HomeMy WebLinkAboutC19-008 Natalie BullardDocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
AGREEMENT FOR SERVICES
BETWEEN EAGLE COUNTY, COLORADO
AND
THE PET VET, LLC
NATALIE BULLARD, DVM
THIS AGREEMENT ("Agreement") is effective as of 1/11/2019 by and between The Pet Vet, LLC,
operated by Natalie Bullard, DVM (hereinafter "Contractor") and Eagle County, Colorado, a body corporate and
politic (hereinafter "County").
RECITALS
WHEREAS, the County desires to provide veterinary services to its small pet population (the "Project") at the
Eagle County Animal Shelter located at 1400 Fairgrounds Road, Eagle, Colorado (the "Property"); 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, and personnel 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 beginning no later than January 1, 2019 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 Animal Services 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 11 hereof, shall continue in full force and effect through the 31 day of December 2019.
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.
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
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 $45,000. 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. Payment will be made for Services satisfactorily performed within thirty (30) days of receipt of a
proper and accurate invoice from Contractor. All invoices shall include detail regarding the hours spent, tasks
performed, who performed each task and such other detail as County may request.
b. If, at any time during the term or after termination or expiration of this Agreement, County
reasonably determines that any payment made by County to Contractor was improper because the Services for
which payment was made were not performed as set forth in this Agreement, then upon written notice of such
determination and request for reimbursement from County, Contractor shall forthwith return such payment(s) to
County. Upon termination or expiration of this Agreement, unexpended funds advanced by County, if any, shall
forthwith be returned to County.
County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor
agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made
pursuant to the terms of this Agreement.
d. Notwithstanding anything to the contrary contained in this Agreement, County shall have no
obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after
December 31 of any year, without an appropriation therefor by County in accordance with a budget adopted by the
Board of County Commissioners in compliance with Article 25, title 30 of the Colorado Revised Statutes, the Local
Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X,
Sec. 20).
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.
2
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
7. Insurance. Contractor agrees to provide and maintain at Contractor's sole cost and expense, the following
insurance coverage with limits of liability not less than those stated below:
a. Types of Insurance.
Workers' Compensation insurance as required by law.
ii. Auto coverage with limits of liability not less than $1,000,000 each accident combined
bodily injury and property damage liability insurance, including coverage for owned, hired, and non -owned
vehicles.
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 automobile and commercial general liability coverage shall be endorsed to include
Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and
volunteers as additional insureds. A certificate of insurance consistent with the foregoing requirements is attached
hereto as Exhibit B.
ii. Contractor's certificates of insurance shall include subcontractors, if any as additional
insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for each
subcontractor.
iii. The insurance provisions of this Agreement shall survive expiration or
termination hereof.
iv. The parties hereto understand and agree that the County is relying on, and does
not waive or intend to waive by any provision of this Agreement, the monetary limitations or rights, immunities and
protections provided by the Colorado Governmental Immunity Act, as from time to time amended, or otherwise
available to County, its affiliated entities, successors or assigns, its elected officials, employees, agents and
volunteers.
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; 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
3
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
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: Abby Musfeldt
500 Broadway
Post Office Box 850
Eagle, CO 81631
Telephone: 970-328-8611
E -Mail: abby.musfeldt@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:
The Pet Vet, LLC
Natalie Bullard, DVM
coloradodvm (a,zmail. com
970.331.4817
133 Fourth Street, Eagle, CO 81631
11. Termination. County and Contractor 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 thirty (30) 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.
4
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
12. Venue, Jurisdiction and Applicable Law. Any and all claims, disputes or controversies related to this
Agreement, or breach thereof, shall be litigated in the District Court for Eagle County, Colorado, which shall be the
sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be
governed by the laws of the State of Colorado.
13. Execution by Counterparts; Electronic Signatures. This Agreement may be executed in two or more
counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same
instrument. The parties approve the use of electronic signatures for execution of this Agreement. Only the following
two forms of electronic signatures shall be permitted to bind the parties to this Agreement: (i) Electronic or
facsimile delivery of a fully executed copy of the signature page; (ii) the image of the signature of an authorized
signer inserted onto PDF format documents. All documents must be properly notarized, if applicable. All use of
electronic signatures shall be governed by the Uniform Electronic Transactions Act, C.R.S. 24-71.3-101 to 121.
14. Other Contract Requirements and Contractor Representations.
a. Contractor has familiarized itself with the nature and extent of the Services to be provided
hereunder and the Property, and with all local conditions, federal, state and local laws, ordinances, rules and
regulations that in any manner affect cost, progress, or performance of the Services.
b. Contractor will make, or cause to be made, examinations, investigations, and tests as he deems
necessary for the performance of the Services.
C. To the extent possible, Contractor has correlated the results of such observations, examinations,
investigations, tests, reports, and data with the terms and conditions of this Agreement.
d. To the extent possible, Contractor has given County written notice of all conflicts, errors, or
discrepancies.
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. 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.
5
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
h. Contractor represents and warrants that at all times in the performance of the Services, Contractor
shall comply with any and all applicable laws, codes, rules and regulations.
i. This Agreement contains the entire agreement between the parties with respect to the subject
matter hereof and supersedes all other agreements or understanding between the parties with respect thereto.
j. Contractor shall not assign any portion of this Agreement without the prior written consent of the
County. Any attempt to assign this Agreement without such consent shall be void.
k. This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their
respective permitted assigns and successors in interest. Enforcement of this Agreement and all rights and obligations
hereunder are reserved solely for the parties, and not to any third party.
1. No failure or delay by either party in the exercise of any right hereunder shall constitute a waiver
thereof. No waiver of any breach shall be deemed a waiver of any preceding or succeeding breach.
in. The invalidity, illegality or unenforceability of any provision of this Agreement shall not affect the
validity or enforceability of any other provision hereof.
n. The signatories to this Agreement aver to their knowledge no employee of the County has any
personal or beneficial interest whatsoever in the Services or Property described in this Agreement. The Contractor
has no beneficial interest, direct or indirect, that would conflict in any manner or degree with the performance of the
Services and Contractor shall not employ any person having such known interests.
o. The Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms
under penalty of perjury that he or she (i) is a citizen or otherwise lawfully present in the United States pursuant to
federal law, (ii) to the extent applicable shall comply with C.R.S. 24-76.5-103 prior to the effective date of this
Agreement.
15. Prohibitions on Government Contracts.
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:
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
6
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
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.
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 INTENTIONALL Y LEFT BLANK]
7
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
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
DocuSigned by:
By: Aff S�t,Va
J ok44Qoawty Manager
CONTRACTOR:
D�olcuSigned,¢b.,y::
By: Nal A.�dL V4A
2186AOE8616845C...
Print Name: Natalie Bullard
Title: Owner, DVM
8
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
EXHIBIT A
SCOPE OF SERVICES, SCHEDULE, FEES
Purpose:
Eagle County Animal Services (ECAS) provides care and shelter to animals in need while maintaining a safe
community and promotes responsible pet ownership through outreach, education and enforcement. ECAS seeks to
contract with a veterinarian to provide basic medical exams, vaccinations, and spay/neuter of animals in ECAS's
care for a sum of $45,000. The county will cover an additional $500 for veterinary insurance and $1,000 for
continuing education. ECAS will provide necessary equipment, supplies and tools for use by Contractor, at its
facility located at 1400 Fairgrounds Road in Eagle, Colorado.
Sheltered animals include those surrendered by owners, found as strays, seized, returned, and transferred from
rescue organizations or other shelters inside and outside of Eagle County. The shelter's philosophy is to maintain a
shelter population at fifty percent of capacity, allowing for the ability of staff to respond and handle any emergencies
that may arise. Eagle County recognizes that the landscape of Eagle County's animal population has changed over
time as stray, seized, and returned animals have been on the decline. Transferring animals into our shelter has
become an important component of the shelter program, however, it must be balanced to ensure staffing and
veterinary needs are not exacerbated. Eagle County is committed to transferring animals when there is capacity, and
animals will come either spayed or neutered, requiring health checks primarily.
Scope of Services:
Responsibility of the veterinary include:
1. Provision of copy of current vet license.
2. Provision of copy of $1,000,000/$3,000,000 liability and malpractice insurance policy, up to $500.00 of
which will be covered by Eagle County.
3. Provision of weekly on-site visits to perform surgery and assess animal health and shelter condition on
Wednesdays beginning at 9:15 A.M. These visits include a variety of actions, such as:
a. Sterilization procedures (spay and neuter);
b. Anesthetic dental cleaning, simple and surgical extractions; and
c. Health exams for all sheltered animals.
4. In addition to the weekly on-site visits, provision of Trap -Neuter -Return (TNR) surgeries, which will be
arranged in advance and animals will be presented for surgery in traps and will be returned to traps for
recovery and return to location of origin.
5. Be provided with a weekly written report from shelter staff detailing animal health, medications
administered, health or behavior concerns. This will prepare the veterinarian for his or her weekly visit.
6. Provision of phone, email and text support for shelter and field services managers.
7. Provision of CO veterinary license:
a. for, and provide oversight for supply ordering; and
b. for, and provide oversight and professional recommendations for the discount shelter feeding
program.
8. Provision of ongoing training and education to shelter and field services staff as requested during weekly
on-site visits.
9. Provision of input to shelter and field services policies, procedures and protocols as requested.
10. Attendance to one Animal Services Advisory Committee meeting per year to update Committee members
on veterinary services at the shelter.
9
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
11. Attendance at conference which provides instruction pertaining specifically to shelter medicine. Contractor
shall share said information with shelter staff upon completion of continuing education credits. $1000
continuing education allowance will be provided.
10
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
EXHIBIT B
INSURANCE CERTIFICATE
11
Eagle County General Services Final 5/14
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
AVMA I P L I T° Veterinary Professional Liability
Protecting you through it all Insurance Policy
Certificate of Insurance
This policy provides occurrence coverage. Please review the policy carefully.
ITEM 1: Insured by the stock company below and hereinafter called the Company
Zurich American Insurance Company
ITEM 2: Named Certificate Holder, member number, rating code and address I Master Policy Number:
Natalie Ann Bullard, DVM
PO Box 3085
Eagle, CO 81631-3085
EOL 5241302 -14
�J
ZURICH
U-VPL-103-A-CW (07/04)
Certificate Number:
VETPR0077305
FOR INFORMATION OR TO FILE A CLAIM
PLEASE CALL (800) 228-7548
ITEM 3: Policy Period
From: 01/01/2019
To: 01/01/2020
12:01 am Standard time at the address of the Named Certificate Holder
as stated herein
ITEM 4: Limits of Liability
Member Name Member No. Rating Code Each claim $ 1,000,000
Natalie Bullard 217614 [IV] Small Animal Exclusive Aggregate $ 3,000,000
ITEM 5: Premium and coverage summary
Primary Professional Liability
Veterinary License Defense
TOTAL DUE:
ITEM 6: Forms Attached at Issuance:
$248.00 U-VPL-100-A CW (07/04); U-VPL-103-A CW (07/04); U -GU -1191-A CW (03/15);
$123.00 U-VPL-126-A CO (09/04); U-VPL-102-B CW (06/11); U -GU -319-F (01/09); U -GU-
I I94 -A CW (08/15)
$371.00
ITEM 7: Schedule of Plan Numbers and location(s) for Professional Extension
Endorsement (Animal Bailee) / Embryo and Semen Storage (if purchased):
For additional locations, please see the attached page
Location Number/Address
ITEM 8: Veterinary Professional Liability Regulatory Action License Defense
Coverage endorsement (if purchased):
Limit:
$ 100,000
Authorized Signature
IQ �- 14j�
Neil R. Hughes, President
HUB International Midwest Limited
Extension Plan Embryo Plan
This Certificate of Insurance is issued off the Master Policy held by the American
Veterinary Medical Association (AVMA) Professional Liability Insurance Trust. By
acceptance of this policy the Named Certificate Holder agrees that the statements in
the certificate and the application and any attachments hereto are the Named
Certificate Holder's agreements and representations and that this policy embodies all
agreements existing between the Named Certificate holder & the Company or any
of its representatives relating to this insurance.
Notice to the Company: Zurich American Insurance Company
P.O. Box 968041
Schaumburg, IL 60196-8041
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
SANCTIONS EXCLUSION
ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ZURICH
The following exclusion is added to the policy to which it is attached and supersedes any existing sanctions
language in the policy, whether included in an Exclusion Section or otherwise:
SANCTIONS EXCLUSION
Notwithstanding any other terms under this policy, we shall not provide coverage nor will we make any
payments or provide any service or benefit to any insured, beneficiary, or third party who may have any rights
under this policy to the extent that such cover, payment, service, benefit, or any business or activity of the
insured would violate any applicable trade or economic sanctions law or regulation.
The term policy may be comprised of common policy terms and conditions, the declarations, notices, schedule,
coverage parts, insuring agreement, application, enrollment form, and endorsements or riders, if any, for each
coverage provided. Policy may also be referred to as contract or agreement.
We may be referred to as insurer, underwriter, we, us, and our, or as otherwise defined in the policy, and shall
mean the company providing the coverage.
Insured may be referred to as policyholder, named insured, covered person, additional insured or claimant, or
as otherwise defined in the policy, and shall mean the party, person or entity having defined rights under the
policy.
These definitions may be found in various parts of the policy and any applicable riders or endorsements.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
U -GU -1191-A CW (03/15)
Page 1 of 1
DocuSign Envelope ID: 0803AE69-4488-46F9-9CAD-57AC9FOFB849
Endorsement #
Colorado Amendatory Endorsement
ZURICH
Master Policy No.
Certificate No.
Eff. Date of Cert.
Exp. Date of Cert.
Eff. Date of End.
Add'1 Prem.
Return Prem.
EOL 5241302 -14
VETPR0077305
01/01/2019
01/01/2020
$371.00
$0.00
Named Certificate Holder and Mailing Address: Producer:
HUB International Midwest Limited
Natalie Ann Bullard, DVM 55 East Jackson Boulevard
PO Box 3085 Chicago, IL 60604-4187
Eagle, CO 81631-3085
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Veterinary Professional Liability Insurance Policy
It is agreed that Section IV — CONDITIONS, Paragraph D is deleted in its entirety and replaced with the following:
1. CANCELLATION
a. This policy may be canceled by the Named Certificate Holder by surrender of the policy to the Company or by mailing
written notice to the Company stating when such cancellation shall take effect. If canceled by the Named Certificate
Holder, the Company shall retain the customary short -rate proportion of the premium. In no event may the requested date of
cancellation be greater than ten (10) days prior to the date the request is received by the Company.
b. This policy may be canceled by the Company by mailing written notice by certified mail or first class mail to the Named
Certificate Holder at the address shown in the Certificate of Insurance. Such cancellation shall be no fewer than forty-five
(45) days from the date the notice is mailed unless the policy is canceled because the Named Certificate Holder has failed to
pay a premium. In that event, such cancellation shall take effect no fewer than ten (10) days from the date the notice is
mailed.
The Company may cancel this policy for the following reasons:
(1) Nonpayment of premium;
(2) A false statement knowingly made on the application for insurance; or
(3) A substantial change in the exposure or risk from what was indicated on the application and underwritten as of the
effective date of the policy unless the Named Certificate Holder has notified the Company of the change and the
Company accepts such change.
If the policy is canceled by the Company, the earned premium shall be computed pro -rata. Premium adjustment may be
made at the time cancellation is effected or as soon as practicable thereafter but not more than forty-five (45) days after the
effective date of cancellation by the Company or after the date of entitlement established by notification of cancellation or as
otherwise established. Failure to pay any premium adjustment at, on, or around the time of the effective date of cancellation
shall not alter the effectiveness of cancellation.
2. NONRENEWAL
a. If the Company elects not to renew this policy, the Company will mail by certified mail or first class mail to the Named
Certificate Holder at the address shown in the Certificate of Insurance, and mail to the producer of record, if any, written
notice of nonrenewal at least forty-five (45) days prior to the expiration of this policy.
b. If notice is mailed, proof of mailing will be sufficient proof of notice.
c. If either one of the following occurs, the Company is not required to provide written notice of nonrenewal:
(1) the Company or another Company within the same insurance group has offered to issue a renewal policy; or the Named
Certificate Holder has obtained replacement coverage or agreed in writing to do so.
U-VPL-126-A CO (09 / 04)
Page 1 of 2
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
3. CONDITIONAL RENEWAL
a. If the Company elects to renew this policy and the rcncwal is subjcct to any of the following:
(1) Increase in premium;
(2) Reduction in Limit of Liability; or
(3) Reduction in coverage;
the Company shall mail by certified mail or first class mail written notice of the change(s) to the Named Certificate Holder,
at the address shown in the Certificate of Insurance and the producer of record, if any, at least forty-five (45) days before
the anniversary or expiration date of the policy.
b. If renewal is subject to any condition described in a(1) through a(4) above, and the Company fails to provide notice forty-five
(45) days before the anniversary or expiration date of this policy, the following procedures apply:
(1) the present policy will remain in effect until the earlier of the following:
(a) Forty-five (45) days after the date of mailing or delivery of the notice; or
(b) The effective date of replacement coverage obtained by the Named Certificate Holder.
(2) If the Named Certificate Holder elects not to renew, any earned premium for the period of extension of the terminated
policy will be calculated pro rata at the lower of the following rates:
(a) The rates applicable to the terminated policy; or
(b) The rates presently in effect.
c. If the Named Certificate Holder accepts the renewal, the premium increase, if any, and other changes are effective the day
following this policy's anniversary or expiration date.
All other terms, conditions and exclusions of this policy remain unchanged.
Signed by: /U�/ �/4j/u�,2,
-
Authorized Representative
10/17/2018
Date
U-VPL-126-A CO (09 / 04)
Page 2 of 2
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
Fraud Warnings Disclosure
ZURICH*
TO BE ATTACHED TO AND FORM PART OF THE APPLICATION. IF FRAUD WARNINGS ARE INCLUDED IN THE
APPLICATION TO WHICH THIS IS ATTACHED, THIS DISCLOSURE REPLACES THOSE WARNINGS.
Any person who knowingly and with intent to defraud any insurance company or another person files an application for
insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading
information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the
person to criminal and civil penalties. (Not applicable in AL, AR, CO, DC, FL, KS, KY, LA, MD, ME, NJ, NM, NY, OH, OK,
OR, PA, PR, RI, TN, TX, VA, VT, WA, and WV.)
In Arkansas, Louisiana, Rhode Island, or West Virginia: Any person who knowingly presents a false or fraudulent
claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a
crime and may be subject to fines and confinement in prison.
In Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who
knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution,
fines or confinement in prison, or any combination thereof.
In Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance
company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines,
denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or
attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds
shall be reported to the Colorado division of insurance within the department of regulatory agencies.
In District of Columbia: Warning: It is a crime to provide false or misleading information to an insurer for the purpose of
defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny
insurance benefits if false information materially related to a claim was provided by the applicant.
In Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim
or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
In Kansas: Any person who, knowingly and with intent to defraud, presents, causes to be presented or
prepares with knowledge or belief that it will be presented to an insurer, purported insurer, or to or by a broker
or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the
rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit
pursuant to an insurance policy for commercial or personal insurance which such person knows to contain
materially false information concerning any fact material thereto; or conceals, for the purpose of misleading,
information concerning any fact material thereto, commits a fraudulent insurance act and may be subject to
criminal and/or civil fines or penalties.
In Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance containing any materially false information or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
In Maine, Tennessee, Virginia, or Washington: It is a crime to knowingly provide false, incomplete or misleading
information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment,
fines or a denial of insurance benefits.
U -GU -1147-A (01/14)
Page 1 of 2
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
In Maryland: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or
who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject
to fines and confinement in prison.
In New Jersey: Any person who includes any false or misleading information on an application for an insurance policy is
subject to criminal and civil penalties.
In New Mexico: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT
OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR
INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES.
In New York: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and
shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such
violation.
In Ohio: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
In Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes
any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a
felony.
In Oregon: Any person who knowingly and with intent to defraud any insurer or other person files an application for
insurance or statement of claim containing any materially false information upon which an insurer relies, if such
information was either material to the risk assumed by the insurer or the misinformation was provided fraudulently, may
commit a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties.
In Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for the purpose of
misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and
subjects such person to criminal and civil penalties.
In Puerto Rico: Any person who has committed fraud, as defined in the law, shall incur a felony, and if convicted, shall be
sanctioned for each violation by a penalty of a fine of not less than five thousand dollars ($5,000), nor more than ten
thousand dollars ($10,000), or a penalty of imprisonment for a fixed term of three (3) years, or both penalties. If there were
aggravating circumstances, the fixed penalty thus established may be increased up to a maximum of five (5) years; if
extenuating circumstances are present, it may be reduced to a minimum of two (2) years. In addition to the penalties
provided in this chapter, any person who, as a result of the fraud thus committed is benefited in any way to obtain
insurance, or in the payment of a loss pursuant to an insurance contract, shall be imposed the payment of restitution of
the amount of money resulting from the fraud. Every violation shall have a prescription term of (5) five years.
In Texas: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and
may be subject to fines and confinement in state prison.
In Vermont: Any person who knowingly presents a false statement in an application for insurance may be guilty of a
criminal offense and subject to penalties under state law.
The undersigned, on behalf of all Insureds, acknowledges that discovery of any fraud, intentional concealment, or
misrepresentation of any material fact may render this policy, if issued, voidable at inception or otherwise cancelled.
Applicant
Applicant Name and Title: Natalie Ann Bullard, DVM Date: 01/01/2019
Applicant Signature:
U -GU -1147-A (01/14)
Page 2 of 2
DocuSign Envelope ID: 0803AE69-44B8-46F9-9CAD-57AC9FOFB849
ZURICH
Important Notice to Policyholders
The address for the headquarters of Zurich North America will change after August 1, 2016 due to a relocation of our
office in the same city. The new address is:
Customer Inquiry Center
Zurich North America
1299 Zurich Way
Schaumburg, IL 60196
1-800-382-2150
For specific questions regarding your policy, please contact your agent or broker. For other questions, you may contact
the Customer Inquiry Center of Zurich North America. Any references to post office boxes previously provided remain
unchanged.
U -GU -1194-A CW (08/15)
Page 1 of 1
