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HomeMy WebLinkAboutC14-203 Colorado Laundry Systems, LLCAGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY, COLORADO AND COLORADO LAUNDRY SYSTEMS, LLC THIS AGREEMENT ("Agreement") is effective as of the day ofrv�w� , 2014 by and between Colorado Laundry Systems, LLC a limited liability company (hereinafter "ContralCtor") and Eagle County, Colorado, a body corporate and politic (hereinafter "County"). RECITALS WHEREAS, County desires to contract for scheduled maintenance and on-call repair services for the washers and dryers at the Eagle County Justice Center and the Eagle County Animal Shelter (the "Properties"); 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 scheduled maintenance described in Exhibit A and on-call services on an as needed basis, at the rates set forth in Exhibit A which is attached hereto and incorporated herein by reference. The scheduled maintenance services or work described in Exhibit A and any on-call services approved in accordance with this Agreement are collectively hereinafter referred to as the "Services" or "Work". All on-call services shall be accompanied by a formal proposal for each on-call service to be performed by Contractor and shall be approved by County in writing. The Services shall be performed in accordance with the provisions and conditions of this Agreement. a. Contractor agrees to furnish the Services twice a year at approximately six month intervals and in accordance with the schedule established in Exhibit A or in each proposal for on-call services that may be approved by County. If no completion date is specified, then Contractor agrees to famish 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. In the event of any conflict or inconsistency between the terms and conditions set forth in any proposal provided by Contractor and the terms and conditions set forth in this Agreement, the terms and conditions set forth in this Agreement and the rates set forth in Exhibit A shall prevail. 2. County's Representative. The Facilities Management Department's designee shall be Contractor's contact with respect to this Agreement and performance of the Services. 610o 3. Term of the Agreement. This Agreement shall commence upon the date first written above, and subject to the provisions of paragraph 11 hereof, shall continue in full force and effect for a period of one year. 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 scheduled maintenance Services in a sum computed and payable as set forth in Exhibit A. In the event Contractor and County agree upon the need for additional maintenance or repair services beyond those described in Exhibit A, then those Services shall be billed at a rate of $75 per hour, plus material costs which materials may include a 20% mark up. Prior to performing any on-call Services, Contractor shall first provide County with a written proposal which shall include the number of hours and material costs to perform the Services. Each proposal must be approved by County's Representative prior to commencement of the Services and all rates shall be in accordance with this Agreement and Exhibit A. Total compensation under this Agreement for all Services and any materials shall not exceed $6,140.00 without a written amendment to this Agreement. 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). 2 U .NLNN TENANCFSe w Agreements Washer -Dryer Maint\2014 Colorado Laundry Systems 5 9 14 RED door 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. 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. Workers' Compensation insurance as required by law. ii. The parties acknowledge that there will be limited driving, if any, in connection with the performance of the Services. As a result, auto coverage may be provided through a personal insurance policy covering the driver and vehicle. A copy of such coverage shall be provided as part of Exhibit B. 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 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. Contractor is not entitled to workers' compensation benefits except as 3 G MAFNTENANCE\Servke Agrmrnents Washer -Drys Maint\1014 Colorado Laundry Systems 5 9 14 RID docs 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 with investigating or defending any such loss, claim, damage, liability or action. This indemnification shall not apply to claims by third parties against the County to the extent that County is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents (including electronic files) and materials obtained during, purchased or prepared in the performance of the Services shall remain the property of the County and are to be delivered to County before final payment is made to Contractor or upon earlier termination of this Agreement. 10. Notice. Any notice required by this Agreement shall be deemed properly delivered when (i) personally delivered, or (ii) when mailed in the United States mail, first class postage prepaid, or (iii) when delivered by FedEx or other comparable courier service, charges prepaid, to the parties at their respective addresses listed below, or (iv) when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date, time and receiving facsimile number for the transmission, or (v) when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this paragraph by giving five (5) days prior written notice of such change to the other party. COUNTY: Eagle County, Colorado Attention: Facilities Management Department 590 Broadway Post Office Box 850 Eagle, CO 81631 Telephone: 970-328-8881 Facsimile: 970-328-3539 E -Mail: ron.siebert@eaglecounty.us With a copy to: Eagle County Attorney 500 Broadway Post Office Box 850 Eagle, CO 81631 Telephone: 970-328-8685 Facsimile: 970-328-8699 E -Mail: atty@eaglecounty.us CONTRACTOR: Colorado Laundry Systems, LLC 636 Alder Ridge New Castle, CO 81647 4 G MA NI ENANCE\Service Agreements\Washer-Dryer Maint\2014\Colorado Laundry Systems 5 9 14 RED door Telephone: 970-355-0171 E -Mail: coloradolaundrysystems@gmail.com 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, 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. C. 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. 5 GAMAMENANCElServim AgrmmentslWnher-Dryer MaintL0 141Colotado laundry Systems 5 9 14 RED. do« 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. 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. in. 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: 6 GANLAMENANCE\Smice Agreement3 Washer -Dryer MaintL014 Colorado laundry Systems 5 9 14 RED docs Knowingly employ or contract with an illegal alien to perform Services under this Agreement; or ii. Enter into a subcontract that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under the public contract for services. 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:llwww.dhs.izov/xpreyprot/prog[ams/mac 1185221678150.shtm C. Contractor shall not use either the E -verify program or other Department Program procedures to undertake pre-employment screening of job applicants while the public contract for services is being performed. d. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien, Contractor shall be required to: i. Notify the subcontractor and County within three (3) days that Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and ii. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subcontractor does not stop employing or contracting with the illegal alien; except that Contractor shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Contractor shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the department is undertaking pursuant to its authority established in C.R.S. 8-17.5-102(5). f. If Contractor violates these prohibitions, County may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Contractor shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Contractor violates this provision of this Agreement and County terminates the Agreement for such breach. [REST OF PAGE INTENTIONALLY LEFT BLANK] 7 GA MATNTENANCE\Service Agreements Washer -Dryer MaintL014•Colorado Lawdry Systems 59 14 RED docs 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: K ' . Montag, County M ager CONTRACTOR: COLORADO LA RY SYSTEMS, LLC By: Print Name: �-A Title: Otyw r G \MAINTENANCE\Sem-e ngrecmc,n, Wuh -nrya Mow\2014\cororeao Launtry SymFINAr-d= r Colorado Laundry Systems Lt. e- 636 Alder Ridge New Castle, CO 81647 (970)355-0171 coloradolaundrysystems@gmail.com CA►'d1E,21� c��,G� Address Eagle County 500 Broadway Eagle, CO 81631 _ Estimate_ Date Estimate No. i-i_j_--- 03/17/2014 1004 _ Exp_Date -j Item code _ T Description _ Quantity Rate Amount _- ..i. - -- -- ---- - - Labor • PIM 2 washers and 2 dryers in the jail 1 570.00 570.00 PIM I washer 1 dryer at the animal shelter Accepted By Bi Annually • Does not include parts , or labor to install any needed parts. With service contract labor is discounted to 75 dollars an hour and 20 percent of list price on all parts S-70.001 b Ss UMS-S ALS. LJ SE$t�tlt�I> DUR.1►.14 "T41�E S�N�I� t�P.`r, Accepted Date Total $570.00 EXHIBIT CREGE-1 OP ID: BO ^kr aiCERTIFICATE OF LIABILITY INSURANCE D DNYYY) 04124/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 Phone: 970-945-9161 GIA Group/Glenwood Ins. Agency P O Box 1270 Fax: 970-945-6027 Glenwood Springs, CO 816024270 Bryan K. Avery CONTANAME: Bonnie Jones AIIc° N E::970-384-8324 AIC.Ne _ 970-945-6027 E-MAIL bonniMg lenwoodins.com INSURER(S) AFFORDING COVERAGE NAIC JI INSURERA: United Fire 8r Casualty INSURED Cameron Creger 636 Alder Ridge New Castle, CO 81647 INSURER B: INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: GCVICInM lul IMGCD. 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 LTR I TYPE OF INSURANCE ADUL 51JISH POLICY NUMBER POLICY EFF MMIDD PO ICY EXP MMIODNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR X 60441891 02/01/14 02/01/15 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRT LOC PRODUCTS- COMPIOP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ (Mandatory In NH) If yes, describe under E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ppliance & Accessories Install Service & Repair commercial. Certificate older is listed as Additional Insured in regard to the Insured's ongoing operations as respects the General Liability policy. rI EAGCO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fax: 970-328-8789 ron.sieber=_eaglecounty.us AUTHORIZED REPRESENTATIVE P.O. Box 850 Eagle, CO 81631 /i ��•',w`'�_ '' O 1988-2010 ACORD CORPORA], EXHIBIT ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD It :151 State Farm Mutual Automobile Insurance . umpany 2700 South Sunland Drive Tempe, AZ 85282-3387 AT1 1 Q-2075 CREGER, CAMERON 636 ALDER RDG NEW CASTLE CO 81647-9467 Policy Number: 2641793-1319-06A Policy Period: February 19, 2014 to August 19, 2014 Vehicle: 2011 TOYOTA TACOMA Principal Driver: CAMERON CREGER Q1 Based on your driving record, you have our Accident -Free Discount for preferred customers. When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use Policy Number: 2641793-1319-06A Prepared January 10, 2014 1004584 :. StateFarm- AUTO RENEWAL PREMIUM PAID: $381.09 DO NOT PAY. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: 1103405220 Your State Farm Agent SUSAN BOYNTON Office: 303-948-2905 Address: 5104 S FIELD ST STE B LITTLETON, CO 80123-7330 If you have a new or different car, have added any drivers, or have moved, please contact your agent. information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. Page number 1 of 4 143599 200 09-16-2012 1 - GETTHE DISCOUNTS foo DESERVE, Talk to your State Farm agent about a FREE Discount Double Check and save. Get to a better State . TP11 :. StateFarm ' VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect, or if there are any changes, please let us know right away. How is this vehicle normally used? Vehicle Identification National average: 12,000 miles driven Vehicle Description Number (VIN) Who principally drives this vehicle? annually per vehicle 2011 TOYOTA TACOMA 5TFLU4EN8BX022254 CAMERON CREGER, a single male, who To Work, School or Pleasure. Driven over will be age 30 as of February 19, 2014. 7,500 miles annually. Premium Adjustment annually to determine which makes and models have Each year, we review our medical payments and personal earned decreases or increases from State Farm's standard injury protection coverages claim experience to determine rates. If any changes result from our reviews, adjustments the vehicle safety discount that is applied to each make and are reflected in the rates shown on this renewal notice. model. In addition, we review the comprehensive, collision, bodily injury and property damage claim experience DRIVER INFORMATION Assigned Driver(s) The following driver(s) are assigned to the vehicle(s) on this policy. Age as of Marital Name February 19, 2014 Gender Status CAMERON CREGER 30 Male Single Principal Driver & Assigned Drivers For each automobile, the Principal Driver is the individual who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that he or she most frequently drives. Your premium may be influenced by the information shown for these drivers. COVERAGE AND LIMITS See your policy for an explanation of these coverages. A Liability $3.50 Bodily Injury 100,0001300,000 Property Damage 100,000 $125.49 C Medical Payments 5,000 $20.21 D 1000 Ded Comprehensive $60.77 G 1000 Deductible Collision $122.52 H Emergency Road Service $3.50 R1 Car Rental & Travel Expense $25 Per Day, $600 Max $11.63 U Uninsured Motor Vehicle Bodily Injury 100,0001300,000 $36.47 Colorado Theft Prevention Authority Fee $380.59 $0.50 'total Premium $381.09 Policy Number: 2641793-1319-06A Page number 2 of 4 Prepared January 10, 2014 If any coverage you carry is changed to give broader protection with no additional premium charge, we will give DISCOUNTS These adjustments have already been applied to your premium. kateFarw you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. Multiple Line ✓ Vehicle Safety ✓ Accident -Free ✓ total Discounts ;123.14 SURCHARGES AND DISCOUNTS AUTOMOBILE RATING PLAN - Applies to private passenger cars only. Accident -Free Discount - Once your policy has been in force for at least three years with no chargeable accidents, you may qualify for our Accident -Free Discount. Once you qualify, this discount applies as long as there are no chargeable accidents, and may even increase over time. Good Driving Discount - Newer policyholders who do not yet qualify for our Accident -Free Discount (available after three years with no chargeable accidents) may already be receiving a Good Driving Discount. This discount continues to apply until your policy qualifies for the Accident -Free Discount as long as there are no chargeable accidents and no new drivers. If you add new drivers, they must also qualify in order for your Good Driving Discount to continue. Chargeable Accidents - For new policies, an accident is chargeable if it results in $1,000 or more of damage to any property. For renewal policies, an accident is chargeable if State Farm pays at least $1,000 (for accidents occurring on ADDITIONAL INFORMATION If the above information is incomplete or inaccurate, or if you want to confirm the information we have in our records please contact your agent. or after April 1, 1999) under property damage liability and collision coverages for an at -fault accident. Surcharges - If there are chargeable accidents, you may lose your Good Driving Discount or Accident -Free Discount and receive accident surcharges. But if the accident is the first to become chargeable in nine years and this policy has been in force for at least that long, the Accident -Free Discount will continue and no surcharge will apply. The surcharge for each accident depends upon the number and timing of the accidents, and each accident surcharge will remain in effect up to three years. Surcharges will be removed if the company is given satisfactory evidence that the driver involved is no longer a member of the household or will not be driving the car in the future. If that driver is insured on another State Farm policy, his or her driving record will be considered in the rating of the other policy. These discounts and surcharges do not apply to all coverages. For complete details, see your State Farm agent. Rates adjusted for auto insurance in Colorado Auto insurance rates for Colorado customers have been adjusted to better reflect changing claim costs. Overall, most customers will see an increase in their premium. The amount your premium may have changed depends on many factors, including: • the coverages you have • where you live • the kind of car you drive • how the car is used • who drives the car (continued on next page) Policy Number: 2641793-1319-06A Page number 3 of 4 Prepared January 10, 2014