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HomeMy WebLinkAboutC16-465 YouthPower365 AGREEMENT FOR PROFESSIONAL SERVICES
BETWEEN EAGLE COUNTY, COLORADO
AND
YOUTHPOWER365
THIS AGREEMENT (“Agreement”) is effective as of the ______ day of _____________, 2016 by and
between YouthPower365 a Colorado nonprofit corporation (hereinafter “Contractor”) and Eagle County,
Colorado, a body corporate and politic (hereinafter “County”).
RECITALS
WHEREAS, the County, through its Department of Human Services (“DHS”) 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, County desires to hire the Contractor to perform the Services defined below in paragraph 1;
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; 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. Contractor agrees to diligently provide all services, labor, personnel and materials
necessary to perform and complete the services described in Exhibit A (“Services”) which 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 no later than June 30, 2017 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.
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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.
c. Contractor agrees that it will not enter into any consulting or other arrangements with
third parties that will conflict in any manner with the Services.
2. County’s Representative. The Manager of the Division of Children, Family & Adult Services
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, 2017.
4. Extension or Modification. This Agreement may not be amended or supplemented, nor may any
obligations hereunder be waived, except by agreement 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 $19,200. 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. Invoices shall include a description
of 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. 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 e-mailed to the following address to ensure proper payment.
E-mail: DHS.Communications@eaglecouty.us
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b. Any out-of-pocket expenses to be incurred by Contractor and reimbursed by County shall
be identified on Exhibit A. Out-of-pocket expenses will be reimbursed without any additional mark-up
thereon and are included in the not to exceed contract amount set forth above. Out-of-pocket expenses
shall not include any payment of salaries, bonuses or other compensation to personnel of Contractor.
Contractor shall not be reimbursed for expenses that are not set forth on Exhibit A unless specifically
approved in writing by County.
c. If, prior to payment of compensation or reimbursement for Services but after submission
to County of a request therefore by Contractor, County disputes an invoice, County will issue written
notice of the dispute within thirty (30) days of the date on which County receives the invoice. Contractor
will then have thirty (30) days from the date on which Contractor receives the written notice to address
and correct such dispute. Should the County reasonably determine that payment as requested would be
improper because the Services were not performed as prescribed by the provisions of this Agreement, the
County shall have no obligation to make such payment. If, at any time after or during the term or after
termination or expiration of this Agreement, County reasonably determines that any payment theretofore
paid 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.
d. 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 furnish progress reports as more
specifically set forth in the attached Exhibit A.
e. 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.
f. 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. Sub-contractors. 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-contractor 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 sub-contractor, as approved by
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County and to the extent of the Services to be performed by the 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. County shall have the right (but not the
obligation) to enforce the provisions of this Agreement against any sub-contractor 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 sub-contractors or sub-contractors.
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 $2,000,000 aggregate limits. This policy shall be
endorsed to include coverage for physical/sexual abuse and molestation.
iv. Intentionally Omitted.
v. Intentionally Omitted.
b. Other Requirements.
i. The automobile and commercial general liability coverage and such other
coverage as indicated above 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.
ii. Contractor’s certificates of insurance shall include sub-contractors as additional
insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for
each sub-contractor. All coverage(s) for sub-contractors shall be subject to the same minimum
requirements identified above. Contractor and sub-contractors, if any, shall maintain the foregoing
coverage in effect until the Services are completed. In addition, all such policies shall be kept in force by
Contractor and its sub-contractors until the applicable statute of limitations for the Services has expired.
iii. Insurance shall be placed with insurers duly licensed or authorized to do business
in the State of Colorado and with an “A.M. Best” rating of not less than A-VII.
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iv. Contractor’s insurance coverage shall be primary and non-contributory with
respect to all other available sources. Contractor’s policy shall contain a waiver of subrogation against
Eagle County.
v. All policies must contain an endorsement affording an unqualified thirty (30)
days’ notice of cancellation to County in the event of cancellation of coverage.
vi. All insurers must be licensed or approved to do business within the State of
Colorado and all policies must be written on a per occurrence basis unless otherwise provided herein.
vii. Contractor’s certificate of insurance evidencing all required coverage(s) is
attached hereto as Exhibit B. Upon request, Contractor shall provide a copy of the actual insurance
policy and/or required endorsements required under this Agreement within five (5) business days of a
written request from County, and hereby authorizes Contractor’s broker, without further notice and
authorization by Contractor, to immediately comply with any written request of County for a complete
copy of the policy.
viii. Contractor shall advise County in the event the general aggregate or other
aggregate limits are reduced below the required per occurrence limit. Contractor, at its own expense, will
reinstate the aggregate limits to comply with the minimum limits and shall furnish County a new
certificate of insurance showing such coverage.
ix. If Contractor fails to secure and maintain the insurance required by this
Agreement and provide satisfactory evidence thereof to County, County shall be entitled to immediately
terminate this Agreement.
x. The insurance provisions of this Agreement shall survive expiration or
termination hereof.
xi. 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.
xii. 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
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Eagle County HHS Prof Serv Final 5/14
of its sub-contractors hereunder including claims for bodily injury or personal injury including death, or
loss or damage to tangible or intangible property; and Contractor shall 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 prepared by Contractor in connection with the Services
shall become property of County. Contractor shall execute written assignments to County of all rights
(including common law, statutory, and other rights, including copyrights) to the same as County shall
from time to time request. For purposes of this paragraph, the term “documents” shall mean and include
all reports, plans, studies, tape or other electronic recordings, drawings, sketches, estimates, data sheets,
maps and work sheets produced, or prepared by or for Contractor (including any employee or
subcontractor in connection with the performance of the Services and additional services under this
Agreement). County shall grant to Contractor a nonexclusive, irrevocable, perpetual, worldwide, royalty-
free, transferable and sublicensable license for noncommercial purposes to use, display, perform,
reproduce, publish, copy, archive, excerpt, distribute, create derivative works from and otherwise
disseminate, in whole or in part, any or all of the aforementioned documents.
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: Kendra Kleinschmidt, LCSW
551 Broadway
Post Office Box 660
Eagle, CO 81631
Telephone: 970-328-8827
E-Mail: DHS.Communications@eaglecounty.us
With a copy to:
Eagle County Attorney
500 Broadway
Post Office Box 850
Eagle, Co 81631
Telephone: 970-328-8685
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Facsimile: 970-328-8699
E-Mail: atty@eaglecounty.us
CONTRACTOR:
YouthPower365
Attention: Melisa Rewold-Thuon
PO Box 6550
Avon, CO 81620
Telephone: 970-777-2015
mthuon@vvf.org
11. Termination. County or Contractor 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 other party. 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.
a. In rendering the Services hereunder, Contractor shall comply with the highest standards
of customer service to the public. Contractor shall provide appropriate supervision of its employees to
ensure the maintenance of these high standards of customer service and professionalism are maintained.
The performance of such obligation shall be determined at the sole discretion of County. 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.
b. Contractor shall be responsible for the completeness and accuracy of the Services,
including all supporting data or other documents prepared or compiled in performance of the Services,
and shall correct, at its sole expense, all significant errors and omissions therein. The fact that the County
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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. This
paragraph shall survive termination of this Agreement.
c. Contractor represents and warrants that it has the expertise and personnel necessary to
properly perform the Services and covenants that its professional personnel are duly licensed to perform
the Services within Colorado.
d. 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.
e. 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.
f. Contractor represents and warrants that at all times in the performance of the Services,
Contractor shall comply with any and all applicable federal and state laws, codes, rules and regulations.
g. Contractor shall comply with the Civil Rights Act of 1964 and Section 504,
Rehabilitation Act of 1973, concerning discrimination on the basis of race, color, sex, age, religion,
political beliefs, national origin or handicap.
h. 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.
i. 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.
j. 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.
k. 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.
l. The invalidity, illegality or unenforceability of any provision of this Agreement shall not
affect the validity or enforceability of any other provision hereof.
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m. Contractor shall maintain for a minimum of three years, adequate financial and other
records for reporting to County. Contractor shall be subject to financial audit by federal, state or county
auditors or their designees. Contractor authorizes such audits and inspections of records during normal
business hours, upon 48 hours’ notice to Contractor. Contractor shall fully cooperate during such audit or
inspections.
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.
As used in this Section 15, the term undocumented individual will refer to those individuals from foreign
countries not legally within the United States as set forth in C.R.S. 8-17.5-101, et. seq. If Contractor has
any employees or subcontractors, Contractor shall comply with C.R.S. 8-17.5-101, et. seq., and this
Agreement. By execution of this Agreement, Contractor certifies that it does not knowingly employ or
contract with an undocumented individual 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 undocumented individual 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 undocumented individual 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
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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 undocumented individual, 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 undocumented individual;
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 undocumented individual; 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 undocumented
individual.
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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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: ______________________________
Brent McFall, County Manager
CONTRACTOR:
YOUTHPOWER365
By:________________________________
Print Name: _________________________
Title: ______________________________
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Eagle County HHS Prof Serv Final 5/14
EXHIBIT A
SCOPE OF SERVICES, FEES, REPORTING REQUIREMENTS
Scope of Services
In Eagle County, two school district systems serve a high percentage of Hispanic residents whose first
language is Spanish. Currently, the Hispanic, Spanish-speaking population is disproportionately over-
represented in referrals of abuse/neglect to the Eagle County Department of Human Services (ECDHS)
child protection/welfare and prevention (Colorado Community Response) team. Referrals to ECDHS also
occur when children act out in classrooms; typically child behavior is not driven by mental health issues
but instead by lack of connectedness and feeling of safety at school due to linguistic and cultural
differences.
Through an already tested school-based Parent Mentor Program, Spanish-speaking parents and
elementary school students at risk of referral or entry into the child protection/child welfare system are
able to develop a greater sense of connectedness, thereby increasing the protective factors that lead to a
family strengthening and overall wellbeing. Anecdotally, teachers share that having a culturally and
linguistically attuned adult partner in the classroom helps students regulate their emotions and behaviors.
Parent Mentors report that students seem to feel more comfortable sharing issues they are experiencing at
home and in school, increasing the likelihood that ECDHS’ prevention program can offer support and
resource navigation.
The Parent Mentor Program Contractor will:
x Recruit, train, and manage up to 14 Parent Mentors to serve in elementary school classrooms;
x Provide a financial stipend of $1200 directly to each Parent Mentor who assists in a classroom
two hours per day, four days per week, ending May 31, 2017; and,
x Weekly, Parent Mentors will receive two hours of personal and professional development training
by the Contractor.
Fees
Contractor will be paid a total of $19,200.
Schedule of Payments
Contractor will receive an initial payment of $16,800 upon submission of an invoice with verification of
14 Parent Mentors recruited and enrolled in the program by January 1, 2017. Initial invoice may be
delivered immediately upon ability to attest that up to 14 Parent Mentors are enrolled and have made
statements of commitment to May 31, 2017.
Contractor may bill for the remainder of the contract value ($2,400) upon submission of the final report.
Final invoice and report must be received by June 30, 2017.
Final Report Requirements
Contractor must report:
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1. Total participation rate in the Parent Mentor program (total number of Parent Mentors initially
engaged and attendance from January 1, 2017 to May 31, 2017).
2. Total number of volunteer hours contributed by Parent Mentors during this contract period.
3. Parent Mentor pre-and post-surveys results from most recent data available.
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EXHIBIT B
Insurance Certificate
DocuSign Envelope ID: 9C7F0C8F-9010-40E0-99E1-D9F725F3ECC7
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
LOCJECT
PRO-POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence)$
DAMAGE TO RENTED
EACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
$
AGGREGATE $
EACH OCCURRENCE $
UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under
DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
$
$
$
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.
INSD
ADDL
WVD
SUBR
N / A
$
$
(Ea accident)
(Per accident)
OTHER:
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
E-MAIL
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
X
2241622 01/01/16
UH4D08456700
Suite 100
C
1705 17th Street
11/01/16
Vail Valley Foundation
YouthPower 365
IMA, Inc. - Colorado Division
1,000,000
12/07/2016
Eagle, CO 81631
11/01/16
500 Broadway
100,000
X
Eagle County
X
01/01/17
DenAccountTechs@imacorp.com
11/01/17X
500,000
1,000,000
X
Denver, CO 80202
11/01/17
500,000
AW4D08460900
10,000,000
PINNACOL ASSUR
HANOVER INS CO
ALLMERICA FIN BENEFIT INS CO(Hanover Ins
MASSACHUSETTS BAY INS CO(Hanover Ins Co)
1-303-534-4567
D
10,000
2,000,000
X
Avon, CO 81620
briannah
B
48587118
48587118
N
PO Box 6550
X
USA
11/01/16 11/01/17ZD4D08456400
by written contract or agreement subject to the policy terms and conditions.
volunteers are included as Additional Insureds on the General, Automobile, and Umbrella Liability Policies if required
Eagle County its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and
2,000,000
A
10,000,000
X
1,000,000
41190
22292
41840
22306
500,000
DocuSign Envelope ID: 9C7F0C8F-9010-40E0-99E1-D9F725F3ECC7