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HomeMy WebLinkAboutC96-122 Colorado Quarter Horse Association• L - C'96 12 2 4 7 LEASE AGREEMENT BETWEEN THE COUNTY OF EAGLE, STATE OF COLORADO AND COLORADO QUARTER HORSE ASSOCIATION C/O DICK KESSLER PO BOX 313, GLENWOOD SPRINGS, CO 81602 845-3818 THIS LEASE made and entered into this 2 day of MAY 1996, by and between the Board of County Commissioners of the County of Eagle, State of Colorado, a body corporate and politic (hereinafter referred to as the "County") and COLORADO QUARTER HORSE ,;How AE5QCTATTnm (hereinafter referred to as "lessee") for the purpose HORSE SHOW WHEREAS, the County represents it is duly authorized to enter into this Agreement pursuant to Sections 30-11-101, 10-11-103, and 30-11-107, C.R.S., as amended. WHEREAS, DICK KESSLER represents that he/she is duly authorized to enter into this agreement for its intended purposes. W I T N E S S E T H: THAT, in consideration of the mutual promises, covenants and conditions contained herein, the parties hereto agree hereby as follows: 1. SCOPE The County does hereby lease to the Lessee the following premises, as indicated and marked below, situated within the Eagle County Fairgrounds property, County of Eagle, State of Colorado, hereinafter referred to as the "leased premises." A. Exhibition Hall, including the restrooms, stage area, .tables and chairs, bar, and kitchen facilities. B. Exhibition Hall, ,including the restrooms, stage area, tables and chairs, and bar. C. Picnic & Lawn Area, including restrooms, playground and picnic tables. D. Concession Stand, including the grill, freezer, cooler, and sinks. X E. Arenas, chutes, the announcer stand, catch pens, grandstands arena bathrooms. F. Horse stalls and holding Pens. ote-p� �, X.- k -t. al 2. PERIOD OF AGREEMENT The term of this lease shall commence MAY 25 , 199_L and expire MAY 26 , 199 6 3. FEES The deposit and fees charged for events will vary depending on the -characteristics of the event and the type of Lessee. PRIVATE FUNCTIONS: Functions which are not open to the general public and are social in nature. NONPROFIT ORGANIZATIONS AND YOUTH GROUPS: Must have proof of nonprofit status from the Secretary of States office in Denver, Colorado, or be a local chapter of a nationally chartered organization. A nonprofit organization is defined as an organization in which no part of the income or profit is distributed to its members, directors, or officers. OTHER: Any individual or group that is not registered as a nonprofit organization, and/or which is open to the general public and/or which advances the individuals or groups financial or business interest. *** See attachment for fee structure. Lessee is a NON-PROFIT ORGANIZATION TOTAL DEPOSIT AND FEE REQUIRED: $ 200.00 4. INSURANCE FOR EVENTS: Insurance coverage for functions held at the Eagle County Fairgrounds for both public and private events shall be determined by the County. If insurance is required for said function or event, the Lessee shall purchase and maintain during the term of this Agreement insurance as illustrated in Paragraphs A and B insuring against all claims, damages, losses or' expenses arising out of- or• resulting from the use of the Eagle County Fairgrounds. The Lessee, in any event which involves the selling of alcohol ("selling" includes accepting donations), shall purchase and maintain during the term of this Agreement insurance in the following type and amounts insuring against all claims, damages, losses or expenses arising out of or resulting from the use of the Eagle County Fairgrounds: A. General Liability Coverage which shall name Eagle County as additional insured, and shall be carried in the minimum amount of $150,000 per injury and $600,000 per occurrence for coverage of claims for damages arising from Lessees use of the Fairgrounds, including but not limited to personal injury and death, property damage, and other damages imposed by law upon the parties hereto. Lessee agrees to provide the County with a Certificate of Insurance acceptable to the County, naming Eagle County as "additional Insured" fourteen (14) days prior to commencement of this Lease Agreement. B. Host Liquor Liability Insurance is required for any event in which alcohol is being served without direct or indirect (including cover charge, single -price admission, contributions or tips) charge." Host Liquor Liability Insurance shall name Eagle County as additional insured, and shall be carried in the minimum amount of $150,000 per injury and $600,000 per occurrence. C. Liquor Legal Liability is required for any event in which alcohol is being sold. Liquor legal liability insurance shall name Eagle County as additional insured, and shall be carried in the minimum amount of $150,000 per injury and $600,000 per occurrence. Please contact the Eagle County Clerk and Recorder's Office for more information. TYPE OF INSURANCE REQUIRED: A. General Liability Coverage X B. Host Liquor Liability Insurance C. Liquor Legal Liability PROOF OF INSURANCE IS ATTACHED YES X NO 5. DEPOSITS The Lessee is to pay one half of the required deposit to reserve the Eagle County Fairgrounds. The remainder of the deposit and the entire daily fee is due and payable a minimum of seven (7) days prior to the event. Failure to pay said deposit and fee seven (7) days prior to the event will result in the loss of the lease. A cancellation fee of Twenty-five dollars ($25.00) will be withheld from the initial deposit if the event is cancelled. Lessee is responsible for any and all damages to leased premises. Leased premises are to be left in a clean, usable and undamaged condition. If Lessee fails to clean leased premisses to the satisfaction of'the County, or if the lease premises incurs any damage during Lessee's occupancy, excluding normal wear and tear, all cleaning and damage expenses incurred by Eagle County shall be deducted from the above deposit, and/or additional charges shall be assessed. (See Cleaning and Damage Charges attached hereto.) In the event that the deposit does not cover the damage, and additional fee will be assessed. Lessee shall have five (5) business days to pay any extra charge due to damage. If an individual or group has forfeited any part of their cleaning and damage deposit in the past, the amount of their next deposit shall be left to the discretion of the county. Deposits and fees are due and payable in advance., 6. KEY RETURN Lessee shall obtain keys to the leased premises only after said deposits and fees are paid in full to. the County. Facilities shall be clean and keys shall be returned to the County no later than the first business day following the end of said lease. A penalty of $5.00 per day will be retained from the deposit for failure to return the key after the first business day following the end of said lease. 7. LICENSES Prior to Lessee's event at the leased premises, Lessee shall obtain any and all licenses or inspections as may be required by law. 8. SECURITY Lessee agrees to provide security for the events contemplated hereby. Lessee shall contact the Eagle County Sheriff's •Office and make security arrangements acceptable to the Eagle County Sheriff's office. Lessee shall be responsible for paying any and all security costs associated with said events. Proof of security is to be provided seven (7) days prior to said event. 9. ALCOHOL CONSUMPTION A. Lessee shall be allowed to serve alcohol in the following designated areas B. Lessee and particiapants shall be allowed to consume alcohol in the following designated areas C. Lessee intends to sell alcohol on Fairground's premises. (A seperate liquor license is required. Please contact the Eagle County Clerk and Recorder's office for information.) D. Lessee shall not serve alcohol on Fairgrounds's premises. Y E. Lessee and participants shall not consume alcohol on fairgrounds premises. 10. RULES AND REGULATIONS Lessee agrees to abide by the Eagle County Fairgrounds Rules and Regulations as set forth in Exhibit "A," attached hereto and made a part hereof by this reference. Lessee is responsible for enforcing the Eagle County Fairgrounds Rules and Regulations during its event and with all guests and participants. U 11. INDEMNIFICATION A. Lessee agrees to hold the County harmless and assume full responsibility for all claims asserted against the County by third parties arising out of Lessee's activities on the lease premises. B. Lessee agrees the leased premises shall not be used for any purposed which would render the insurance thereon void or the insurance risk more hazardous, or for any purpose unauthorized by law. 12. LESSEE'S DUTIES Lessee agrees to leave the leased premises in the same clean and usable condition which existed at the time of the commencement of this Lease Agreement. Prior to the commencement and termination of the Lease Agreement, Lessee and an authorized representative of the County shall inspect the leased premises, and shall make written note of any damaged or unclean property. If at the termination of this Lease the County's representative. finds the leased premises to be unclean or damaged, Lessee shall be held responsible for.any cleaning or repair of damage costs incurred by the County as a result of Lessee's occupancy of the leased premises. Said costs shall be deducted from Lessee's deposit. If said costs exceed Lessee's deposit, Lessee agrees to pay any additional costs immediately. 13. MISCELLANEOUS A. Lessee shall permit the County to have free access to the leased premises before, during and after the scheduled event. B. No modification or waiver of this Agreement or of any covenant, condition, or provision herein contained shall be valid unless agreed to in writing by all parties. C. This written Agreement embodies the whole agreement between the parties hereto and there are no inducements, promises, terms, conditions, or obligations made or entered into either by the County or Lessee other than that contained herein. D. All agreements and covenants herein are severable, and in the event that any of them shall be held invalid by a court of competent jurisdiction, this Agreement shall be interpreted as if such invalid agreement or covenant were not contained herein. IN WITNESS WHEREOF, the parties hereto have executed this Agreement in duplicate. One counterpart.each has been delivered to County and Lessee. THE COUNTY: COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its BOARD OF COUNTY COMMISSIONERS By: Name: -PAUL GREGG "V SUPERVISOR Title: BUILDINGS AND GROUNDS DEPT. Name: nTru VPgQTrp Title: DIRECTOR OF COLORADO QUARTER HORSE SHOW ASSOC. STATE OF COLORADO ) ) ss County of Eagle ) The foregoing w s ackno�wled d before me this 1G day of �b , Y 3� My commission expires: MgcommissionExr?reci1091999 660 P6 G � (�w ,Notary Publi EAGLE COUNTY FAIRGROUNDS RULES AND REGULATIONS PART 1. GENERAL RULES AND REGULATIONS A. It is intended that the Eagle County Fairgrounds (hereinafter referred to as the "Fairgrounds") be used to meet as many needs and serve as many organizations as possible. Scheduling of events to be held at the Fairgrounds shall be done on a first come, first serve basis, at the discretion of the Eagle County Board of County Commissioners (hereinafter referred to as "the County"). No individual, organization or corporation shall be permitted to reserve the exhibit hall for more than one (1) event per month unless otherwise authorized or permitted by the County. B. Scheduling and use of the Fairgrounds and its facilities shall be managed by the Eagle County Manager or his designee. A deposit and/or fee may be required for specific facilities. Deposits shall be returned upon the approval of the County if the facilities are left in the condition in which they were found. C. In the event the deposit does not cover the damage, an additional fee will be assessed. Lessee shall have five (5) business days to pay any extra charge due to damage. D. The County shall -not be responsible for losses due to theft, fire or vandalism during activities held on the premises of the Fairgrounds. E. Smoking is prohibited in all buildings, and within fifty (50) feet of any barn, hay or straw storage area, or as posted on the Fairgrounds property. F. The user shall be responsible for parking control and for insuring that fire lanes (12 feet minimum) and access lanes (12 feet minimum) are kept clear of obstruction during all events occurring at the Fairgrounds. Unless otherwise authorized, parking shall be in designated areas only. G. Children shall not be permitted in any areas where livestock are kept or used unless participating in a scheduled event, or unless supervised or accompanied by a parent or adult who shall accept complete responsibility in case of any injury accident or damage. H. All dogs shall be on a leash and under the control of the owner, unless participating in a scheduled event, and will not be allowed in any buildings unless the dog or animal is a service animal assisting a disabled person. I. Glass beverage containers are prohibited on Fairgrounds property except in the exhibition hall, or as otherwise authorized. J. All County -owned equipment shall be operated by County Employees only. K. All props, poles, portable fence panels, barrels and jump standards shall be returned to their designated storage location after each use. L. Camping or overnight parking is prohibited on Fairgrounds property unless previously authorized by the County. M. All Fairgrounds users shall be responsible for cleaning up after themselves and their animals. N. The County reserves the right to deny any group or person access to the Fairgrounds. O. The County reserves the right to close any part of the Fairgrounds to public access. P. No intoxicated person shall be allowed on the Fairgrounds. No person under the age of 21 shall consume alcoholic beverages on Fairgrounds property. Q. Any and all -persons using the arena shall sign a release of liability and agreement to indemnify the County from any and all claims against the County, its agents, or assigns. R. User shall obtain all necessary permits and licenses prior to scheduled use, and shall promptly pay all taxes, - excise or license fees applicable to the sue of the Fairgrounds. S. User shall use and occupy the Fairgrounds, or any portion thereof, in a safe and careful manner and shall comply with all local, state, and federal laws, rules and regulations as may be in force and effect during the scheduled event, including any and all health laws and regulations. T. If, in the judgement of the County, persons attending a scheduled, event are in violation of these Rules and Regulations, the County may terminate the event and require all persons to immediately leave the premises. U. The County reserves the right to enter upon the Fairgrounds property at any time to insure compliance with these Rules and Regulations. PART 2. BOARDING ANIMALS A. Unless authorized by the County, Boarding of Animals is prohibited on Fairgrounds property. Unless otherwise authorized by the County, user shall pay a $25.00 deposit and $5.00 per day fee, for each stall or pen used to insure that the premises are left in a clean and undamaged condition. Cleaning and damage expenses shall be deducted from the deposit and/or additional charges shall be assessed to the user in event the premises are not left in a clean and undamaged condition. B. All users shall be responsible for the daily cleaning of stalls and holding pens. If user fails to clean any stall or pen, the County shall clean them and charge the user $25.00 per day per stall or pen. C. Only one horse or mule shall be permitted in any single stall, unless otherwise authorized by the County. D. The County reserves the right to inspect any animal kept on Fairgrounds property and shall attempt to call the owner in the event any animal appears to be sick or a carrier of any contagious disease. Incoming animals that appear sick shall not be admitted without a veterinarian's certificate of health stating the animal is healthy. Any animal that contracts a contagious disease must be moved immediately from the Fairgrounds at the owner's expense. E. Owners of any animal kept on Fairgrounds property shall be responsible for insuring that the animal is properly fed and watered on a daily basis. No bulk feed shall be permitted in the barns at any time. The County shall designate a feed storage area. F. Animals shall not be relocated from their assigned stalls without the prior consent of the County. G. No animal shall be permitted to be kept or stalled in the arena area. H. At the discretion of the County, the stalls and pens shall not be available for use on days when scheduled events or maintenance is planned. I. Prior to boarding an animal, all owners of animals shall sign a waiver agreeing to hold the County harmless and assume full responsibility for all claims asserted against the County. I have read the foregoing Eagle County Fairgrounds Rules and Regulations and fully understand my duties and obligations as stated in the Rules and Regulations. LESSEE: FEE SCHEDULE EAGLE COUNTY FAIRGROUNDS Lessee agrees to pay the County the following fees for the rental and deposit of each Fairgrounds Facility: NONPROFIT ORGANIZATIONS AND YOUTH GROUPS: Must have proof of nonprofit status from the Secretary of State,'s office in Denver, Colorado, or be a local chapter of a nationally chartered organization. A nonprofit organization is defined as an organization in which no part of the income or profit is distributed to its members, directors, or officers. A nonprofit organization may distribute income or profit to a member provided the member is another non-profit organization. 1. 2. 3. 4. 3 Exhibition Hall CLEANING AND DAMAGE DEPOSIT: WITH ALCOHOL CONCESSION STAND CLEANING AND DAMAGE DEPOSIT DEPOSIT DAILY FEE $2.50.00 NO DAILY FEE $500.00• $150.00 NO DAILY FEE ARENAS CLEANING AND DAMAGE DEPOSIT $200.00 NO DAILY FEE STALLS AND PENS CLEANING AND DAMAGE DEPOSIT PICNIC AND LAWN AREA CLEANING AND DAMAGE DEPOSIT WITH ALCOHOL (DAY = EACH 24 HOUR PERIOD) 0 $ 25.00 $5.00 $250.00 NO DAILY FEE $500.00 NO DAILY FEE TOTAL AMOUNT OF DEPOSIT AND FEES: $ 200.00 The following charges will, be- assessed against lessee's cleaning and damage deposit when Ja5es has failed to leave leased premises clean and free of damage as per the County's Rules and Regulations- ents -allminur alcohol, $25.00 per man hour Minimum charges $350.00 Events without alcohol $25.00 per man hour Minimum charges $125..00 Other than normal wear and tear, charge will be based an cast to repair or replace. Lessee's Initials 02-20-199 "zAM FROM TO 32$7720 P.02 cl Ara 1. pob w "rslwi u, DEPAn,rNj ;*i, OF S'r.&TE CERTIFICATE• .�, MARY ESTILL BUCHANAN, ,l'ermlava �l'lafi� c me .rilirl � ' �(�r'/%lir rir/r.� - • � � 1Aal /fir, �fP yftk. lej 2 f1,.�1 t,,.3rru�rctr.� t�rJ ret/r`�aQ!�e ken /irJ�,l�ed rrI camf �ajzc� rrr'� lair= er�zd Io cam/dim 1a 41bi . &e it,4: Zed �� r:i?etre al die au l2rYi��i rit Wle try lurr:, lf j4dited F1 C,EG,-r i F I FiTE OF ItaC:OPPOR•RT I,3r•4 DI sr: ;'C _: I RT I (_ N., H Nr—tNF'F'4F J T C -OP - DATED SECRETARY OF STATE ACOR.Rm CERTIFICATE 01: INSURANCE ISSUE DATE (MM/DDNY) 4/8/96 PRODUCER THIS CERTIFICATE IS ISSUED AS A M . . ER OF INFORMATION ONLY AND CONFERS ' NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Markel Underwriters & Brokers 4600 Cox Road EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen, Virginia 23060-9817 A Division of Markel Service, Inc. COMPANIES AFFORDING COVERAGE COMPANY CODE SUB -CODE LATER A MARKEL INSURANCE COMPANY COMPANY INSURED B LETTER Colorado Quarterhorse Show Assoc. COMPANY C c/o Brenda Mayer LETTER P.O. Box 313 COMPANY D Glenwood Springs, CO 81602 LETTER COMPANY E LETTER COVERAGES 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 co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS TR DATE (MM/DD/YY) DATE (MM/DD/YY) A GENERAL LIABILITY GENERAL AGGREGATE 8 None PRODUCTS-COMP/OPS AGGREGATE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX occuR. 3602AGO25708-0 05-20-1995 05-20-1996 PERSONAL &ADVERTISING INJURY 7 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNERS ✓9 CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) $ 0 MEDICAL EXPENSE (Any one person) $ 0 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO ` LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE 0 UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT $ AND DISEASE - POLICY LIMIT b EMPLOYERS' LIABILITY DISEASE - EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate holder only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Eagle County Fairgrounds MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Attn: Laurie Asmussen OR LIABILITY OF ANY KIND UPO COMPANY, ITS AGENTS OR P.O. Box 239 /THE REPRESENTATIVES. Eagle, CO 81631 AUTHORIZED REPRESENTATIVE Bruce A. Kay ACORD 25-S(7/90) (c) ACORD CORP TION 1990 02-28-1996 ii•.1AM FROM To: Company: Fax #: From: Date: TO 3287720 P.01 REAL ESY'AT'E TA. R.,he P p a. I- A L S 1 Nt 1 1 L. E Time: Total # of Pages Including Cover Page: Message: A 100 ' Mr�r�� ti This facsimile transmission contains documents belonging, to the sender which may be confidential and legally privileged. information is intended only for whom this transmission was sent as indicated above. if you are not the intended recipient, any disclosure, copying, distribution or action taken in relianec on contents is strictly prohibited. if you have received this transmission in error, please notify us by itlephone immediately so we mai arrange w reirieve this transmission at no cost to you, Thank you. 11 I G H L A N D S L O D G E r DRAWER 2820, AVON, COLORADO 81620 • TELEPHONE: (303) 845-9400 • TELEFAX: (303) 845-7118 Fxclusivc Affiliare ' SOT EBY"S INTERNATIONAL REALTY . 02-28-199b•11:32AM FROM TO 3287720 P.03 Gi_S-0006976.02 4SURANCI_ COMPANY OF EVANSTON SHAND MORAHAN PLAZA Renewal of Number EVANSTON, ILLINOIS 60201 A STOCK COMPANY COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy No. 3602AGO25708 - 0 Named Insured and Mailing Address (Iwo. street, Town or City, County, State, Zh) code) Colorado Quarterhorse Show Assoc, c/o Brenda Mayer P.O. Box 313 Glenwood Springs, CO 81602 Policy Period: From 05-20-1996 to 05-20-1996 at 12:01 A.M. Standard Time at your mailing address shown above, IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS POLICY, VILE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE General Aggregate Limit (Other Than Products --Completed Operations) $ NONE Products --Completed Operations Aggregate Limit 11000,000 Personal and Advertising Injury Limit 'Thi;^)��� .,;; r.� 'i^ E'^� ^^, ^~" . � ,.�:.. 3 $_ 1/100,000 Each Occurrence Limit :cad $ 11000,000 Fire Damage Limitu: �y ca? fill $ Not Covered Any One Fre Medical Expense Limit $ Not Covered Any One Person RETROACTIVE DATE (CG 00 02 only) Coverage A of this Insurance does not apply to 'bodily injury' or 'property damage' which occurs before the Retroactive Date, if any, shown here: None lFmw Dare at 'Nam' it no Ratreartve Data applip� DESCRIPTION OF BUSINESS AND LOCATION OF PREMISES Form of Business: Organization Business Description: Riding Club Location of All Premises You Own, Rent or Occupy SEE ATTACHED "EXTENSION OF DECLARATIONS" Classification Code No. Premium Basis SEE ATTACHED "EXTENSION OF DECLARATIONS" otfai Advance Premium:$ 1,244.00 Advance Rate Premium A 4y AN ter[, �: ..J `i4' v'K ,'Y t_`i•. r ^y7 rlU ::V sv SUGH EVENT. Cry rt_L N13T 5„r. .,�-}r ..; ,:. i�-•G`5C;1�. Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue: F SJS (06 {4/ /92), GUDECA84), C00001{10/113), CG"2411 1 /86), C43216lil I/88), CO21IOil 1M), CO213311 IMS), CG2136t10AB3), 002144(11/86), CG2146111/061. CL /102A18/971 E707{4/88), E704 18!87), IXCL-3o416/s}e), EXCL-6)12/)!8!. SAiti18W/86), NA017f11/86), IL0021f11/65), )L0226f10/581, NCElf12-841 Countersigned: 6/16/95 PGR Glen Allen VA By Bruce A. Kay I Authorized Representative THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED To FORM A PART THEREOF. COMPI = THF ARnvC N1 JURMLn eni