted. 2 Eagle County HI-IS General Services Final 5/14 Eagle County Health and Human Services Business Office 550 Broadway Post Office Box 660 Eagle, CO 81631 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. All funds received by Contractor under this Agreement shall be or have been expended solely for the purpose for which granted,and any funds not so expended,including funds lost or diverted for other purposes, shall be returned to County. Contractor shall provide the County with progress reports upon County's request; or Contractor shall furnish progress reports as more specifically set forth in the attached Exhibit A. d. 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. e. 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 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 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. 3 Eagle County HHS General Services Final 5/14 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.This policy shall be endorsed to include coverage for physical/sexual abuse and molestation. b. Other Requirements. i. Intentionally Omitted. ii. Intentionally Omitted. iii. The insurance rovisions of this Agreement shall survive expiration or p �' P 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. Responsibility for Injuries. Each party hereto agrees to be responsible and assume liability for its own wrongful or negligent acts or omissions,or those of its officers,agents or employees to the full extent allowed by law.It is specifically understood and agreed that nothing contained in this paragraph or elsewhere in this Agreement will be construed as: an express or implied waiver by either party of their governmental immunity or of the governmental immunity of the State of Colorado; an express or implied acceptance by either party of liabilities arising as a result of actions which lie in tort or could lie in tort in excess of the liabilities allowable under the Colorado Governmental Immunity Act,C.R.S. §§ 24-10-101 et seq.; a pledge of the full faith and credit of a debtor agreement; or, as the assumption by either party of 4 Eagle County HHS General Services Final 5/14 a debt,agreement,or liability of the other party in violation of Article XI, Section 1 of the Constitution of Colorado. No liability hereunder shall result to a party by reason of delay in performance caused by force majeure that is circumstances beyond the reasonable control of the party, including,without limitation,acts of God,fire, flood,war,civil unrest, or shortage of or inability to obtain material and equipment. Notwithstanding the foregoing,in no event shall either party be liable hereunder(whether in an action in negligence, contract or tort or based on a warranty or otherwise)for loss of profits,revenue,or loss or inaccuracy of data, or any indirect,incidental, special or consequential damages incurred by the other party or any third party, even if the party has been advised of the possibility of such damages, except that this limitation shall not apply to damage to tangible property or injuries to persons,including death. 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: Katie Haas 500 Broadway Post Office Box 850 Eagle,CO 81631 Telephone: 970-328-8855 E-Mail:katie.haas @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 5 Eagle County HHS General Services Final 5/14 CONTRACTOR: Regents of the University of Colorado Health Links Colorado Attention: Lili Tenney 13199 E.Montview Ave. Suite 200 Aurora,CO 80045 Telephone: 303-724-6440 Email: lili.tenney@healthlinkscolorado.org 11. Termination. Contractor may terminate this Agreement at any time by giving the other party written notice of not less than sixty(60)days. 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 deemed 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.Notwithstanding the foregoing, Contractor reserves the right to terminate this Agreement,with no further obligation to provide services, upon nonpayment by County of unpaid amounts owed to Contractor under this Agreement. County's payment obligations for services previously rendered by Contractor shall survive the termination of this Agreement. 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. 6 Eagle County HHS General Services Final 5/14 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. In the event County finds these standards of customer service are not being met by Contractor,County may terminate this Agreement,in whole or in part,upon seven(7)days' notice to Contractor. County shall pay Contractor for Services satisfactorily performed to the date of termination.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 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. 7 Eagle County HMS General Services Final 5/14 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. p. Contractor shall comply with the Civil Rights Act of 196 and Section 504,Rehabilitation Act of 1973,concerning discrimination on the basis of race,color, sex,sexual orientation,age,religion, political beliefs,national origin or handicap. [Rest of page intentionally left blank] 8 Eagle County HHS General Services Final 5/14 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 BOARD OF COUNTY COMMISSIONERS BY: 4i A..A L .iJI A i l valigizthy handler-Henry, Chai Attest: By: off° Teak J. Simonton, Clerk to the Board REGENTS OF THE UNIVERSITY OF COLORADO B Y• -e l t '�7 Print Name: Shaun P.McMullin,CPA Title: Deputy Controller Date: it ACKNOWLEDGED AND AGREED BY: COLORADO SCHOOL OF PUBLIC HEALTH PRINC INVESTIGATOR By: lj By: Name: David C.Goff .MD,PhD Name: Lee Newman,MD,MA Title: Dean Title: Professor Date: 7—/3�-/S'— Date: -7-(O•(C- 9 Eagle County HHS General Services Final 5/14 EXHIBIT A SCOPE OF SERVICES, SCHEDULE,FEES SERVICES: 1. Hire,train,coordinate and oversee Health Links Advisors to be representative of the entire Economic Development Region 12(Pitkin,Eagle, Summit,Grant,and Jackson Counties). Budget for Health Links Advisors shall not exceed$67,000. 2. Conduct up to eight training events throughout Region 12—target audience and topics may vary based on locally identified needs. Training supporting materials will always be provided to Eagle County Public Health and Environment. Budget for trainings shall not exceed$20,000—eight training events at$2,500 each. 3. Provide ongoing technical assistance and support to the Health Links Advisors in their effort to support employers in developing evidence-based worksite wellness and safety programs. This should include,at minimum, a bi-weekly or monthly call with Region 12 Advisors. Health Links shall bill $25 per hour for Advisor support,up to$5,000. 4. Provide quarterly reports,both in aggregate and separated by County,to Eagle County Public Health and Environment. Quarterly reports should be submitted to ECPHE by the 7th of the month. The reports will include,at a minimum: a. Number of employers receiving advising b. Number of employers who have achieved Healthy Business Certification c. Number of employers who have received kick-start funding, and what amount d. Number of employees who are part of Certified Healthy Business employers e. Qualitative examples of worksite wellness and safety programs implemented by employers as a result of Health Links' involvement. 5. Provide communications and promotions materials to key partnership and Health Links Advisors; contribute to development of localized materials. 6. Maintain consistent communication with core collaborators including Eagle County Public Health and Environment and Northwest Colorado Council of Governments. SCHEDULE: The Contractor shall work the hours required to fulfill the scope of work. FEES: The Contractor will submit an invoice by the 3rd day of each month for services provided the month prior. The invoice will include all costs associated with the grant project as defined above. Contract amount may not exceed$92,000 for the Term of the Agreement. Payment will by check and mailed to the Contractor from Eagle County Public Health and Environment grant funds. 10 Eagle County HHS General Services Final 5/14 EXHIBIT B INSURANCE CERTIFICATE 11 Eagle County HHS General Services Final 5/14 ACOREI CERTIFICATE OF LIABILITY INSURANCE 07/14/201 ) 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 1-303-773-9999 CONTACT Anita Bruner NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX (A/C.No.EM): 303-889-2574 (A/C,No): 303-889-2575 6399 S. Fiddlers Green Cir ADDRESS: anita_brunereajg.com Suite 200 Greenwood Village, CO 80111 INSURER(S)AFFORDING COVERAGE NAIC S Karen Graham INSURERA: PRINCETON EXCESS & SURPLUS LINES INS 10786 INSURED INSURERB: ARCH INS CO 11150 Board of Regents of University of Colorado University of Colorado Denver INSURERC: University Risk Management INSURERD: 1945 N Wheeling St, Campus Mail Stop F-418 Aurora, CO 80045 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 44553561 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY MMI EXP LIMITS LTR INSR WVD POLICY NUMBER ( DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY N3A3RL000001008 10/01/14 10/01/15 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES p (Ea occurrence) $Excluded CLAIMS-MADE X OCCUR MED EXP(Any one person) $Excluded _ x Educ Legal Liab. PERSONAL&ADV INJURY $Included X SIR - $1,250,000 GENERALAGGREGATE _ $None GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Included POLICY JECT LOC $ A AUTOMOBILELIABILITY N3A3RL000001008 10/01/14 10/01/15 COMBINED BIrtSINGLELIMIT $Included _ X ANY AUTO BODILY INJURY(Per person) $InAbove ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) X SIR Limit x $1,250,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCX002954806 10/01/14 10/01/15 X TORYLIMITS 0T AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $2,000,000 N s,desaibeunder 2,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) For WC Coverage - SIR - $1,500,000. Evidence of Insurance re: University of Colorado Denver School of Public Health - Health Links Colorado Contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County, Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Katie Haas 500 Broadway AUTHORIZED REPRESENTATIVE Post Office Box 850 / Eagle, CO 81631 V M USA ��..00�.� .... ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD lasmith 44553561