HomeMy WebLinkAboutC21-028 Hays CompaniesAGREEMENT FOR SERVICES BETWEEN EAGLE COUNTY, COLORADO AND HAYS COMPANIES, INC. THIS AGREEMENT (“Agreement”) is effective as of the January 1, 2021 by and between Hays Companies, Inc. a Florida Corporation (hereinafter “Contractor”) and Eagle County, Colorado, a body corporate and politic (hereinafter “County”). RECITALS WHEREAS, Eagle County requires assistance with certain insurance related services as set forth in this agreement (the “Project”); and WHEREAS, Contractor is authorized to do business in the State of Colorado and has the time, skill, expertise, and experience necessary to provide the Services as defined below in paragraph 1 hereof; and WHEREAS, this Agreement shall govern the relationship between Contractor and County in connection with the Services. AGREEMENT NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and County agree as follows: 1.Services or Work. Contractor agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the services or work described in Exhibit A (“Services”) 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 in accordance with the schedule established in Exhibit A. If no completion date is specified in Exhibit A, then Contractor agrees to furnish the Services in a timely and expeditious manner consistent with the applicable standard of care. By signing below Contractor represents that it has the expertise and personnel necessary to properly and timely perform the Services. b.In the event of any conflict or inconsistency between the terms and conditions set forth in Exhibit A and the terms and conditions set forth in this Agreement, the terms and conditions set forth in this Agreement shall prevail. 2.County’s Representative. The Human Resources Department’s designee shall be Contractor’s contact with respect to this Agreement and performance of the Services. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC C21-028 2 Eagle County 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 12 months from the Effective Date of this Agreement. 4. Extension or Modification. This Agreement shall be automatically renewed for successive periods of 12 months (each a “Renewal Term”) for two Renewal Terms, unless either party notifies the other party that it does not desire to renew this Agreement in writing, at least sixty (60) days before the end of the initial term or any Renewal Term (a total of three terms). The second Renewal Term expires December 31, 2023, unless terminated earlier pursuant to the terms of this Agreement. This Agreement may be extended for up to three additional one-year terms upon written agreement of the parties. Any amendments or modifications shall be in writing signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services in accordance with County’s internal policies. Accordingly, no course of conduct or dealings between the parties, nor verbal change orders, express or implied acceptance of alterations or additions to the Services, and no claim that County has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by County for such additional services is not timely executed and issued in strict accordance with this Agreement, Contractor’s rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. 5. Compensation. County shall compensate Contractor for the performance of the Services in a sum computed and payable as set forth in Exhibit A. The performance of the Services under this Agreement shall not exceed $65,000 each year. Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business hours unless specifically authorized in writing by County. a. Payment will be made for Services satisfactorily performed within thirty (30) days of receipt of a proper and accurate invoice from Contractor. All invoices shall include detail regarding the hours spent, tasks performed, who performed each task and such other detail as County may request. b. If, at any time during the term or after termination or expiration of this Agreement, County reasonably determines that any payment made by County to Contractor was improper because the Services for which payment was made were not performed as set forth in this Agreement, then upon written notice of such determination and request for reimbursement from County, Contractor shall forthwith return such payment(s) to County. Upon termination or expiration of this Agreement, unexpended funds advanced by County, if any, shall forthwith be returned to County. c. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 3 Eagle County General Services Final 5/14 d. Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after December 31 of any year, without an appropriation therefor by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). 6. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the performance of any of the Services or additional services without County’s prior written consent, which may be withheld in County’s sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the subject Project during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the Project. Contractor shall require each subcontractor, as approved by County and to the extent of the Services to be performed by the subcontractor, to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and subcontractors. 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 Eagle County, its associated or affiliated entities, its successors and assigns, elected officials, employees, agents and volunteers as additional insureds. A certificate of insurance consistent with the foregoing requirements is attached hereto as Exhibit B. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 4 Eagle County General Services Final 5/14 ii. Contractor’s certificates of insurance shall include subcontractors, if any as additional insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for each subcontractor. iii. The insurance provisions of this Agreement shall survive expiration or termination hereof. iv. The parties hereto understand and agree that the County is relying on, and does not waive or intend to waive by any provision of this Agreement, the monetary limitations or rights, immunities and protections provided by the Colorado Governmental Immunity Act, as from time to time amended, or otherwise available to County, its affiliated entities, successors or assigns, its elected officials, employees, agents and volunteers. v. Contractor is not entitled to workers’ compensation benefits except as provided by the Contractor, nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Contractor or some other entity. The Contractor is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8. Indemnification. The Contractor shall indemnify and hold harmless County, and any of its officers, agents and employees against any losses, claims, damages or liabilities for which County may become subject to insofar as any such losses, claims, damages or liabilities arise out of, directly or indirectly, this Agreement, or are based upon any performance or nonperformance by Contractor or any of its subcontractors hereunder; and Contractor shall reimburse County for reasonable attorney fees and costs, legal and other expenses incurred by County in connection with investigating or defending any such loss, claim, damage, liability or action. This indemnification shall not apply to claims by third parties against the County to the extent that County is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents (including electronic files) and materials obtained during, purchased or prepared in the performance of the Services shall remain the property of the County and are to be delivered to County before final payment is made to Contractor or upon earlier termination of this Agreement. 10. Notice. Any notice required by this Agreement shall be deemed properly delivered when (i) personally delivered, or (ii) when mailed in the United States mail, first class postage prepaid, or (iii) when delivered by FedEx or other comparable courier service, charges prepaid, to the parties at their respective addresses listed below, or (iv) when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date, time and receiving facsimile number for the transmission, or (v) when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this paragraph by giving five (5) days prior written notice of such change to the other party. COUNTY: Eagle County, Colorado DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 5 Eagle County General Services Final 5/14 Attention: Human Resources Hollis Dempsey 500 Broadway Post Office Box 850 Eagle, CO 81631 Telephone: 970-328-8793 Facsimile: 970-328-3039 E-Mail: hollis.dempsey@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: Hays Companies Sarah Manning Vice President 1125 17th Street, Suite 1450 Denver, CO 80202 Phone: 720-279-3440 Email: smanning@hayscompanies.com 11. Termination. County or Contractor may terminate this Agreement, in whole or in part, at any time and for any reason, with or without cause, and without penalty therefor with thirty (30) calendar days’ prior written notice to the Contractor. Upon termination of this Agreement, Contractor shall immediately provide County with all documents as defined in paragraph 9 hereof, in such format as County shall direct and shall return all County owned materials and documents. County shall pay Contractor for Services satisfactorily performed to the date of termination. 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 DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 6 Eagle County General Services Final 5/14 Agreement: (i) Electronic or facsimile delivery of a fully executed copy of the signature page; (ii) the image of the signature of an authorized signer inserted onto PDF format documents. All documents must be properly notarized, if applicable. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act, C.R.S. 24-71.3-101 to 121. 14. Other Contract Requirements and Contractor Representations. a. Contractor has familiarized itself with the nature and extent of the Services to be provided hereunder and the Property, and with all local conditions, federal, state and local laws, ordinances, rules and regulations that in any manner affect cost, progress, or performance of the Services. b. Contractor will make, or cause to be made, examinations, investigations, and tests as he deems necessary for the performance of the Services. c. To the extent possible, Contractor has correlated the results of such observations, examinations, investigations, tests, reports, and data with the terms and conditions of this Agreement. d. To the extent possible, Contractor has given County written notice of all conflicts, errors, or discrepancies. e. Contractor shall be responsible for the completeness and accuracy of the Services and shall correct, at its sole expense, all significant errors and omissions in performance of the Services. The fact that the County has accepted or approved the Services shall not relieve Contractor of any of its responsibilities. Contractor shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to contractors performing similar services. Contractor represents and warrants that it has the expertise and personnel necessary to properly perform the Services and shall comply with the highest standards of customer service to the public. Contractor shall provide appropriate supervision to its employees to ensure the Services are performed in accordance with this Agreement. This paragraph shall survive termination of this Agreement. f. Contractor agrees to work in an expeditious manner, within the sound exercise of its judgment and professional standards, in the performance of this Agreement. Time is of the essence with respect to this Agreement. g. This Agreement constitutes an agreement for performance of the Services by Contractor as an independent contractor and not as an employee of County. Nothing contained in this Agreement shall be deemed to create a relationship of employer-employee, master-servant, partnership, joint venture or any other relationship between County and Contractor except that of independent contractor. Contractor shall have no authority to bind County. 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. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 7 Eagle County General Services Final 5/14 i. This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding between the parties with respect thereto. j. Contractor shall not assign any portion of this Agreement without the prior written consent of the County. Any attempt to assign this Agreement without such consent shall be void. k. This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted assigns and successors in interest. Enforcement of this Agreement and all rights and obligations hereunder are reserved solely for the parties, and not to any third party. l. No failure or delay by either party in the exercise of any right hereunder shall constitute a waiver thereof. No waiver of any breach shall be deemed a waiver of any preceding or succeeding breach. m. The invalidity, illegality or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision hereof. n. The signatories to this Agreement aver to their knowledge no employee of the County has any personal or beneficial interest whatsoever in the Services or Property described in this Agreement. The Contractor has no beneficial interest, direct or indirect, that would conflict in any manner or degree with the performance of the Services and Contractor shall not employ any person having such known interests. 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 DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 8 Eagle County 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 County within three (3) days that Contractor has actual knowledge that the subcontractor is employing or contracting with an undocumented individual; and ii. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subcontractor does not stop employing or contracting with the undocumented individual; except that Contractor shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an undocumented individual. e. Contractor shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the department is undertaking pursuant to its authority established in C.R.S. 8-17.5-102(5). f. If Contractor violates these prohibitions, County may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Contractor shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Contractor violates this provision of this Agreement and County terminates the Agreement for such breach. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 9 Eagle County General Services Final 5/14 IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first set forth above. Eagle County, Colorado by and through its County Manager _______________________________ Jeff Shroll, County Manager CONTRACTOR: By:________________________________ Print Name: _________________________ Title: ______________________________ DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC Vice President Sarah Manning 10 Eagle County General Services Final 5/14 EXHIBIT A SCOPE OF SERVICES, SCHEDULE, FEES DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 1. Services. 1.1 General. Hays will provide the services set forth in this Agreement regarding the following lines of Health and Welfare benefits: Medical COBRA Dental Long-Term Disability Vision Employee Assistance Program (EAP) Basic/Voluntary Life/AD&D Flexible Spending Account (FSA) 1.2 Types of Services. The Company and/or its affiliates shall provide the following services to the Client under this Agreement: 1. Review the Client’s Employees Benefits Program, on a continuing basis to ensure that those plans are compliant with federal requirements and their adequacy of benefits with respect to other plans. Recommend alternative benefit designs or delivery systems as dictated by emerging plan costs or benefit practices. 2. Review and reaffirm changes to the goals and objectives of the benefit design. Notify, monitor and provides information on pending or new legislation including, but not limited to, Patient Protection and Affordable Care Act and HIPPA and changes in tax laws. Consult on benefit and funding trends that may affect the benefits program, applying assumptions to various scenarios, often with only a few hours’ notice. Advise Client of market and like business benefit trends. Recommend appropriate action to be taken by the Client’s Employee Benefits Program. 3. Provide the Client's Employee Benefits Program with (1) writing plan modifications and new plans (2) assisting in the amendment approval process (3) submitting written reports and other documents as required by the Federal Government and (4) evaluate potential benefit plan cost reductions. 4. Prepare/develop “Request for Proposal” for products necessary to implement the benefit plans or for competitive analysis of marketplace costs to ensure Client receives the best possible pricing. 5. Manage the vendor renewal/selection process, including contract negotiations with the third-party administrator (TPA) or insurance carrier. 6. Review contracts, plan documents, summary plan descriptions, insurance policies and other documents for applicability, accuracy and consistency. Prepare and deliver necessary reports to the Client's Employee Benefits Program. 7. Prepare alternative funding analysis and conduct actuarial analysis of claims reserves and funds requirements as requested. 8. Provide any necessary actuarial services, including projecting funding needs for upcoming fiscal year. 9. Maintain records of the financial and claims experience, condition, and progress of Client’s plans and provides quarterly reports. 10. Review all benefit services for technical accuracy. 11. Participate with Client when requested in communications and actions with the insurance and healthcare reimbursement carriers; and with boards or other independent bodies. 12. Prepare the Client's Employees Benefit Program and wellness communication materials. Provide print ready communication materials. 13. Conduct employee education meetings as requested. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 14. Personal availability for meetings as required. Provide a backup service person that is knowledgeable about the Employee Benefits Program. 15. Adjudication of specific claims when requested by Client. 16. Discuss and coordinate information with other consultants employed with Client when requested. 17. Provide liaison services between Client’s Employee Benefits Program and other benefits contractors, including coordination of reporting and assistance resolving claims. 18. Prepare the quarterly financial reports for the self-funded plan. Conduct quarterly meetings, or more often if necessary, to review the financials, utilization and benefits design. 19. Manage annual open enrollment process with TPA/Carrier. 20. Prepare strategic plan for Client's Employee Benefits Program. 21. Provide ongoing customer support to address claims, billings, benefit, eligibility and other service issues. 22. Perform special projects as requested by Client. For example:  Develop and assist in implementation of new insurance plans.  Assist in drafting, reviewing, issuing and evaluating requests for proposals and invitations to bid.  Advise Client in contract negotiations and renewals.  Assist in developing the costs associated with various issues involving the benefit plans.  Assist with special employee communication projects, which may result from legislative or regulatory changes.  Prepare special reports showing claims experience. 23. Responsible for maintaining the confidentially of Client’s records and data, which cannot be sold, shared or otherwise disclosed to other companies or individuals without written permission from Client's Employee Benefits Plan Officials. 24. Assist Client with the development of performance guarantees relating to vendors’ performance of services to the Client’s Benefits Plan Administrator and evaluate the performance of vendors. 25. Provide medical and dental management oversight including, but not limited to precertification requirements, paid claims, prescription drug utilization and high cost claims/stop loss. 26. Assist Client with wellness programs and provides continuing consultative services for the development and improvement of Client’s wellness program. 27. Provide recommendations on voluntary benefit plans. 1.3 Information. The Company shall make available to the Client upon its request documents and information reasonably requested relating to the Client’s account. The Client shall provide to the Company all information reasonably requested by the Company to fulfill its obligations under this Agreement. The Client shall report to the Company any material changes in its exposures, loss or other relevant items which are pertinent to the provision of services under this Agreement. The Company may rely on all information provided by the Client and on all decisions made and approvals given by the Client about this Agreement. The Company is under no obligation to verify the accuracy or completeness of the information provided by the Client, and the Company shall have no liability or responsibility for any inaccuracies in the information provided by the Client. The Company may supply information provided by the Client to any insurance company or intermediary or employee as necessary to fulfill its obligations under this Agreement but will otherwise take reasonable steps to ensure the confidentiality of such information. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 1.4 Placement of Insurance. The Company is hereby authorized to assist the Client in discussions and transactions with insurance companies, provided that the Company shall not place any insurance coverage on behalf of the Client unless authorized by the Client to do so. The parties acknowledge that the Company sells insurance and that the Client is under no obligation to purchase any insurance through the Company and that the Company does not have the authority to make binding commitments on behalf of any insurance company. Upon request, the Company shall provide to the Client additional information about its licensure status and the companies by which it is appointed to sell insurance. 1.5 Additional Available Services. The Company may be able to make available to the Client, for an additional negotiated fee, additional services. The Client may consult with the Company if it needs additional services. DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 11 Eagle County General Services Final 5/14 EXHIBIT B INSURANCE CERTIFICATE DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC 01/28/2021 Brown & Brown - Daytona Beach 300 N Beach Street Daytona Beach FL 32114 Laurie DeSandre (386) 239-7242 (386) 239-5729 ldesandre@bbdaytona.com BROWN & BROWN INC ETAL Po Box 2412 Daytona Beach FL 32115 Travelers Property Casualty Company of America 25674 XL Specialty Insurance Company 37885 The Continental Insurance Company 35289 The Charter Oak Fire Insurance Company 25615 21003 A TC2JGLSA9527B87421 01/01/2021 01/01/2022 1,000,000 1,000,000 5,000 1,000,000 10,000,000 2,000,000 A TC2JCAP9527B86221 01/01/2021 01/01/2022 2,000,000 50,000 C 6011849429 01/01/2021 01/01/2022 5,000,000 5,000,000 D UB1R8701982151K 01/01/2021 01/01/2022 1,000,000 1,000,000 1,000,000 B INS AGENTS/BROKERS PROFESSIONAL LIAB E&O ELU172413-21 01/01/2021 01/01/2022 EA WRONGFUL ACT 20,000,000 AGGREGATE 20,000,000 NAMED INSURED: HAYS COMPANIES, INC. RE: AGREEMENT FOR SERVICES EAGLE COUNTY, ITS ASSOCIATED OR AFFILIATED ENTITIES, ITS SUCCESSORS AND ASSIGNS, ELECTED OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE ADDITIONAL INSUREDS ON THE GENERAL LIABILITY, PER FORM CG D2 48 04 19. EAGLE COUNTY COLORADO 500 BROADWAY POST OFFICE BOX 850 EAGLE CO 81631 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-MAIL ADDRESS: 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 ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR 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: E27E6C96-E980-48AD-B6D5-050617ABE8FC BROWN & BROWN INC ETALBrown & Brown of Florida, Inc. 25 Certificate of Liability Insurance: Notes INSURER A-WORKERS COMPENSATION-POLICY UB1R8612692151R-EFF 1-1-21 TO 1-1-22, LIMITS 1,000,000/1,000,000/1,000,000 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: DocuSign Envelope ID: E27E6C96-E980-48AD-B6D5-050617ABE8FC