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HomeMy WebLinkAboutC18-190 Mitzi MarquezAGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY, COLORADO AND MITZI MARQUEZ THIS AGREEMENT (“Agreement”) is effective as of ________________________________ by and between Mitzi Marquez, a sole proprietor (hereinafter “Contractor”) and Eagle County, Colorado, a body corporate and politic (hereinafter “County”). RECITALS WHEREAS, the County, through its Department of Human Services (“DHS”) works to promote the health, safety and welfare of County residents of all ages; and WHEREAS, the County uses outside providers and professionals to enhance the ability of County to promote such health, safety and welfare; and WHEREAS, the County desires to hire the Contractor to perform the services defined below in paragraph 1; and WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the Services 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 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 from July 1, 2018 through December 31, 2018 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. County’s Representative. The Human Services Department’s designee shall be Contractor’s contact with respect to this Agreement and performance of the Services. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 6/27/2018 2 Eagle County HHS General Services Final 5/14 3. Term of the Agreement. This Agreement shall commence upon the date first written above, and subject to the provisions of paragraph 11 hereof, shall continue in full force and effect through the 31st day of December, 2018. 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 Services in a sum computed and payable as set forth in Exhibit A. The performance of the Services under this Agreement shall not exceed $15,000. Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business hours unless specifically authorized in writing by County. a. For reimbursement Contractor must submit invoices monthly. Invoices shall include a description of the Services performed. If County is not satisfied with the completeness of a submitted invoice, County may request Contractor to either revise the invoice or provide additional information. Payment will be made for Services satisfactorily performed within thirty (30) days of receipt of a proper and accurate invoice 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. All invoices must be mailed or delivered in-person to the following address to ensure proper payment. Invoices sent by fax or e-mail will not be accepted. Eagle County Department of Human Services Business Office 550 Broadway Post Office Box 660 Eagle, CO 81631 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. All funds received by Contractor under this Agreement shall be or have been expended solely for the purpose for which granted, and any funds not so expended, including funds lost or diverted for other purposes, shall be returned to County. Contractor shall provide the County with progress reports upon County’s request; or Contractor shall furnish progress reports as more specifically set forth in the attached Exhibit A. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 3 Eagle County HHS General Services Final 5/14 d. 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. e. Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after December 31 of any year, without an appropriation therefor by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). 6. 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. i. 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. Should Contractor or any of its employees drive their personal vehicles in connection with the performance of the Services under this Agreement, Contractor shall be solely responsible for any 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 occurrence and $1,000,000 aggregate limits b. Other Requirements. i. The commercial general liability coverage and as set forth above shall be endorsed to include Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers as additional insureds. A certificate of insurance consistent with the foregoing requirements is attached hereto as Exhibit B. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 4 Eagle County HHS General Services Final 5/14 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. v. Contractor is not entitled to workers’ compensation benefits except as provided by the Contractor, nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Contractor or some other entity. The Contractor is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8. Indemnification. The Contractor shall indemnify and hold harmless County, and any of its officers, agents and employees against any losses, claims, damages or liabilities for which County may become subject to insofar as any such losses, claims, damages or liabilities arise out of, directly or indirectly, this Agreement, or are based upon any performance or nonperformance by Contractor or any of its subcontractors hereunder; including claims for bodily injury or personal injury including death or loss or damage to tangible or intangible property; and Contractor shall reimburse County for reasonable attorney fees and costs, legal and other expenses incurred by County in connection with investigating or defending any such loss, claim, damage, liability or action. This indemnification shall not apply to claims by third parties against the County to the extent that County is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents (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: Kathleen Lyons 500 Broadway Post Office Box 660 Eagle, CO 81631 Telephone: 970-328-8841 Facsimile: 1-855-846-0751 DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 5 Eagle County HHS General Services Final 5/14 E-Mail: Kathleen.lyons@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: Mitzi Marquez PO Box 444 Edwards, CO 81632 Phone: 405-694-0825 Email: mitzimarquez@ymail.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. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 6 Eagle County HHS General Services Final 5/14 d. To the extent possible, Contractor has given County written notice of all conflicts, errors, or discrepancies. e. 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. In the event County finds these standards of customer service are not being met by Contractor, County may terminate this Agreement, in whole or in part, upon seven (7) days’ notice to Contractor. 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 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. l. 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. m. 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. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 7 Eagle County HHS General Services Final 5/14 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. p. Contractor shall comply with the Civil Rights Act of 196 and Section 504, Rehabilitation Act of 1973, concerning discrimination on the basis of race, color, sex, age, religion, political beliefs, national origin or handicap. 15. Prohibitions on Government Contracts. As used in this Section 15, the term undocumented individual will refer to those individuals from foreign countries not legally within the United States as set forth in C.R.S. 8-17.5-101, et. seq. If Contractor has any employees or subcontractors, Contractor shall comply with C.R.S. 8-17.5-101, et. seq., and this Agreement. By execution of this Agreement, Contractor certifies that it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement and that Contractor will participate in the E-verify Program or other Department of Labor and Employment program (“Department Program”) in order to confirm the eligibility of all employees who are newly hired for employment to perform Services under this Agreement. a. Contractor shall not: i. Knowingly employ or contract with an undocumented individual to perform Services under this Agreement; or ii. Enter into a subcontract that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an undocumented individual to perform work under the public contract for services. b. Contractor has confirmed the employment eligibility of all employees who are newly hired for employment to perform Services under this Agreement through participation in the E-Verify Program or Department Program, as administered by the United States Department of Homeland Security. Information on applying for the E-verify program can be found at: https://www.uscis.gov/e-verify c. Contractor shall not use either the E-verify program or other Department Program procedures to undertake pre-employment screening of job applicants while the public contract for services is being performed. d. If Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an undocumented individual, Contractor shall be required to: i. Notify the subcontractor and County within three (3) days that Contractor has actual knowledge that the subcontractor is employing or contracting with an undocumented individual; and ii. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subcontractor does not stop employing or contracting with the undocumented individual; except that Contractor shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an undocumented individual. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 8 Eagle County HHS General Services Final 5/14 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] DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 9 Eagle County HHS General Services Final 5/14 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: ______________________________ Kelley Collier, Deputy County Manager CONTRACTOR: By:________________________________ Print Name: Mitzi Marquez Title: Owner DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 10 Eagle County HHS General Services Final 5/14 EXHIBIT A SCOPE OF SERVICES, SCHEDULE, FEES 1. PURPOSE: Eagle County Department of Human Services (ECDHS) provides a wide array of State & Federally- mandated services to ensure the safety and stability of the most vulnerable populations in Eagle County. It is also statutorily required to provide services under the Colorado Child Care Assistance Program (CCCAP) with the purpose of providing eligible households with access to high quality, affordable child care that supports healthy child development and school readiness while promoting household self- sufficiency and informed child care choices. With one of the priorities of the BoCC being early childhood, ECDHS seeks to contract with an ECDHS Professional to provide services outlined below to ensure compliance with program requirements and provide timely and appropriate client service delivery. 2. PROVIDER RESPONSIBILITIES: Contractor will provide the following services for Eagle County’s Colorado Child Care Assistance Program (CCCAP). a. Manage Eagle County’s CCCAP Fiscal Agreement Renewal Process 2018. The period for this project is July 1, 2018 and September 30, 2018. Deliverables for this project include: a. Maintain communication with Eagle County CCCAP Providers throughout the Fiscal Agreement Renewal process. b. Create new and, if necessary, revise existing Fiscal Agreements pursuant to program regulations and procedures. c. Issue new Fiscal Agreements and any related documents to providers for review and signature. d. Update the Child Care Automated Tracking System (CHATS) with the new fiscal agreement information pursuant to program procedures. e. Update all child care authorization in CHATS which are impacted by the Fiscal Agreement renewal process ensuring no gaps in authorized care occur. f. Notify Eagle County CCCAP program staff of any issues throughout the project and when all Fiscal Agreement renewals and child care authorization updates have been completed. g. Maintain records of all documents and case actions and document all specific provider and case actions in CHATS. b. Assist with Eagle County’s CCCAP program transition to the CHATS Modernization system. The period for this project is anticipated to be July 1, 2018 through September 30, 2018. Deliverables for this project include: a. Participate in state calls, webinars, etc. during transition period and report out to CCCAP leadership on necessary tasks and other preparation activities needed for a successful transition for Eagle County to CHATS Modernization. b. Complete assigned tasks as needed to move toward implementation of CHATS Modernization. Tasks may include, but are not limited to: i. Cleaning data in existing CHATS to allow for seamless transition of this data to CHATS Modernization system. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 11 Eagle County HHS General Services Final 5/14 ii. Entering data in CHATS Modernization system in preparation for transition to CHATS Modernization. iii. Entering and/or updating data in CHATS Modernization post-transition for items identified by Colorado Department of Human Services (CDHS) iv. Coordinate with other DHS Divisions as needed to ensure those Divisions are aware of upcoming changes and tasks which need to be completed. v. Communicate with CCCAP providers as needed to keep them informed of any changes impacting them. c. Ongoing CCCAP Provider Management. Deliverables for these services for the time period July 1, 2018 through December 31, 2018 include: a) Collaboration and communication with Eagle County CCCAP program staff to ensure seamless delivery of provider services. b) Manage provider fiscal agreement changes based on tier rating or provider rate changes including: o Bi-monthly review of the Colorado Shines report, o Creating new or revising existing fiscal agreements pursuant to program regulations and procedures, o Issuing fiscal agreement to providers for review and signature, o Updating CHATS with the new fiscal agreement information pursuant to program procedures, and o Maintain records of all documents and case actions and document all specific provider and case actions in CHATS. c) Respond to provider inquiries regarding fiscal agreements, payments, and authorizations for care. d) Maintain provider list up-to-date including holidays, closures, hours, etc. (and includes the provider email distribution group) e) Engage two current CCCAP providers per month with in person visits providing program information and assistance, f) Provide outreach and education to CCCAP providers when system or program changes occur, g) Recruit at least one new child care provider to the Eagle County CCCAP program within the contract period, h) Conduct orientation for all new CCCAP providers, i) Conduct program outreach to ensure community is aware of and can access Eagle County’s CCCAP program. j) Provide monthly updates and act upon any feedback or requested changes from ECDHS leadership team to ensure continued alignment against professional services agreement deliverables. 3. FEES AND COMPENSATION: County shall pay Contractor in six (6) monthly installments. Compensation for the months of July through September 2018 will be paid at $3,500.00 each. Compensation for the months of October 2018 through December 2018 will be paid at $1,500 each. Total compensation is not to exceed $15,000. Each installment will be paid upon receipt of an invoice and satisfactory completion of Services performed for DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 12 Eagle County HHS General Services Final 5/14 each monthly service period which begins on the 1st of each month and ends on the last calendar day of each month. Detailed reports of tasks performed and activity progress and any additional information requested by the County are due monthly on the 5th of each month following the monthly service period. The first report is due on or about August 5, 2018. The final detailed report of tasks performed and any additional information requested by the County is due on or about January 5, 2019 (following completion of the Agreement term). DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 13 Eagle County HHS General Services Final 5/14 EXHIBIT B INSURANCE CERTIFICATE DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD UDC-2292053-CGL-18 Eagle Hiscox Insurance Company IncNew York, NY 10022 32nd Floor 520 Madison Avenue 1,000,000 100,000 5,000 1,000,000 2,000,000 S/T Gen. Agg. Mitzi Marquez 06/21/2019 (888) 202-3007 700 Chambers Ave. , Bldg 2 Unit 1B Hiscox Inc. Y Eagle County, its associated or affiliated entities, its successors and assigns, effected officials, 500 Broadway PO Box 660 Eagle CO 81631 81631 06/21/2018 CO A contact@hiscox.com 06/21/2018 10200 Eagle County, its associated or affiliated entities, its successors and assigns, effected officials, employees, agents and volunteers are named as additional insured subject to the policy terms and conditions. DocuSign Envelope ID: 5CFD2B8E-C6BB-4D63-B7F4-5AE046D64CE3