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HomeMy WebLinkAboutECHDA20-06 SRD PlumbingAGREEMENT FOR SERVICES
BETWEEN EAGLE COUNTY HOUSING AND DEVELOPMENT AUTHORITY
AND
SRD PLUMBING INC.
THIS AGREEMENT (“Agreement”) is effective as of ______________________, by and between SRD Plumbing
Inc., a Colorado Corporation (hereinafter “Contractor”) and Eagle County Housing and Development Authority, a
body corporate and politic (hereinafter “ECHDA”).
RECITALS
WHEREAS, the ECHDA desires to install a laundry sink, faucet and 4-gallon electric water heater in the basement
of the Two10 Apartments located at 210 Freestone Road, Eagle, Colorado (the “Project”); and
WHEREAS, Eagle County is the owner of the Two10 Apartments (the “Property”) and has contracted with ECHDA
to serve as the property manager of the Property; and
WHEREAS, Eagle County has authorized ECHDA to contract on its behalf for maintaining, repairing or servicing
the Property and any of the constituent parts of the Property subject to the approved operating budget for 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 November 30, 2020, 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 Property Manager, Matt Andrews, the Housing Department’s designee
shall be Contractor’s contact with respect to this Agreement and performance of the Services.
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
11/4/2020
ECHDA20-06
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ECHDA General Services Final 5/14
3. Term of the Agreement. This Agreement shall commence upon the date first written above, and subject to
the provisions of paragraph 11 hereof, shall continue in full force and effect through the 31st day of December,
2020.
4. Extension or Modification. This Agreement may be extended for up to three additional one year terms
upon written agreement of the parties. Any amendments or modifications shall be in writing signed by both parties.
No additional services or work performed by Contractor shall be the basis for additional compensation unless and
until Contractor has obtained written authorization and acknowledgement by 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 $2,050.00. 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
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
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ECHDA General Services Final 5/14
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.
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/or Eagle County and any
of their respective officers, agents and employees against any losses, claims, damages or liabilities for which
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ECHDA and/or Eagle 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 ECHDA and/or Eagle County for reasonable
attorney fees and costs, legal and other expenses incurred by ECHDA and/or Eagle 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 ECHDA and/or Eagle County to the extent that ECHDA and/or Eagle 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 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:
SRD Plumbing Inc.
PO Box 371
Hugo, CO 80821
Telephone: 970-524-0898
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
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ECHDA General Services Final 5/14
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.
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
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ECHDA General Services Final 5/14
between ECHDA and Contractor except that of independent contractor. Contractor shall have no authority to bind
ECHDA.
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
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ECHDA General Services Final 5/14
ii. Enter into a subcontract that fails to certify to Contractor that the subcontractor shall not
knowingly employ or contract with an undocumented individual to perform work under the public contract for
services.
b. Contractor has confirmed the employment eligibility of all employees who are newly hired for
employment to perform Services under this Agreement through participation in the E-Verify Program or Department
Program, as administered by the United States Department of Homeland Security. Information on applying for the
E-verify program can be found at:
https://www.uscis.gov/e-verify
c. Contractor shall not use either the E-verify program or other Department Program procedures to
undertake pre-employment screening of job applicants while the public contract for services is being performed.
d. If Contractor obtains actual knowledge that a subcontractor performing work under the public
contract for services knowingly employs or contracts with an undocumented individual, Contractor shall be required
to:
i. Notify the subcontractor and 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: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
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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:
Its: ______________________________________
CONTRACTOR:
By:________________________________
Print Name:__________________________
Title: ______________________________
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
VP
Michelle Nestor
Kimberly Bell Williams
Housing Director
9
ECHDA General Services Final 5/14
EXHIBIT A
SCOPE OF SERVICES, SCHEDULE, FEES
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
PROPOSAL
Date
10/2/2020
Estimate #
2025
Name / Address
Eagle County
Two10 Apartments
William.wright@eaglecounty.us
SRD Plumbing Inc.
P.O. Box 371
Hugo, CO 80821
(970) 524-0898
Total
Description Qty Rate Total
We hereby submit specifications and estimates for:
Installation of complete plumbing system in accordance with state and local codes
WASTE ABS WATER LINES AQUAPEX GASLINE GASTITE
Labor and Materials to add waste and water for laundry sink in mechanical room, install sink
Laundry sink with faucet
4 gallon electric water heater
2,050.00 2,050.00
Any extras must be approved
The above prices, specifications and conditions are satisfactory and are hereby accepted. SRD
Plumbing Inc. is authorized to do the work as specified.
Acceptance of Proposal
Signature________________________
Date of Acceptance: _______________
All material is guaranteed to be specified. All work to be completed in a workmanlike
manner according it standard practices. Any alteration or deviation from above
specifications involving extra costs will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements are contingent upon
strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other
necessary insurance.
NOTE: This proposal may be withdrawn if not
accepted within ____30____ days
$2,050.00
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
Distributed Exclusively by Ferguson and Wolseley Canada
© 2016 Ferguson Enterprises, Inc. 0216 24947
Two Handle
Laundry Faucet
PFWSC1120 Series
Product Features
• Ceramic Cartridges
• Metal Lever Handles
• Flow Rate (with hose thread adapter): Min. 4.0 GPM
• Flow Rate (with optional aerator): Max. 1.2 GPM
• Meets ANSI: A112.18.1M
• ADA Compliant
PFWSC1120CP
Warranty and Codes
This product comes complete with installation, operating, care and maintenance instructions. This PROFLO faucet carries a limited lifetime
warranty when installed in residential applications.
The warranty is five years in commercial applications.
This product meets ANSI: A112.18.1M.
Compliant with lead content requirements of California AB 1953.
Model Numbers
PFWSC1120CP Polished chrome
* All measurements are nominal. Please verify before actual installation.
Product Specifications
7 1/2"
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COMPLIANT
NSF / ANSI 372
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
®
Distributed Exclusively by Ferguson and Wolseley Canada
© 2013 Ferguson Enterprises, Inc. All Rights Reserved 17474 09/13
Single Basin Laundry Sink
PFLT2024
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Warranty and Codes
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Available Parts
Product FeaturesOptional Accessories
PF83BRSS Chrome plated stainless steel
sink strainer
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DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
10
ECHDA General Services Final 5/14
EXHIBIT B
INSURANCE CERTIFICATE
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
ACORD 25 (2001/08) The registration notices indicate ownership of the marks by their respective owners ©ACORD CORPORATION 1988, 2007 132849 03-13-2007 All rights reserved
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
11/04/2020
PRODUCER
COMERFORD INSURANCE AGENCY INC
P O BOX 4079
EAGLE, CO 81631
(970) 328-4000
THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW .
INSURERS AFFORDING COVERAGE NAIC #
INSURED
SRD PLUMBING INC
P O BOX 814
GYPSUM, CO 81637
INSURER A: State Farm Fire and Casualty Company 25143
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD’L
INSRD TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY) LIMITS
A GENERAL LIABILITY 96-C7-X598-2 11/03/2020 11/03/2021 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 100,000
CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
(Per accident) $ NON-OWNED AUTOS
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $
ANY AUTO OTHER THAN
AUTO ONLY:
EA ACC $
AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
a WORKERS COMPENSATION AND
EMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
96-C3-N353-1 11/03/2020 11/03/2021 X WC STATU-
TORY LIMITS OTH-
ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
BLANKET ADDITIONAL INSURED Two10 at Castle Peak its associated or affiliated entities, its successors and
assigns, elected officials, employees, agents and volunteers are Additional Insureds under the commercial
general liability policies of insurance.
CERTIFICATE HOLDER CANCELLATION
Two10 at Castle Peak
210 Freestone P.O. Box 850
Eagle, CO 81631
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
ACORD 25 (2001/08)
AUTHORIZED REPRESENTATIVE
WILL COMERFORD
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8
ACORD 25 (2001/08)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
DocuSign Envelope ID: 77BE23B9-93F6-4007-8EAC-C4D5BD2362F8