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HomeMy WebLinkAboutECHDA17-001 FreeForm ConsultingAGREEMENT FOR SERVICES
BETWEEN EAGLE COUNTY HOUSING AND DEVELOPMENT AUTHORITY
AND
FreeForm LLC
THIS AGREEMENT ("Agreement") is effective as of 04/03/2017 by and between FreeForm LLC a
Colorado limited liability company doing business as Freeform Consulting Anew (hereinafter "Contractor") and
Eagle County Housing and Development Authority, a body corporate and politic (hereinafter "ECHDA").
RECITALS
WHEREAS, ECHDA desires to obtain facilitation services for the Eagle County Housing Department and Eagle
County Housing and Development Authority (the "Project") 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 ECHDA in connection with the
services.
R_[*I. a0LVA 8aL400
NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and ECHDA agree
as follows:
1. Services or Work. Contractor agrees to diligently provide all services, labor, personnel and materials
necessary to perform and complete the services or work described in Exhibit A ("Services" or "Work") which is
attached hereto and incorporated herein by reference. The Services shall be performed in accordance with the
provisions and conditions of this Agreement.
a. Contractor agrees to furnish the Services no later than April 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.
b. In the event of any conflict or inconsistency between the terms and conditions set forth in Exhibit
A and the terms and conditions set forth in this Agreement, the terms and conditions set forth in this Agreement
shall prevail.
2. ECHDA's Representative. The Housing Department's designee shall be Contractor's contact with respect
to this Agreement and performance of the Services.
3. Term of the Agreement. This Agreement shall commence upon the date first written above, and subject to
the provisions of paragraph 1 1 hereof, shall continue in full force and effect through the 30th day of April, 2017.
4. Extension or Modification. 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 ECHDA for such additional services in
accordance with ECHDA's internal policies. Accordingly, no course of conduct or dealings between the parties, nor
EC H DA17-001
verbal change orders, express or implied acceptance of alterations or additions to the Services, and no claim that
ECHDA 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 ECHDA 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 ECHDA 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 $960. 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 ECHDA-
a.
CHDA
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 ECHDA may request.
b. If, at any time during the term or after termination or expiration of this Agreement, ECHDA
reasonably determines that any payment made by ECHDA 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 ECHDA, Contractor shall forthwith return such payment(s) to
ECHDA. Upon termination or expiration of this Agreement, unexpended funds advanced by ECHDA, if any, shall
forthwith be returned to ECHDA.
C. ECHDA 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, ECHDA 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 ECHDA in accordance with a budget adopted by the
Board of ECHDA in compliance with the Local Government Budget Law (C.RLS. 29-1-1O1 et. seq.) and the
TABOR Amendment (Colorado Constitution, Article X, Sec. 20).
6. Subcontractors. Contractor acknowledges that ECHDA 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 ECHDA's prior written consent, which
may be withheld in ECHDA's sole discretion. ECHDA 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
ECHDA has an objection, in its reasonable discretion, shall be assigned to the Project. Contractor shall require each
subcontractor, as approved by ECHDA 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 ECHDA ECHDA 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:
2
ECMA General Services Final 5/14
a. Types of Insurance.
Workers' Compensation insurance as required by law.
ii. Consultant hereby represents and warrants that it will not operate a vehicle in connection
with the performance of the Services. Notwithstanding the foregoing, Consultant shall be solely responsible for any
liability or claim should any operation of a motor vehicle occur and Consultant or its members shall maintain
personal auto insurance coverage for the same.
iii. Commercial General Liability coverage to include premises and operations,
persona I/ad vert i s ing injury, prod uctslcompleled operations, broad form property damage with limits of liability not
less than $1,0{10,0[10 per occurrence and $1,000,000 aggregate limits.
iv. Professional liability insurance with prior acts coverage for all Services required in a
form and with an insurer or insurers satisfactory to County, with limits of liability of not less than $1,000,000 per
claim and $1,000,000 in the aggregate. In the event the professional liability insurance is on a claims -made basis,
Consultant warrants that any retroactive date under the policy shall precede the effective date of this Agreement.
Continuous coverage will be maintained during any applicable statute of limitations.
b. Other Requirements.
i. The commercial general liability coverage shall be endorsed to include ECHDA, 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 ECHDA 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 ECHDA 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 ECHDA, its affiliated entities, successors or assigns, its elected officials, employees, agents and
volunteers.
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.
S. Indemnification. The Contractor shall indemnify and hold harmless ECHDA, and any of its officers,
agents and employees against any losses, claims, damages or liabilities for which ECHDA 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 ECHDA for reasonable attorney fees and costs, legal and other expenses incurred by
3
ECMA General Services Final 5/14
ECHDA 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 ECHDA to the extent that ECHDA 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 ECHDA and are to be
delivered to ECHDA 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.
ECHDA:
Attention: Jill Klosterman
500 Broadway
Post Office Box 850
Eagle, CO 81631
Telephone: 970-328-8773
Facsimile: 970-328-8787
E-mail: jill.klosterman@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:
Angelo Fernandez
PO Box 1438
Gypsum, CO 81637
Telephone: 720-84t-8667
E-mail: angelo@freeformnow.corn
11. Termination. ECHDA 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 ECHDA with all documents
as defined in paragraph 9 hereof, in such format as ECHDA shall direct and shall return all ECHDA owned
materials and documents. ECHDA shall pay Contractor for Services satisfactorily performed to the date of
termination.
4
ECMA General Services Final 5/14
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.
B. 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. 24-71.3401 to 1.21.
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 ECHDA 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
ECHDA has accepted or approved the Services shall not relieve Contractor of any of its responsibilities. Contractor
shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of
care, skill and diligence applicable to contractors performing similar services. Contractor represents and warrants
that it has the expertise and personnel necessary to properly perform the Services and shall comply with the highest
standards of customer service to the public. Contractor shall provide appropriate supervision to its employees to
ensure the Services are performed in accordance with this Agreement. This paragraph shall survive termination of
this Agreement.
F. Contractor agrees to work in an expeditious manner, within the sound exercise of its judgment and
professional standards, in the performance of this Agreement. Time is of the essence with respect to this
Agreement.
g. This Agreement constitutes an agreement for performance of the Services by Contractor as an
independent contractor and not as an employee of ECHDA 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 EC HDA and Contractor except that of independent contractor. Contractor shall have no authority to bind
ECHDA
5
ECMA General Services Final 5/14
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
ECNDA. 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 ECHDA 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.KS. 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. 5-17.5-101, et, seq. If Contractor has any employees or
subcontractors, Contractor shall comply with C.ILS. 5-17.5-101, 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:
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.
6
ECMA General Services Final 5/14
b. Contractor has confirmed the employment eligibility of all employees who are newly hired for
employment to perform Services under this Agreement through participation in the E -Verify Program or Department
Program, as administered by the United States Department of Homeland Security. Information on applying for the
E -verify program can be found at:
http://www.dhs.gov/xprevprot/programs/gc 1185221678150.shtm
C. Contractor shall not use either the E -verify program or other Department Program procedures to
undertake pre-employment screening of job applicants while the public contract for services is being performed.
d. If Contractor obtains actual knowledge that a subcontractor performing work under the public
contract for services knowingly employs or contracts with an undocumented individual, Contractor shall be required
to:
Notify the subcontractor and ECHDA 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.
C. 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).
If Contractor violates these prohibitions, ECHDA 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 ECHDA as required by law.
g. ECHDA will notify the Colorado Secretary of State if Contractor violates this provision of this
Agreement and ECHDA terminates the Agreement for such breach.
[Rest of page intentionally left blank]
7
ECMA General Services Final 5/14
IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first set forth above.
EAGLE COUNTY HOUSING AND DEVELOPMENT
AUTHORi��s�
By:
Jill Klosterman, Executive Director
CONTRACTOR: FreeForm LLC doing business as FreeForm
Consulting Anew
By:
Print Name:
Title:
ECMA General Services Final 5114
SCOPE OF SERVICES, SCHEDULE, FEES
ECMA General Services Final 5114
Ifs
freeform
CONSULTING ANEW
March 13, 2017
Eagle County Government
Jill Klosterman, Housing Director
500 Broadway St.
Eagle, CO 81631
Dear Ms. Klosterman,
Thank you for the opportunity to submit this proposal and the possibility of building a strong relationship
with you. As we discussed during our meeting, attached is a proposal for facilitation services to assist the
Housing Department.
I am an experienced organizational development professional with 17 years of experience as a practitioner
and executive that can help the Housing Department achieve its goals. I use strategies and techniques to
help teams identify a vision, align their values, work towards shared purpose, and develop effective
implementation plans. I also have extensive experience in meeting and work session facilitation and can
provide a structured and enjoyable process that allows for open, free-flowing dialogue for all participants.
From our recent conversation, I understand that the Housing Department is seeking facilitation services to
assist the team in developing an action plan that can be presented to the Board of County Commissioners
(BOCC) for approval and guide work for 2017 & 2018. To address this need, I propose a 4 -hour planning work
session. The scope of work below describes the intent and approach for the work session.
Account Approach and Scope
Housing Planning Work Session
1. Preparation and Deliverables
C, Free Form will develop the content and work session format focusing on the following
areas:
■ Current State, Mission/Purpose/Values, Prioritization Exercise, Action Planning
o Free Form will create a Summary Report, including action steps for 2017-2018 after the
completion of the Work Session.
2. Meeting Facilitation
720-841-8667 PO Box 1438 Gypsum, CO 81637
FreeForm will facilitate a 4 -hour planning work session with the Housing Department. The
work session will include all 13 members of the team. The work session will cover the
following areas:
■ Introduction & Ice Breaker
s Objective: Short exercise to set the tone for the work session.
■ Mission, Purpose, Values Review
• Objective: To determine the relevancy of the Housing Department's
Mission and Purpose in relation to today's environment and challenges.
• FreeForm will facilitate a review the Housing Department's Mission and
Purpose Statement to set the context for the next 18 months.
■ Current State Analysis
• Objective: To build a shared understanding within the team about what's
working well, areas in need of improvement, and areas of opportunity.
• FreeForm will facilitate an exercise that will identify the areas of work and
priority that will provide the framework for 2017-2018.
■ Action Planning
• Objective: To document the objectives, goals, and work to to be reported to
the BoCC for approval and performed over the next 18 months.
• Starting with long term objectives, FreeForm will facilitate a planning
exercise to create an action plan that cascades from 18 months/1 year
Objectives > 6-8 Month SMART Goals > 30/60/90 Day Action Items.
I look forward to hearing back from you and working together.
Sincerely,
Angelo Fernandez
Principal, FreeForm
720-841-8667 PO Box 1438 Gypsum, CO 81637
Total
Task
Hours/Qty
cost
Housing Planning Work Session
Project Management (Includes planning, content
development, and documentation)
4 hrs
$1201hr
$480
Facilitation
4 hrs
$1201hr
$480
Project Total
$960
I look forward to hearing back from you and working together.
Sincerely,
Angelo Fernandez
Principal, FreeForm
720-841-8667 PO Box 1438 Gypsum, CO 81637
EX-IIBIT B
INSURANCE CERTIFICATE
10
ECMA General Services Final 5114
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AC"R"v CERTIFICATE OF LIABILITY INSURANCE
1
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S}, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement{s}.
PRODUCER
CONTACT
NAME:
Hiscox Inc
PHOC.NE (888) 202-3007 FAS
520 Madison Avenue
E-MAILADUREss: contact@hiscox.com
INSURER ($) AFFORDNG COVERAGE NAACO
32nd Floor
New York, NY 10022
w$URERA: Hiscox Insurance Company Inc 10200
IN$URER B
INURED
FreeForm LLC
IN$URER C c _
1349 S. Leged Dr
IN$LIRER D:
PREMISES [Eao curDn $
INSURER E
Gypsum CO 81637
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WSR ADDL SUBR POLICY EFF P Y EXP
LTR TYPEOF'INSURANCE INSD WVD POLICYNUMBER DpyyyyY LIMITS
ACCORDANCE WITH THE POLICY PROVISIONS.
CO1i1MERCIALGENERAL LIABILITY
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
CLAIMS -MADE ( OCCUR
PREMISES [Eao curDn $
MED EXP (Anyone ) $
PERSONA L & A DV I NJU RY $
GENERAL AGGREGATE $
LAGGREGATE LIMIT APPLIES PER:
'--ILOC
POLICYPRO-
MOTHER:
PRODUCTS - COMPIOP AGG $
$
AUTOMOBILE LIABILITY
COM BIN ED81NGLELIMIT $
(Ea acciden
ANY AUTO
BODILY INJURY [Per person] $
ALL OWNED SCHEDULED
BODILY INJURY [Per aopdent] $
AUTOS AUTOS
NON -OWNED
PROPERTY DAMAGE $
HIRED AUTOS AUTOS
[Per =idlenn
UMBRELLALIAB
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AGGREGATE $
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CLAIMS -MADE
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WORKERS COMPENSATION
PER OTH-
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OF FIC ERIM EM BER EXCLU DED? ❑
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(Mandatory In NH)
E.L. DISEASE- EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT 1 $
Professional Liability
Each Claim: $ 1,000,000
A
UDC -1597'609 -EO -16 06/23/2016
06!2312017
Aggregate: $ 1,000,000
DESCRIPTION 0 F 0 PERATID NS I LOCATIONSI VEHICLES {ACDRD 101,AdditionaI Remarks Schedule, may be attached f more space f req ufred)
Eagle County Housing and Development Authority, its associated or affiliated entities, its successors and assigns,
elected officials, employees, agents and volunteers are Additional Insureds under the commercial general liability
and automobile liability policies of insurance.
CERTIFICATE HOLDER CANCELLATION
Eagle Count Housingand Development AuthoritySHOULD
County
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
p
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
® yj "i DATE(MWDDIYYYY)
AC"R"v CERTIFICATE OF LIABILITY INSURANCE
1
`�" 05/09/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S}, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement{s}.
PRODUCER
CONTACT
NAME:
Hiscox Inc.
PHOC.NE 888 202-3007 FAS
520 Madison Avenue
E-MAILADUREss: contact@hiscox.Com
INSURER ($) AFFORDING COVERAGE NAIC9
32nd Floor
New York, NY 10022
fI$URER A: Hiscox Insurance Company Inc 10200
INSURER B
INSURED
FreeForm LLC
INSURER C c _
1349 S. Leged Dr
IN$LIRER D:
A
INSURER E
Gypsum CO 81637
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN$R ADDL SUBR POLICY EFF POLICY EXP
LTR TYPEOF'INSURANCE INSD WVD POLICYNUMBER DDYYYY LIMITS
ACCORDANCE WITH THE POLICY PROVISIONS.
X CWMERCIALGENERAL LIABILITY
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $ 2,000,000
CLAIMS -MADE OCCUR
FR
DAMAGE TO RENTED
PREM ISES [Ea occur n $ 100,000
MED EXP (Anyone ) $ 5,000
PERSONA L&ADV INJURY $ 2,000,000
A
UDC -1597609 -CGL -16 06/23/2016
06!2312017
GENERAL AGGREGATE $ 2,000,000
GE N'L AGG REGATE LIMIT APPLIES PER:
X POLICY F7 JECT PRO- '—ILOC
PRODUCTS - COMPIOP AGG $ S/T Gen.
$
OTHER..
AUTOMOBILE LIABILITY
COM BIN ED81NGLELIMIT $
(Ea acciden
ANY AUTO
BODILY INJURY [Per person] $
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY [Per aoddent] $
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE $
[Per =idlentl
LUBRELLALIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS UAB
CLAIMS -MADE
11
DED RETENTION
$
WORKERS COMPENSATION
ANDEMPLOYERS'LULBILITY YIN
PER OTH-
TA TE ER
ANYPROPRIETORIPARTNERIEXECUTIVE❑NIA
E.L. EACH ACCIDENT $
OF FIC ERIMEMBER EXCLUDED ?
E.L. DISEASE- EA EMPLOYEE $
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS be law
E.L. DISEASE -POLICY LIMIT 1 $
DESCRIPTION 0F0PERATIONSI LOCATIONSI VEHICLES {ACORD 101,AddlllonaI Remarks Schedule, may be a[La chad It more space Is required}
Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and
volunteers are Additional Insureds under the commercial general liability and automobile liability policies of
insurance.
CERTIFICATE HOLDER CANCELLATION
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Eagle COLI11tV
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD