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HomeMy WebLinkAboutC17-053 Architectural Doors Inc AGREEMENT FOR EQUIPMENT AND/OR MATERIALS BETWEEN
EAGLE COUNTY,COLORADO
AND
ARCHITECTURAL DOORS, INC.
THIS AGREEMENT("Agreement")is effective as of ,0.2/09/2017 by and lx. tween Architectural Doors,
Inc. a Colorado corporation(hereinafter"Vendor")and Eagle County,Colorado, a body corporate and Politic
(hereinafter"County").
RECITALS
WHEREAS, Eagle county desires to purchase four(4)Eggers wood doors, four(4)Von Duprin exit device ]ever
trim and four(4) Falcon closures for the Eagle County Justice Center Court Rooms#d and #2;and
WHEREAS, Vendor is authorized to do business in the State of Colorado and has the time,skill,expertise, and
experience necessary to provide the equipment and/or materials as set forth below in paragraph I hereof,and
WHEREAS, this Agreement shall govern the relationship beetween Vendor and County in connection with the
procurement of equipment and/or materials.
AGREEMENT
NOW,THEREFORE, in consideration of the foregoing and the following promises Vendor and County agree as
follows:
1. hqMjpjpD)Lt. Vendor agrees to procure the materials,equipment and/or products(collectively the
"Equipment")described in Exhibit A which is attached hereto and incorporated herein by reference. The Equipment
shall be provided in accordance with the provisions and conditions of this Agreement.
a. Vendor agrees to furnish the Equipment specified in Exhibit A in a timely and expeditious
manner. By signing below,Vendor represents that it has the expertise and personnel necessary to properly and
timely provide the Equipment.
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. County shall have the right to inspect all Equipment. Inspection and acceptance shall not be
unreasonably delayed or refused. In the event County does not accept the Equipment for any reason in its sole
discretion, then Vendor shall upon County's request and at no charge to County:
i_ take the Equipment back,
ii_ exchange the Equipment,or
iii. repair the Equipment.
2. CountyLs�Re resentative. The Facilities Management Department's designee shall be Vendor's contact
with respect to this Agreement.
C17-053
3. Term of the A�reemeiit. This agreement shall commeme Lipm the date first written above,aild subbed to
the provisims of paragraph 10 hereof,shall mitimie in full force mid effect through the acceptalice of the
Equipimit by the Facilities Mail agement Departimit's designee.
4. Extemimi or Modificatim. any aimichmits or modificatimis shall be in writing signed by both parties.
No additimial Equipimit shall be provided by Vender Lmless mid Lititil Vender has obtahied written authorizatioll
mid acknowledgement by Comity for such additimal equipimit in accordame with Cowity's hitemal Policies.
accordingly,no course of cmduct or dealhigs between the parties,nor verbal change orders,express or implied
acceptaiiee of alteratims or additims to the Equipimit, mid no claim that Cowity has bceii wiJustly enriched by ariy
Equipimit, whether or riot there is in fact ariy such Lm.just emichimit, shall be the basis of ariy hicrease in the
compeiisatim payable hereunder. hi the emit that written authorizatimi mid ackiiowledgimit by Coulity for such
additimial equipimit is riot timely executed mid issued hi strict accordame with this agreement, Vemlor's rights
with respect to such additimial equipimit shall be deemed waived mid such failure shall result hi imi-payineiit for
such additimal equipimit.
5. Compematiom Comity shall compeiisate Vender for the Equipimit hi a sum computed mid payable as set
Barth in Exhibit A. The Equipimit under this agreement shall not exceed seven thousand nine hundred fifty six
dollars($7,956.00). In the emit Cmitractor mid Cowity agree Lipm the need for additimial Equipment IX. ,yoIld the
Equipimit described in Exhibit A,Cmitractor shall first provide Cowity with a written estimate which shall include
aii estimate of the labor, materials without ariy mark Lip mid ariy additimal costs accessary to perform the
services. Each estimate must be approved by Cowity's Representative prior to commencement of the services by
Cmitractor mid all rates shall be in accordame with the rates set forth herein. Total compeiisatim under this
agreement shall riot exceed eight thousand nine hundred fifty six dollars($8,956.00) without a writteii
aimidimit to this agreement. Cmitractor shall riot lxx,entitled to bill at overtime mid/or double time rates for work
clone outside of tiormal business hours unless specifically authorized in writing by Comity.
a. Payment will be made for Equipimit satisfactorily delivered mid accepted by Comity within thirty
(30)days of receipt of a proper mid accurate invoice from Vender. All invokes shall include detail regardilig the
Equipimit and such other detail as Cowity may request.
b. If,at ariy time during the term or after tenniiiatim or expiry time of this agreement,County
reasombly determines that arty payment made by Comity to Vendor was improper because the Equipimit for which
payment was made were riot provided as set forth hi this agreement, then Lipm written notice of such detenniiiatimi
mid request for reimbursement from Cowity, Vendor shall forthwith return such payments)to County. Upoll
termi iiati m or expirati mi of this agreement,unexpended Imids advamed by CoLm ty,i f ariy,shall forthwith be
returned to Comity.
C. Comity will riot withhold ariy taxes from monies paid to the Vender hereunder mid Vender agrees
to be solely responsible for the accurate reporting mid payment of ariy taxes related to payments made pursualit to
the terms of this agreement.
d. Notwithstaiidiiig aiiythhig to the cmitrary cmitahied hi this agreement,Comity shall have no
oblige timis under this agreement after, nor shall ariy payineiits be made to Vendor hi respect of ariy period after
December 3l of ariy year, without aii appropriatimi therefor by Comity in accordame with a budget adopted by the
Board of Cowity Commissimiers hi complimice with Article 25,title 30 of the Colorado Revised Statutes,the Local
Government Budget Law(C.R.S. 29-t-M I. et.seq.)mid the TABOR Aimidimit(Colorado Cmistitutim,Article X,
Sec. 20).
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6. Insurance. Vendor agre�es to provide and maintain at Vendor'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.The Services do not require the operation of a motor vehicle.
Notwithstanding the foregoing,should Consultant or ally of its employees drive their personal vehicles in
connection with the performance of the Services under this Agreement, such individual shall maintain auto
insurance as required by law and shall be solely responsible for ally injury or damage arising out of use and
operation of such personal vehicle.
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 oc^c^cirrenc^e and $1,000,000 aggregate limits.
b. Other Requirements.
i. The commercial general liability coverage shall be endorsed to include Eagle Comity, 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. The insurance provisions of this Agreement shall survive expiration or
termination hereof.
iii. The parties hereto understand and agree that the County is relying oil,and does
not waive or intend to waive by ally 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.
iv. Vendor is not entitled to workers' compensation benefits except as
provided by the Vendor, nor to unemployment insurance benefits unless unemployment compensation coverage is
provided by Vendor or some other entity. The Vendor is obligated to pay all federal and state income tax oil ally
moneys paid pursuant to this Agreement.
7. Indemnification. The Vendor shall indemnify and hold harmless County, and ally of its officers,agents and
employees against ally losses,claims,damages or liabilities for which County may become subbed toy illsorar as ally
such losses,claims,damages or liabilities arise out of,directly or indirectly,this Agreement, or are based upon ally
performance or nonperformance by Vendor or ally of its subcontractors hereunder,and Vendor shall reimburse
County for reasonable attorney fees and costs, legal and other expenses incurred by County in connection with
investigating or defending ally such loss,claim,damage,liability or action. This indemni fication 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 Vendor. This paragraph shall survive expiration or termination hereof.
Final DI'aflAAivMIvIuraI Ns�rs%AivMIcvIuraI Ns�rs.FquipvknI and
8. Documents. Vendor shall execute any bill of sale or other documents required by County to transfer title
of the Equipment to County. Vendor shall provide copies of any instruction or operations manuals and shall further
provide copies of any manufacturers warranties associated with the Equipment.
9. Notice. Any notice required by this Agreement shall be demed 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 call provide facsimile machine or other confirmation showing
the date, time and receiving facsimile number for the transmission,or(v) when transmitted wire-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: Ron Sielxxrt
590 Broadway
Post Office Box 850
Eagle,CO 81631
Telephone: 970-328-8881
Facsimile: 970-328-8782
E-mail: ron.siebert @eaglecoun ty.LIS
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 @eaglecoun ty.Lis
VENDOR:
Colorado Doors, Inc.
3900 Holly Strep t
Deliver,CO 80207
Telephone: 303-322-1410
Facsimile: 303-322-1433
E-Mail: al.j @archdoorsi ric.coin
10. Termination. County may terminate this Agreement,in whole or in part, at any time and for ally reason,
with or without cause,and without penalty therefor with seven (7)calendar days' prior written notice to the Vendor.
Upon termination of this Agreement,Vendor shall immediately provide County with all documents as defined ill
paragraph 8 hereof, in such format as County shall direct and shall return all County owned materials and documents
in the possession of Vendor, if any.County shall pay Vendor for Equipment satisfactorily inspected and accepted to
the date of termination.
It. Vel Ue JUrisdiction
i ���vplicable 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
Final D1,aflAAivfii1,v1ma1 iNs�rsAArdii1cv1ma1 iNsrs.Fquijmkn1 and
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.
12. Execution by Counterparts.Electronic Signatures. This Agreement may be executed in two or more
COLIllterparts,each of which shall be deemed all 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 tri billd 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 all 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.
13. Other Contract Reouirements and Vendor Representations.
a. Vendor has familiarized itself with the intended purpose and use of the Equipment to lxx, provided
hereunder, the intended use of such Equipment by County, and with all local conditions, federal, state and local
laws,ordinances, rules and regulations that in ally manner affect cost, progress,or Equipment.
b. Vendor will make, or cause to be made,examinations, investigations, and tests as he deems
necessary for the performance of this Agreement.
C. The fact that the County has accepted or approved the Equipment shall not relieve Vendor of ally
of its responsibilities. Vendor represents and warrants that it has the expertise and personnel necessary to properly
perform the terms of this Agreement. Vendor shall provide appropriate supervision to its employees to ensure the
performance in accordance with this Agreement. Vendor will provide the Equipment in a skillful, professional and
competent manner and in accordance with the standard of care applicable to vendors supplying similar equipment.
d. Vendor warrants merchantability and fitness of the Equipment for its intended use and purpose.
e. Vendor hereby represents and warrants that the Equipment will be new and guarantees all
Equipment against defects for a period of one(1)year from the date the Equipment is accepted by County,or such
longer period as may be provided by the law or as otherwise agreed tri by the parties.
f. All guarantees and warranties of Equipment furnished to Vendor by ally manufacturer or supplier
are for the benefit of County. If ally manufacturer or supplier of ally Equipment furnishes a guarantee or warrantee
for a period longer than one (1) year, then Vendor's guarantee or warrantee shall extend for a like period as to such
Equipment.
9. Vendor warrants that title to all Equipment shall pass to County either by incorporation into the
County facility or upon receipt by Vendor of payment from County(whichever occurs first) free and clear of all
liens,claims,security interests or encumbrances. Vendor further warrants that Vendor(or ally other person
performing Work)purchased all Equipment free and clear of all liens,claims,security interests or encumbrances.
Notwithstanding the foregoing,Vendor assumes all risk of loss with respect to the Equipment until County has
inspected and approved the same.
h. Within a reasonable time after receipt of written notice,Vendor shall correct at its own expense,
will cost to County,and will interruption to County:
i. Ally defects in Equipment which existed prior to or during the period of ally guarantee or
warranty provided in this Agreement,and
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Final D1'aflAAivM1,v1ma1 Ns�rs,%Ardiilcvlural Ns�rs.Fquijmkn1 and
ii. Ally damage to ally property caused by such defects or the repairing of such defects.
i. Guarantees and warranties shall not be construed to modify or limit ally rights or actions County
may otherwise have against Vendor in law or in equity.
J. Vendor agrees to work in all expeditious manner, within the sound exercise of itsJudgment and
professional standards, in the performance of this Agreement. Time is of the essence with respect tri this
Agreement.
k. This Agreement constitutes all agreement for performance by Contractor as all independent
Contractor and not as all employee of County. Nothing contained in this Agreement shall be deemed to create a
relationship of employer-employee, master-servant,partnership,joint venture or ally other relationship betweell
County and Vendor except that of independent Vendor. Vendor shall have no authority to bind County.
1. Vendor represents and warrants that at all times in the performance of the Agreement,Vendor
shall comply with ally and all applicable laws,codes,rules and regulations.
in. This Agreement contains the entire agreement between the parties with respect to the subbed
matter hereof and supersedes all other agreements or understanding between the parties with respect thereto.
11. Vendor shall not assign ally portion of this Agreement without the prior written consent of the
County. Ally attempt to assign this Agreement without such consent shall be void.
0. 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 toy ally third party.
P. No failure or delay by either party in the exercise of ally right hereunder shall constitute a waiver
thereof. No waiver of ally breach shall be deemed a waiver of ally preceding or succeeding breach.
q. The invalidity,illegality or unenforceability of ally provision of this Agreement shall not affect the
validity or en forceabi I ity of ally other provision hereof.
r. The signatories to this Agreement aver to their knowledge no employee of the County has ally
personal or beneficial interest whatsoever in the Equipment described in this Agreement.The Vendor has no
beneficial interest,direct or indirect,that would conflict in ally manner or degree with the performance of the
Agreement and Vendor shall not employ ally person having such known interests.
S. The Vendor, if a natural person eighteen (18)years of age or older, hereby swears and affirms
under penalty of perliury that he or she (i) is a citizen or otherwise lawfully present in the United States pursuant to
Bedevil law,(ii)to the extent applicable shall comply with C.R.S. 24-76.5-103 prior to the effective date of this
Agreement.
14. Prohibitions oil Government Contracts.
As used in this Section 14,the term undocumented individual will refer to those individuals from foreign
countries not legally in the United States as set forth in C.R.S. 8-17.5-101,et. seq. If Vendor has ally employees or
subcon tractors, Vendor shall comply with C.R.S. 8-17.5-101,et.seq., and this Agreement. By execution of this
Agreement, Vendor certifies that it does not knowingly employ or contract with all undocumented individual who
will perform under this Agreement and that Vendor will participate in the E-verify Program or other Department of
Final D1'aflAAivM1,v1ura1 Ns�rs,%Ardiilvlural Ns�rs.Fquipvkn1 and
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. Vendor shall not:
i. lKnowingly employ or contract with all undocumented individual to perform Services
under this Agreement,or
ii. Enter into a subcontract that fails to certify to Vendor that the subcontractor shall not
knowingly employ or contract with all undocumented individual to perform work under the public contract for
services.
b. Vendor 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 oil applying for the
E-veri fy program call be found at:
shnn
!� 78 15522 16� 0.
C. Vendor 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 Vendor obtains actual knowledge that a subcontractor performing work under the public
contract for services knowingly employs or contracts with all undocumented individual, Vendor shall be required to :
i. Notify the subcontractor and County within three (3) days that Vendor has actual
knowledge that the subcontractor is employing or contracting with all 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 Vendor shall not terminate the contract with the
subcon tractor if duri ng such three (3)days the subcontractor provides information to establish that the subcontractor
has not knowingly employed or contracted with all undocumented individual.
e. Vendor shall comply with any reasonable request by the Department of Labor and Employment
made in the course of all investigation that the department is undertaking pursuant to its authority established ill
C.R.S. 8-17.5-102(5).
f. If Vendor 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, Vendor shall IX. , liable
for actual and consequential damages to County as required by law.
9. County will notify the Colorado Secretary of State if Vendor violates this provision of this
Agreement and County terminates the Agreement for such breach.
REST OF PAGE INTENTIONALLY LEFT BLANK]
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Final Ns�rsAArdii1cvInral Ns�j,s,.F&jnipvkn1 and
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: . . . . . . . . . . . . .
Rr-ei4� MoPall,C-k4w;4", Uaaag"
Bryan Treu,Interim County Manager
VENDOR:
IN
�11"4
?76
B y:
Print Name:
AI Johnson
. . . . . . . . . . .
Title: Project Manager
. . . . . . . . . . . . .
Final D1'aflAAivfii1,vwra1 Ns�rs%Ardii1cv1nra1 Ns�rs.Fqnipvkn1 and
acff'71KR90RS' ZV^LtEH4 D.—SCU AW-FR.(JnJ HFix�.�v).ru-rcu Ti
PROPOSAL-REVISED 12-14-2016
Customer: Eagle County Late: 10-28-2016
Attention: Ron Siebert—Facilities Project Manager
Project Name: Courtroom Replacement Doors Plan Late:
Exclusions:Any AWL LEER,or FSC Certification of the wood doors; and Installation.
Quantity Description Amount
4 each Eggers Wood Doors,20 Min.Fire Rated,STC 41,Plain Sliced White
Birch,Reveals to Match Existing both Faces,Pre-fit for Existing
Hardware and Pre-finished to Match Existing, Includes Eggers Required
Gasketing. TOTAL $4,830.00
4 each Von Duprin Exit Device,Lever Trim 996L US26D ADD $1,310.00
4 each LCN 4040XP EDA Alum ADD $1,216.00
1 each Project Site Visit for Sizing Verification ADD $ 350.00
1 each Delivery Charge ADD $ 250.00
TOTAL FOR THE ABOVE MATERIALS,SITE VIST AND $7,956.00
DELIVERY
Our terms are net 30-days.
Price(s)quoted reflect F.O.B.Jo6site,Tailgate Delivery.Prfce(s)quoted good for 30-days.
APPROVED BY: /� ] n Date: �1 P.O.#
PREPARED BY: ALJ�Vl�So�, AFfa
NOTE:Eggers Industries color sample N13993-16GM in Guardrail finish was approved.
EXII BIT
A
Stile and Rail Doors,Door Frames Architectural Veneer Faces.
Veneered Components,Plywood Flush Doors Custom Wood Products,Plywood
Two Were Chien Neenah Division Kentucky Dlvtslon
One Eggers Drive 164 North Lake Street 2125 Lake Jericho Roar!
Milo ries TWo Rivers,WI 64241 Neenah,WI 54956 Smithfield,KY 40988
www.eggers[ndusMes.com Phone:920.793.1351 Phone:920.IM6444 Phone;502.845.4154
sales@eggsrsindustdoo.com Fax:920.793.2M Fax:920.722.4357 Fax 502.949.0444
Dec 4,2016
Enclosed is a set of 3 samples that have been submitted for approval.All 3 sample pieces
must be utilized when determining whether or not finished product falls into the approved
range.This sample set represents Eggers'finish quality and standard satin sheen (unless
noted otherwise).This finish sample set represents a light,medium and dark veneer color In
the finish specified.Some of the products on your order could be lighter and/or dancer than
the sample set,dependent upon the base veneer of the samples.The products for the order,
represented by this sample set,were quoted based on industry and Eggers'standards for
color range. If your project requires that the products match a narrower color range than
visually depleted,this can be provided at an additional charge byselecting veneerfor uniform
color and grain,or a specified flitch could be selected to meet the project requirements.
Please Note:This sample set is the species of veneer that will be used on your order.The
size of the samples cannot reflect all of the grain characteristics that may appear in the
veneer of a door, panel face,or all the pieces on the job.The color range you might expect
to see on the veneer Is on the Inside of the front cover.
If you have any questions, please contact your Eggers Sales Representative.
Sample: N13993-16GM Id: 43283
Please Check one of the following:
Accept
Rejected
Note:
Customer:ARCHITECTURAL DOORS INC
Project: Eagle County
Species: Plain Sliced White Birch EOL
Finish: Standard Stain
Customer Approval:. 12111d
Date: 1 l m l i,
ARCHDOD-111 MAR 111
CER'TIFICA'TE OF LIABILITY INSURANCE F °ATE/MMfa°rYYYY'
11f6f20117
THIS CERTIFICATE IS ISSUED AS A HATTER 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 IBY 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(fes)must have ADDITIONAL INSURED provisions or be endorsed.
If SUIBROGATION 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 h-older in lieu of such endorsement(s).
PRODUCER CONTACT Shaleen Martin
raylea;
............................................................................................
Six&Geving Insurance,Inc. RHONE rAX
225 Union(Blvd. (AIC,No,Ext): (720)962-091 (Arc,No):('720)952-0942
E-MAIL snnartln SIX- eVln ccYm
Suite All DRES :.. � 9
Lakewood,ooCO f3fi22f3 .................... IN SuRER(S)�iFFPR[NNG MERA E.............................wAlc#....
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INSURED Assl,urance I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1 41111901
,Architectural Doors Inc.
.,IFISURER
Michelle Curless
3900 Holly Street irJsuRFR a .............................. ............
Denver,CO 80207 irJsuRFR ;
INSURER r
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........... AGGPRE �TE ..........
I Di„EDEDX RETENTION$ 01.... .... ... .... .... .... ,....
B WORKERS COMPENSATION X PER 07TH
AND EMPLOYERS`LIABILI'TY YI M ..,,,.,STATUTE_.... ER......................4t?548Cf2 O3JO'id2O'15 f13JO'i12D1 F SCDtD,fytDtD
ANY PRR+PARTNER+Ex
ECIT I'E
MaPnICElR1rMEMBER EXCLUDED?
N NIA E L EAQH ACCIDENT ...$...
..PdaeyIn MH) E L,D IS EASE,EA,EMPLOYEE,$.........................
IIi yes,describe under
500,DOO.
.... a CMESCR.IL�If 9N C7P,,,PEERATII4;�„NS beim.... .... s ... .... .... .... s.... .... .... s,,,,,, L DIISE�8,§jE POLIIc:Y LIIMa .;. .... .... ....
DESCRIPTION Or OPERATIONS I LOCATIONS/VEHICLES(ACORD 1101,Additional Remarks Schedule,may be attached If more spade is required)
..........CERTIFICATE
..HOLDER.................................................................................................................................................................................................................AN......E L LATL......N..................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................................................................................
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Eagle County, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g y ACCORDANCE WITH THE POLICY PROVISIONS.
Attn:Ron Siebert
599(Broadway
Post Office lBox 850 AUTHORIZED REPRESEN'TATIV'E ������
Eagle,CO 81531 �`',N
ACORD .. (20D16/0D3) 0 i
� 985-20015 ACORD CORPORA
The ACORD name and logo are registered marks of ACORD