HomeMy WebLinkAboutECHDA19-017 ALM AbatementsAGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY HOUSING AND DEVELOPMENT AUTHORITY AND A.L.M. ABATEMENTS, INC. THIS AGREEMENT (“Agreement”) is effective as of the _______________________ by and between A.L.M. Abatements, Inc., a Colorado Corporation (hereinafter “Contractor”) and Eagle County Housing and Development Authority, a body corporate and politic (hereinafter “ECHDA”). RECITALS WHEREAS, ECHDA desires a contractor to perform Asbestos Abatement after testing returned positive results in specific areas (the “Project”) at the former CenturyTel site located at 766 Castel Drive, Eagle, CO, 81631 (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 ECHDA in connection with the services. AGREEMENT NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and ECHDA agree as follows: 1. Services or Work. Contractor agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the services or work described in Exhibit A (“Services” or “Work”) which is attached hereto and incorporated herein by reference. The Services shall be performed in accordance with the provisions and conditions of this Agreement. a. Contractor agrees to furnish the Services no later than October 31, 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. ECHDA’s Representative. The Maintenance Supervisor, William Wright, the Housing Department’s designee shall be Contractor’s contact with respect to this Agreement and performance of the Services. 3. Term of the Agreement. This Agreement shall commence upon the date first written above, and subject to the provisions of paragraph 11 hereof, shall continue in full force and effect through the 31st day of October, 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: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 9/12/2019 2 ECHDA General Services Final 5/14 No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by ECHDA for such additional services in accordance with ECHDA’s internal policies. Accordingly, no course of conduct or dealings between the parties, nor verbal change orders, express or implied acceptance of alterations or additions to the Services, and no claim that ECHDA has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by ECHDA for such additional services is not timely executed and issued in strict accordance with this Agreement, Contractor’s rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. 5. Compensation. ECHDA shall compensate Contractor for the performance of the Services in a sum computed and payable as set forth in Exhibit A. The performance of the Services under this Agreement shall not exceed $4,708.06. Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business hours unless specifically authorized in writing by ECHDA. a. Payment will be made for Services satisfactorily performed within thirty (30) days of receipt of a proper and accurate invoice from Contractor. All invoices shall include detail regarding the hours spent, tasks performed, who performed each task and such other detail as ECHDA may request. b. If, at any time during the term or after termination or expiration of this Agreement, ECHDA reasonably determines that any payment made by ECHDA to Contractor was improper because the Services for which payment was made were not performed as set forth in this Agreement, then upon written notice of such determination and request for reimbursement from ECHDA, Contractor shall forthwith return such payment(s) to ECHDA. Upon termination or expiration of this Agreement, unexpended funds advanced by ECHDA, if any, shall forthwith be returned to ECHDA. c. ECHDA will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. d. Notwithstanding anything to the contrary contained in this Agreement, ECHDA shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after December 31 of any year, without an appropriation therefor by ECHDA in accordance with a budget adopted by the Board of ECHDA in compliance with the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). 6. Subcontractors. Contractor acknowledges that ECHDA has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the performance of any of the Services or additional services without ECHDA’s prior written consent, which may be withheld in ECHDA’s sole discretion. ECHDA shall have the right in its reasonable discretion to approve all personnel assigned to the subject Project during the performance of this Agreement and no personnel to whom ECHDA has an objection, in its reasonable discretion, shall be assigned to the Project. Contractor shall require each subcontractor, as approved by ECHDA and to the extent of the Services to be performed by the subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes toward ECHDA. ECHDA shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and subcontractors. DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 3 ECHDA General Services Final 5/14 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. 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 ECHDA, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers as additional insureds. A certificate of insurance consistent with the foregoing requirements is attached hereto as Exhibit B. ii. Contractor’s certificates of insurance shall include subcontractors, if any as additional insureds under its policies or Contractor shall furnish to ECHDA separate certificates and endorsements for each subcontractor. iii. The insurance provisions of this Agreement shall survive expiration or termination hereof. iv. The parties hereto understand and agree that the ECHDA is relying on, and does not waive or intend to waive by any provision of this Agreement, the monetary limitations or rights, immunities and protections provided by the Colorado Governmental Immunity Act, as from time to time amended, or otherwise available to ECHDA, its affiliated entities, successors or assigns, its elected officials, employees, agents and volunteers. 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 ECHDA, and any of its officers, agents and employees against any losses, claims, damages or liabilities for which ECHDA may become subject to insofar as any such losses, claims, damages or liabilities arise out of, directly or indirectly, this Agreement, or are based upon any performance or nonperformance by Contractor or any of its subcontractors hereunder; and Contractor shall reimburse ECHDA for reasonable attorney fees and costs, legal and other expenses incurred by ECHDA in connection with investigating or defending any such loss, claim, damage, liability or action. This indemnification shall not apply to claims by third parties against ECHDA to the extent that ECHDA is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 4 ECHDA General Services Final 5/14 9. Ownership of Documents. All documents (including electronic files) and materials obtained during, purchased or prepared in the performance of the Services shall remain the property of the ECHDA and are to be delivered to ECHDA before final payment is made to Contractor or upon earlier termination of this Agreement. 10. Notice. Any notice required by this Agreement shall be deemed properly delivered when (i) personally delivered, or (ii) when mailed in the United States mail, first class postage prepaid, or (iii) when delivered by FedEx or other comparable courier service, charges prepaid, to the parties at their respective addresses listed below, or (iv) when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date, time and receiving facsimile number for the transmission, or (v) when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this paragraph by giving five (5) days prior written notice of such change to the other party. ECHDA: Attention: Kim Williams 500 Broadway Post Office Box 850 Eagle, CO 81631 Telephone: 970-328-8773 Facsimile: 970-328-8787 E-mail: kim.williams@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: A.L.M. Asbestos Abatements, LLC Attn: Scott Tash 3407 S. Umatilla Street Englewood, CO 80110 Telephone: 720-242-9043 Facsimile: 720-242-9137 E-mail: info@almabatements.com 11. Termination. ECHDA may terminate this Agreement, in whole or in part, at any time and for any reason, with or without cause, and without penalty therefor with seven (7) calendar days’ prior written notice to the Contractor. Upon termination of this Agreement, Contractor shall immediately provide ECHDA with all documents as defined in paragraph 9 hereof, in such format as ECHDA shall direct and shall return all ECHDA owned materials and documents. ECHDA shall pay Contractor for Services satisfactorily performed to the date of termination. DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 5 ECHDA General Services Final 5/14 12. Venue, Jurisdiction and Applicable Law. Any and all claims, disputes or controversies related to this Agreement, or breach thereof, shall be litigated in the District Court for Eagle County, Colorado, which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 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 ECHDA 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 ECHDA has accepted or approved the Services shall not relieve Contractor of any of its responsibilities. Contractor shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to contractors performing similar services. Contractor represents and warrants that it has the expertise and personnel necessary to properly perform the Services and shall comply with the highest standards of customer service to the public. Contractor shall provide appropriate supervision to its employees to ensure the Services are performed in accordance with this Agreement. This paragraph shall survive termination of this Agreement. f. Contractor agrees to work in an expeditious manner, within the sound exercise of its judgment and professional standards, in the performance of this Agreement. Time is of the essence with respect to this Agreement. g. This Agreement constitutes an agreement for performance of the Services by Contractor as an independent contractor and not as an employee of ECHDA. Nothing contained in this Agreement shall be deemed to create a relationship of employer-employee, master-servant, partnership, joint venture or any other relationship between ECHDA and Contractor except that of independent contractor. Contractor shall have no authority to bind ECHDA. DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 6 ECHDA General Services Final 5/14 h. Contractor represents and warrants that at all times in the performance of the Services, Contractor shall comply with any and all applicable laws, codes, rules and regulations. i. This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding between the parties with respect thereto. j. Contractor shall not assign any portion of this Agreement without the prior written consent of the ECHDA. 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 ECHDA has any personal or beneficial interest whatsoever in the Services or Property described in this Agreement. The Contractor has no beneficial interest, direct or indirect, that would conflict in any manner or degree with the performance of the Services and Contractor shall not employ any person having such known interests. o. The Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (i) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (ii) to the extent applicable shall comply with C.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: 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. DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 7 ECHDA General Services Final 5/14 b. Contractor has confirmed the employment eligibility of all employees who are newly hired for employment to perform Services under this Agreement through participation in the E-Verify Program or Department Program, as administered by the United States Department of Homeland Security. Information on applying for the E-verify program can be found at: 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 ECHDA within three (3) days that Contractor has actual knowledge that the subcontractor is employing or contracting with an undocumented individual; and ii. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subcontractor does not stop employing or contracting with the undocumented individual; except that Contractor shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an undocumented individual. 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, ECHDA may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Contractor shall be liable for actual and consequential damages to ECHDA as required by law. g. ECHDA will notify the Colorado Secretary of State if Contractor violates this provision of this Agreement and ECHDA terminates the Agreement for such breach. [Rest of page intentionally left blank] DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 8 ECHDA General Services Final 5/14 IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first set forth above. EAGLE COUNTY HOUSING AND DEVELOPMENT AUTHORITY By: _____________________________ Kimberly Bell Williams, Executive Director CONTRACTOR: By:________________________________ Print Name:__________________________ Title: ______________________________ DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 President Scott Tash 9 ECHDA General Services Final 5/14 EXHIBIT A SCOPE OF SERVICES, SCHEDULE, FEES DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 1 A.L.M. Abatements, LLC. 3407 S. Umatilla Street Tax ID# 36-4742444 Englewood CO 80110 Office# (720) 242-9043 Fax# (720) 242-9137 info@almabatements.com Client:Eagle County Housing- Bill Wright Cellular:(970) 328-3783 Property:766 Castel Drive Eagle, CO Operator Info: Operator:SCOTT Estimator:Scott Tash Cellular:(303) 565-0465 Business:3407 S. Umatilla Street Englewood, CO 80110 Type of Estimate:Asbestos Abatement Date Entered:8/14/2019 Date Assigned:8/13/2019 Date Est. Completed:8/15/2019 Date Job Completed: Price List:CORE7X_NOV18 Labor Efficiency:Restoration/Service/Remodel Estimate:2019-08-15-0758 All abatement projects performed by ALM Abatements, will be conducted following The Colorado Department of Public Health and Environments Regulation 8 & OSHA Guidelines. All Environmental bulk sampling, air monitoring and final air clearances will be performed by a third party certified consulting firm chosen by the client and or insurance company. This is a separate charge from this estimate. All costs for the above services will be billed directly to the client and or insurance company. It is the clients responsibility to provide water and power for the duration of the project. These can be terminated at the completion of the project by the client. NOTE: Secondary damage to walls, paint and texture is probable from the staples, tapes and adhesives used to create the air tight containment requirements for proper abatement procedures. ALM Abatements cannot be held liable for these minor damages occurring during abatement. We will not use staples, tapes and/or adhesives on finished surfaces. We will use every precaution to minimize any minor damage to any surface. By signing below property owner/representative acknowledges they have read and fully understand above statements. _______________________________________________________________________ (signature of property owner or property owner representative) DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 2 A.L.M. Abatements, LLC. 3407 S. Umatilla Street Tax ID# 36-4742444 Englewood CO 80110 Office# (720) 242-9043 Fax# (720) 242-9137 info@almabatements.com 2019-08-15-0758 8/15/2019 Page: 2 2019-08-15-0758 Asbestos General Cost DESCRIPTION QNTY REMOVE REPLACE TOTAL 1. Asbestos Permit Fee- CDPHE 1.00 EA 0.00 400.00 400.00 2. Asbestos Containment 850.00 SF 0.00 1.75 1,487.50 Barrier/Airlock/Decon. Chamber This line item is for the required asbestos containment, sealing off the Back Entry and Bathroom together as one regulated asbestos work area. This includes decontamination units, waste load, portable shower unit and the proper negative air pressure system for the duration of the project. 3. Add for personal protective equipment 6.00 EA 0.00 10.94 65.64 (hazardous cleanup) 4. Respirator cartridge - HEPA only (per 6.00 EA 0.00 11.82 70.92 pair) Totals: Asbestos General Cost 2,024.06 Back Entry DESCRIPTION QNTY REMOVE REPLACE TOTAL 5. Tear off asbestos"ceiling" drywall 72.00 SF 7.00 0.00 504.00 (double bag for disposal) Totals: Back Entry 504.00 Bathroom DESCRIPTION QNTY REMOVE REPLACE TOTAL 6. Tear out asbestos vinyl SHOWER 60.00 SF 7.00 0.00 420.00 covering (double bag for disposal) Totals: Bathroom 420.00 Asbestos Cleaning Technician DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 3 A.L.M. Abatements, LLC. 3407 S. Umatilla Street Tax ID# 36-4742444 Englewood CO 80110 Office# (720) 242-9043 Fax# (720) 242-9137 info@almabatements.com 2019-08-15-0758 8/15/2019 Page: 3 CONTINUED - Asbestos Cleaning Technician DESCRIPTION QNTY REMOVE REPLACE TOTAL 7. Asbestos Cleaning Technician - per hour 16.00 HR 0.00 60.00 960.00 2 men 8 hours each to do a detailed asbestos clean, hepa vacuum, asbestos wash down and rywipe of the entire contained area, AFTER all demo and removal is complete. This also includes the additional time needed to prep for asbestos final clearance testing. Totals: Asbestos Cleaning Technician 960.00 Asbestos Hazardous Disposal Fee DESCRIPTION QNTY REMOVE REPLACE TOTAL 8. Asbestos Hazardous Disposal Fee 1.00 EA 300.00 0.00 300.00 Totals: Asbestos Hazardous Disposal Fee 300.00 Travel Expenses DESCRIPTION QNTY REMOVE REPLACE TOTAL 9. Travel Expenses Hotel & Perdium - 2 1.00 EA 0.00 500.00 500.00 nights 3 days Totals: Travel Expenses 500.00 Line Item Totals: 2019-08-15-0758 4,708.06 DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 4 A.L.M. Abatements, LLC. 3407 S. Umatilla Street Tax ID# 36-4742444 Englewood CO 80110 Office# (720) 242-9043 Fax# (720) 242-9137 info@almabatements.com 2019-08-15-0758 8/15/2019 Page: 4 Summary Line Item Total 4,708.06 Replacement Cost Value $4,708.06 Net Claim $4,708.06 Scott Tash DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 10 ECHDA General Services Final 5/14 EXHIBIT B INSURANCE CERTIFICATE DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5 08/26/2019 Blue Sky Ins 88 Inverness Circle East Suite A-103 Englewood CO 80112 Bill Vaughan (303) 647-5477 billv@bskyins.com ALM Abatements, LLC 3407 S. Umatilla St Englewood CO 80110 Colony Insurance Co. SECURA 22543 Pinnacol Assurance 41190 CL18101012051 A Professional Y PACEP4223253 10/09/2018 10/09/2019 1,000,000 50,000 10,000 1,000,000 2,000,000 2,000,000 Employee Benefits B Y A3244337 10/09/2018 10/09/2019 1,000,000 C 4191195 10/01/2018 10/01/2019 1,000,000 1,000,000 1,000,000 A Contractors Pollution Liability PACEP4223253 10/09/2018 10/09/2019 Each Occurence 1,000,000 General Aggregate 2,000,000 Lake Creek Village, LLC its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers are Additional Insureds under the commercial general liability and automobile liability policies of insurance. Lake Creek Village, LLC 4923 Lake Creek Village Dr. 10-101 Edwards CO 81632 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 have ADDITIONAL INSURED provisions or 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 ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: D0E7C388-57E3-4C9A-9926-C7E739A41DB5