No preview available
HomeMy WebLinkAboutC19-047 Roaring Fork School DistrictDocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 AGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY, COLORADO AND THE ROARING FORK SCHOOL DISTRICT THIS AGREEMENT ("Agreement") is effective as of 2/7/2019 , by and between the Roaring Fork School District (hereinafter "District") and Eagle County, Colorado, a body corporate and politic (hereinafter "County"). RECITALS WHEREAS, the County, through its Department of Health and Human Services ("HHS") 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, Eagle County is committed to supporting early childhood care and education to ensure that all children develop a strong foundation for learning and life. The County issued a Request for Proposals ("RFP"), seeking contractors to perform professional services for early childhood programs and/or services that are aligned to the County's Early Childhood Roadmap (http://www.ea leg county.us/earlychildhoodroadMap ). The District, through its Family Resource Center, submitted a proposal in response to such RFP and was chosen by County to perform the proposed services. The project will address the need for high quality parenting and early childhood development instruction available and accessible to families and increase coordination of childhood family services for more efficient expenditure of resources. This work will ultimately help the County reach its strategic goal: Great Place to Live for All; and WHEREAS, the District 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 the District and County in connection with the services. AGREEMENT NOW, THEREFORE, in consideration of the foregoing and the following promises District and County agree as follows: 1. Services or Work. The District, through its Family Resource Center, 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. The District agrees to furnish the Services no later than December 31, 2019, and in accordance with the schedule established in Exhibit A. If no completion date is specified in Exhibit A, then District agrees to furnish the Services in a timely and expeditious manner consistent with the applicable standard of care. By signing below District represents that it has the expertise and personnel necessary to properly and timely perform the Services. DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 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. 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. No additional services or work performed by the District shall be the basis for additional compensation unless and until the District 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, the District'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 the District 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 $40,000. The District 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 the District must submit invoices quarterly. Invoices shall include a description of the Services performed. If County is not satisfied with the completeness of a submitted invoice, County may request the District 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 the District. 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 submitted via email to: dhsacctpayable@eaglecounty.us to ensure proper payment. 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 the District 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, the District 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 the District 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. The District shall provide the County with progress reports upon County's request; or the District shall furnish progress reports as more specifically set forth in the attached Exhibit A. 2 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 d. County will not withhold any taxes from monies paid to the District hereunder and the District 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 the District 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. The District acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of the District. The District 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. The District 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 the District by the terms of this Agreement, and to assume toward the District all the obligations and responsibilities which the District, 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 the District and the District shall cooperate in such process. The District shall be responsible for the acts and omissions of its agents, employees and subcontractors. 7. Insurance. The District agrees to provide and maintain at District'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. b. Other Requirements. i. The automobile and 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. ii. The District's certificates of insurance shall include subcontractors, if any as additional insureds under its policies or the District shall furnish to County separate certificates and endorsements for each subcontractor. hereof. iii. The insurance provisions of this Agreement shall survive expiration or termination 3 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 iv. The parties hereto understand and agree that the parties are relying on, and do 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 the District and the County, and their respective affiliated entities, successors or assigns, its elected officials, employees, agents and volunteers. V. The District is not entitled to workers' compensation benefits except as provided by the District, nor to unemployment insurance benefits unless unemployment compensation coverage is provided by the District or some other entity. The District is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8. Indemnification. To the extent permitted by law, the District 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 the District 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 the District 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 the District 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: Leigh Carlson -Hernandez 500 Broadway Post Office Box 850 Eagle, CO 81631 Telephone: 970-328-2609 E -Mail: leigh.carlson-hemandez@eaglecounty.us With a copy to: Eagle County Attorney 500 Broadway Post Office Box 850 Eagle, Co 81631 Telephone: 970-328-8685 4 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 Facsimile: 970-328-8699 E -Mail: atty@eaglecounty.us DISTRICT: Roaring Fork School District Family Resource Center 1405 Grand Ave. Glenwood Springs, CO 81601 p:970-384-6005 f. 970-384-5795 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 the District. Upon termination of this Agreement, the District 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 the District 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. The District 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. The District 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, the District 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, the District has given County written notice of all conflicts, errors, or discrepancies. The District 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 the District of any of its responsibilities. The District shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of 5 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 care, skill and diligence applicable to contractors performing similar services. The District 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. The District 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 the District, County may terminate this Agreement, in whole or in part, upon seven (7) days' notice to the District. This paragraph shall survive termination of this Agreement. f. The District 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 the District 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 the District except that of independent contractor. The District shall have no authority to bind County. h. The District represents and warrants that at all times in the performance of the Services, the District 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. The District 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. 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 District has no beneficial interest, direct or indirect, that would conflict in any manner or degree with the performance of the Services and the District shall not employ any person having such known interests. o. The District, 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. The District 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. 6 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 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 the District has any employees or subcontractors, the District shall comply with C.R.S. 8-17.5-101, et. seq., and this Agreement. By execution of this Agreement, the District certifies that it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement and that the District 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. The District 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. The District 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. The District 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 the District obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an undocumented individual, the District shall be required to: Notify the subcontractor and County within three (3) days that the District 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 the District 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. The District 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 the District 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, the District shall be liable for actual and consequential damages to County as required by law. 7 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 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. 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 Do[�uSigned by: By: S�ra Je 6IP6"--Manager DISTRICT: By:RDocuSigned by: I sar4' F(JISU�,�, AB765CHBND4A4... Print Name: Sarah Fedishen Title: Family Services Director 8 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 EXHIBIT A SCOPE OF SERVICES INTRODUCTION As part of the 2019 Early Childhood Roadmap Systems Building initiative requests for proposals were solicited to address the four priorities; Early Learning, Family Support & Education, Social Emotional Development & Mental Health and Health. Under the Family Support and Education priority, the following are strategic outcomes addressed through this contract with the Family Resource Center of the Roaring Fork School District: • High quality parenting and early childhood development instruction available and accessible to all parents • Tracking and increased coordination of early childhood family services for more efficient expenditure of resources and fewer families left out of the network CONTRACTOR SHALL PERFORM OR PROVIDE THE FOLLOWING SERVICES The Family Resource Center of the Roaring Fork School District's Early Childhood Liaison will provide the following services in Western Eagle County: • provide oversight of family support services to children identified by preschools or health screenings • work with school district resources to identify younger siblings of enrolled students, determine if they are enrolled in early childhood programming, and outreach to family to encourage early childhood education • connect with vulnerable and isolated families with young children through targeted outreach activities in the community • work with key community stakeholders to identify and build trust with targeted populations • be a link to provide connectivity among stakeholders in the Ready for Kindergarten Network • provide relationship based parent/caregiver education through group and individual interactions focused on increasing social emotional development and early literacy skills in children FEES District shall be compensated for performance of assigned services as follows: 1. County agrees to pay District $10,000 payable upon execution of contract; $10,000 payable upon receipt of April report; $10,000 payable upon receipt of July report; and $10,000 payable upon receipt of December report, for a total not to exceed contract value of $40,000 based on a 11 -month contract period. 2. District shall submit invoices on a quarterly basis with required reporting submitted through google forms THE DISTRICT SHALL BE REQUIRED TO SUBMIT THE FOLLOWING REPORTS TO COUNTY: All reports will be completed using google forms, report links will be sent prior to the report deadline three times a year (April, July, December). The Early Childhood Liaison program reporting will include and is not limited to: • number of outreach events/opportunities to families • number of families and children reached through outreach and programs • basic demographics of those served 9 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 EXHIBIT B INSURANCE CERTIFICATE 10 Eagle County HHS General Services Final 5/14 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 PINN/ICOL ASSURANCE Roaring Fork School Dist Rel Attn Nikki Jost 1405 Grand Ave Glenwood Springs, CO 81601 ENDORSEMENT: Include/Exclude Rate And Class 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com NCCI #: WC890415 Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970) 945-9161 Item 4 of this policy, classification of operations is amended as follows: Exclude Classification: 886805 College -Professional Employees & Clerical Minimum Premium: $217 Rate: 0.6144 Estimated Annual Payroll: $0 For Location: Roaring Fork School Dist Rel (Business 1, Location 1) 1405 Grand Ave. Glenwood Springs, CO 81601 Effective Date: July 1, 2018 Pinnacol Assurance has issued this endorsement May 8, 2018, Sabrina Willis Underwriter 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P WILLISS - Underwriter 05/08/2018 18:14:13 4021076 51548265 422 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 Coverage Information for 4021076 ESTIMATED PREMIUM Location: Roaring Pork School Dist Rel 1405 Grand Ave. Glenwood Springs, CO 81601 Period: 07/01/2018 - 07/01/2019 Class RT Description Emp Payroll Rate Prem Charge 738005 EM Drivers, chauff 43.00 $951,305 5.504000 $52,360 881105 BD Municipal, town 5.00 $78,000 .051200 $40 886805 EM College -profess 698.00 $36,344,391 .614400 $223,300 886805 ST College -profess 3.00 $15,600 .614400 $96 910105 EM College -all emp 59.00 $3,000,189 4.492800 $134,792 Total for Roaring Fork School Dist Rel $40,389,485 $410,588 Description Period Adjustment Amount Ratable Manual Premium 07/01/2018 - 07/01/2019 $410,588 Deductible Discount ($2500 Ded) 07/01/2018 - 07/01/2019 ,905 $39,006 - Experience Modification 07/01/2018 - 07/01/2019 .910 $33,442 - Schedule Rating & Designated Provider 07/01/2018 - 07/01/2019 1.055 $18,598 Cost Containment Credit 07/01/2018 - 07/01/2019 .950 $17,837 - Premium Discount 07/01/2018 - 07/01/2019 .903 $32,873 - Annual Policy Fee 07/01/2018 - 07/01/2019 $195 Terrorism Insurance Coverage 07/01/2018 - 07/01/2019 $2,019 Catastrophe Insurance Coverage 07/01/2018 - 07/01/2019 $4,039 Net Estimated Annual Premium 07/01/2018 - 07/01/2019 $312,281 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 3 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 P1NN/ICOL ASSURANCE Roaring Fork School Dist Rel Attn Nikki ,lost 1405 Grand Ave Glenwood Springs, CO 81601 ENDORSEMENT: Premium Credit Addendum 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacoi.com NCCI #: WC050403 Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970) 945-9161 Current Schedule of Credits for Policy Period 07/0112018 - 07/01/2019 2.5% The premium differential for a designated provider has been applied to the policy premium from 07/01/2018 thru 07/0112019. 5.0% The premium differential for cost containment has been applied to the policy premium from 07/01/2018 thru 07101/2019. Premium Credits for Qualifying Risk Management Programs that have received Cost Containment Certification from the State of Colorado. Implementation of a certified cost containment program potentially qualifies your business for a 5% premium dividend as filed with the Division of Insurance. For new and renewal business, the underwriting review of a policyholder includes determining if the entity has a certified workers' compensation risk management program. If certified, a premium dividend of 5% will be applied. If during the course of the policy period, the certification is eliminated, the cost containment premium dividend will be removed at renewal. Pinnacol Assurance can assist you in setting up a program to potentially reduce losses and protect your employees as well as reducing premium costs. Pursuant to Colorado Insurance Regulation 5-1-11 (lll)(F) all workers' compensation insurers must allow a credit of 2.5% on all policies when you have selected a designated medical provider. If you have selected a designated medical provider, we must allow a credit of 2.5%. If you are eligible for schedule rating, the 2.5% credit must be included in the total schedule credit or debit, subject to the 25% maximum limitation. If you are not eligible for experience or schedule rating, the 2.5% credit will be applied, in addition to the premium credit applicable. The combined premium credit and the 2.5% credit for selection of a designated medical provider shall not exceed 12.5%. Right to Appeal Classifications 1 Experience Modification: If Pinnacol Assurance determines that the employees at your business are misclassified, Pinnacol Assurance can correct the classification and charge and collect additional premium not included in the initial premium. If you have any questions regarding the employee classification 1 experience modification assigned to calculate your workers' compensation insurance premium, you must direct your questions to Pinnacol Assurance or to your authorized Pinnacol Assurance agent within thirty (30) days after the anniversary date of the policy, or thirty (30) days after the date of receipt by you of notice of a change in a classification. Pinnacol Assurance or the authorized Pinnacol Assurance agent must explain to you why a particular employee classification 1 experience modification was used, and must explain sufficiently to eliminate any possible confusions within thirty (30) days after receipt of your request for information. If you continue to disagree with a classification applied to your policy, Section 8-55-102, C.R.S. gives you the right to appeal Pinnacol Assurance's final decision by filing written notice with the Worker's Compensation Classification Appeals Board within 30 days after you have exhausted all appeal review procedures provided by Pinnacol Assurance. Your written request for appeal should be sent to the Worker's Compensation Appeals Board, c/o NCCI - Attn: Tim Hughes, 10920 W. Glennon Dr., Lakewood, CO, 80226. Written instructions for your appearance before the Colorado Workers' Compensation Appeals Board will be furnished by the Secretary of the Board. The Board will render a decision as to whether a misclassification has occurred. 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 5 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 PINMA COL ASSURANCE Roaring Fork School Dist Rel Attn Nikki Jost 1405 Grand Ave Glenwood Springs, CO 81601 NOTICE TO POLICYHOLDERS Dear Policyholder, 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com May 25, 2018 Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970) 945-9161 The cost containment discount applied to your policy is subject to recertification, as well as the improved loss experience requirement of the State of Colorado insurance regulations. If you fail to maintain your certification, this cost containment discount may be withdrawn. If you have any questions about the cost containment certification, please call Sabrina Willis at (303) 361-45711(888) 852-2263. 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 7 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 PINNncoL ASSURANCE Roaring Fork School Dist Rel Attn Nikki Jost 1405 Grand Ave Glenwood Springs, CO 81601 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 1800.873.7242 Pinnacol.com NCCI #: WC000422B Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970)945-9161 ENDORSEMENT: Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers' compensation losses caused by Acts of Terrorism, including workers' compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state law, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers' compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 9 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 PINNAcot ASSURANCE Roaring Fork School Dist Rel Attn Nikki Jost 1405 Grand Ave Glenwood Springs, CO 81601 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 1800.873.7242 Pinnacol.com NCCI #: WC000421 D Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970) 945-9161 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) attached to this policy. For purposes of this endorsement, the following definitions apply Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers' compensation losses in excess of $50 million. Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure. b. The acts results in damage within the United States, or outside of the United States in the case of the premises of the United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers' compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Thank you for your business. Pinnacol Assurance SCHEDULE State Rate Premium CO 0.01 $4,039 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 11 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 GLOSSARY OF TERMS Annual Policy Fee: This dollar amount is charged annually on every Pinnacol Assurance policy for fixed administrative costs for writing and renewing a policy. Class: These are class codes which apply to your policy. The object of the classification procedure is to assign one basic classification which best describes the business of the employer within a state. It is the business which is classified, not the individual employments, occupations or operations within a business. Under special circumstances separate classifications may apply. Cost Containment Discount: Employers that are experience rated may be eligible for a 5% Cost Containment Discount and non -experience rated employers may be eligible for a discount of 2-10% if they implement the six -step safety plan and become certified by the State Cost Containment Certification Board. Deductible Adjustment: This applies to adjustments to the optional deductible plan when selected by the employer. A deductible is the dollar amount you agree to reimburse Pinnacoi Assurance for each claim that occurs during the policy period. Designated Provider Discount: A 2.5% premium discount will be awarded to employers who have implemented a designated medical provider program as outlined in Colorado Insurance Commissioner's Regulation 5-1-11. This discount applies to all policies, except for those who pay the minimum premium amount only. Experience Modification Adjustments: If you qualify for experience modification, your past loss experience is compared to the average or "expected" experience for businesses in your class. This comparison is converted to a loss of experience factor, which we apply to your premium. If your losses are less than average, your premium will be reduced. If your losses are more than average, your premium will be increased. Increased Limits: This is the additional premium we charge to increase the limit for Employer's Liability above the standard coverage provided: Bodily Injury by Accident: $100,000 --each employee; Bodily Injury by Disease: $500,000 --policy limit. Manual Premium: Payroll/100 times the rate for the business classification. Minimum Premium: Annual premium will never be less than minimum premium, regardless of your payroll, even if you terminate your policy before the expiration date. Modified Premium: This is the premium after the experience modification is applied. Posting: A check is posted to your account after it is deposited by our bank. Premium Adjustment: Pinnacol Assurance offers this discount based on the amount of premium developed by your policy. Rate: The premium charge developed for your business classification. Rates are based on loss statistics for each class. Most rates are applied per $100 of payroll. For example, if you have $100,000 of payroll under a classification with a $5.00 rate, the manual premium is $5,000 ($100,0001100 = 1,400 x $5.00 = $5,000). Others are per capita. Rating Type: The most common rating type codes and descriptions are listed below. Please contact your underwriter if a more comprehensive list is needed. CODE DESCRIPTION CODE DESCRIPTION AC Agricultural Corporate Officer IN Individual Owner CL Contract Labor MB Member CO Corporate Officer SE Subcontractor Employee EM Employee WP Working Partner IC Independent Contractor Retention Adjustment: Pinnacol Assurance offers this discount based on continuous long-term coverage. Right to Appeal Classification and Experience Modification: Pin nacol Assurance can charge and collect any additional amount of money not included in the initial premium charged as a result of a job misclassification or experience modification. If you have any questions regarding the employee classification/modification used to calculate your premium, contact your underwriter or your insurance agent, Pinnacol Assurance or its representative must explain why a particular employee classification/modification was used, to eliminate any possible confusion. - If you still disagree, you may further appeal to have your classification reviewed. Send your request, in writing, to Pinnacol Assurance's Ciassification and Rating Committee at the above address. The Committee will review your file and will issue a final decision. - If you still disagree with the Pinnacol Assurance review, Section 8-55-102, C.R.S. gives you the right to appeal Pinnacol Assurance's final decision by filing written notice with the Workers' Compensation Classification Appeals Board within 30 days of the final decision. The address of the Workers' Compensation Appeals Board is: Workers' Compensation Appeals Board, c/o NCCI - Attn: Tim Hughes, 10920 W. Glennon Dr., Lakewood, CO 80226. Please send Pinnacoi Assurance a copy of your appeal. Scheduled Rating: Pinnacol Assurance offers a premium discount based on risk characteristics for your business. Seat Surcharge: This represents the seat surcharge for the operation of private airplanes to transport employees and is not subject to discount or deviations on your bill. Subject Premium: Manual premium + increased limits premium - deductible adjustment. 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 13 of 13 P - 4021076 51660576 UB202 DocuSign Envelope ID: 7BCA5AFD-7A36-43EF-B8B4-EB9F325B5BC9 PINNAA COL ASSURANCE Roaring Fork School Dist Rel Attn Nikki Jost 1405 Grand Ave Glenwood Springs, CO 81601 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 1800.873.7242 Pinnacol.com NCCI #: WC890406 Policy #: 4021076 Glenwood Insurance PO Box 1270 Glenwood Springs, CO 81602 (970) 945-9161 ENDORSEMENT: Debit/Credit Contingent/ Exp. Mod. Factor Risk Id: 050162168 In accordance with the provisions of the policy to which this endorsement is attached, and as a result of the application of the experience rating plan approved by Colorado's Commissioner of Insurance, the premium, as mentioned in Item 4 of the Declarations (classifications of operations), or in any audit statement or quarterly adjustment statement forming a part of said policy, shall be adjusted by the experience modification set forth, and paid in accordance with the provisions of the said policy. Roaring Fork School Dist Rel EXPERIENCE PREMIUM MODIFICATION Experience Modification Factor of 0.91 or 9 Percent CREDIT Nothing herein contained shall be held to vary, waive, alter or extend any of the provisions or conditions of said policy except as above stated. Effective Date: July 1, 2018 TO July 1, 2019 Pinnacol Assurance has issued this endorsement April 3, 2018. Sabrina Willis Underwriter 7501 E. Lowry Blvd Denver, CO 80234-7006 Page 1 of 1 P ISA - 04/03/2018 18:15:12 4021076 51300300 412