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HomeMy WebLinkAboutGE21-03 Old Growth Tree ServiceAGREEMENT FOR SERVICES
BETWEEN GOLDEN EAGLE ELDERLY HOUSING CORPORATION
AND
OLD GROWTH TREE SERVICE
THIS AGREEMENT (“Agreement”) is effective as of ________________________, by and between Old Growth
Tree Service, LLC, a Colorado limited liability corporation (hereinafter “Contractor”) and Golden Eagle Elderly
Housing Corporation, a Colorado non-profit corporation (hereinafter “Golden Eagle”).
RECITALS
WHEREAS, Golden Eagle desires 8 large Russian Olive trees to be removed from behind Building A, including
herbicide and stump grinding (the “Project”) at the Golden Eagle Elderly Apartments located at 700 Broadway,
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 Golden Eagle in connection with
the Services.
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and Golden Eagle
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 April 15, 2021 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.Golden Eagle’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 May, 2021.
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
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Golden Eagle General Services Final 5/14
until Contractor has obtained written authorization and acknowledgement by Golden Eagle for such additional
services in accordance with Golden Eagle’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 Golden Eagle 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 Golden Eagle 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. Golden Eagle 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 $5,180.75. 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 Golden Eagle.
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 Golden Eagle may request.
b. If, at any time during the term or after termination or expiration of this Agreement, Golden Eagle
reasonably determines that any payment made by Golden Eagle 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 Golden Eagle, Contractor shall forthwith return such payment(s)
to Golden Eagle. Upon termination or expiration of this Agreement, unexpended funds advanced by Golden Eagle,
if any, shall forthwith be returned to Golden Eagle.
c. Golden Eagle 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.
6. Subcontractors. Contractor acknowledges that Golden Eagle 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 Golden Eagle’s prior written
consent, which may be withheld in Golden Eagle’s sole discretion. Golden Eagle 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 Golden Eagle has an objection, in its reasonable discretion, shall be assigned
to the Project. Contractor shall require each subcontractor, as approved by Golden Eagle 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 Golden Eagle. Golden Eagle 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.
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Golden Eagle General Services Final 5/14
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
Golden Eagle, 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 Golden Eagle 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 Golden Eagle 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 Golden Eagle, 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 unemplo yment 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 Golden Eagle, and any of its officers,
agents and employees against any losses, claims, damages or liabilities for which Golden Eagle 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 Golden Eagle for reasonable attorney fees and costs, legal and other expenses incurred by
Golden Eagle 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 Golden Eagle to the extent that Golden Eagle 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 Golden Eagle and are to be
delivered to Golden Eagle before final payment is made to Contractor or upon earlier termination of this Agreement.
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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.
GOLDEN EAGLE:
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:
Old Growth Tree Service
Attn: Mike Earl
PO Box 927
Eagle, CO 81631
Telephone: 970-401-0274
Email: info@oldgrowth-tree.com
11. Termination. Golden Eagle 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 Golden Eagle with all
documents as defined in paragraph 9 hereof, in such format as Golden Eagle shall direct and shall return all Golden
Eagle owned materials and documents. Golden Eagle 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
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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 Golden Eagle 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 Golden
Eagle 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 Golden Eagle. 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 Golden Eagle and Contractor except that of independent contractor. Contractor shall have no
authority to bind Golden Eagle.
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
Golden Eagle. Any attempt to assign this Agreement without such consent shall be void.
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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 Golden Eagle 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 Contracts.
a. As used in this Section 15, the term undocumented individual will refer to those individuals from
foreign countries not legally in 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 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 contract for services.
b. If Contractor obtains actual knowledge that a subcontractor performing work under the contract
for services knowingly employs or contracts with an undocumented individual, Contractor shall be required to:
i. Notify the subcontractor and Golden Eagle 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 (3) days of receiving the
notice required pursuant to subparagraph (i) of the paragraph 14(b) 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.
c. If Contractor violates these prohibitions, Golden Eagle 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 Golden Eagle.
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d. Golden Eagle may notify the Colorado Secretary of State if Contractor violates this provision of
this Agreement and Golden Eagle terminates the Agreement for such breach.
IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first set forth above.
GOLDEN EAGLE ELDERLY HOUSING
CORPORATION
By: _____________________________
Kimberly Bell Williams, Secretary
CONTRACTOR:
By:________________________________
Print Name:_________________________
Title: ______________________________
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
Mike Earl
Owner/Partner
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EXHIBIT A
SCOPE OF SERVICES, SCHEDULE, FEES
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
RECIPIENT:
Eagle County Government - Golden Eagle Senior
Center
700 Broadway Street
Eagle, CO 81631
Sales Arborist: Mike Earl
SERVICE ADDRESS:
700 Broadway Street
Eagle, CO 81631
SENDER:
Old Growth Tree Service
PO Box 927
Eagle, CO 81631
Phone: 970.401.0274
Email: info@oldgrowth-tree.com
Website: https://oldgrowth-tree.com
PRODUCT / SERVICE DESCRIPTION TOTAL
Tree Removal Estimated completion time is April.
Crane and climber removal of 8 russian olive trees flagged white.
$3,200.00
Crane Rental Subcontractor fees associated with the tree removal.$1,550.00
Stump Kill Treatment A custom formula of herbicide applied to the cut stump to prevent
excessive suckering from tree roots and stumps.
In the rare occurrence there is damage to neighboring trees, we cannot be
held responsible. This herbicide can cause damage due to the nature of
the chemicals.
$320.00
Chip Disposal The hauling and disposal of all debris generated from the project.$125.00
Stump Grinding The grinding of 8 stumps to 4 to 6 inches below grade. Chips will be leveled
into hole and remaining chips will be hauled from site.
$900.00
02/23/2021
Date Client Signature
This proposal is valid for the next 30 days, after which values may be subject to
change.
All work shall be completed in specifications written in accordance with ANSI
A300 standards.
Old Growth Tree Service, LLC’s Terms and Conditions are made a part of and are
Subtotal $6,095.00
Discount (15.0%)- $914.25
Total $5,180.75
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QUOTE #4254
SENT ON:
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Notes Continued...
incorporated into this proposal. You will find these attached.
It is agreed by and between Old Growth Tree Service and the authorizing party (customer and/or customer’s agent) that the following
provisions are made as part of this contract:
Insurance by Contractor:
Old Growth Tree Service warrants that it is insured for liability resulting from injury to person(s) or property and that all employees are
covered by Workers’ Compensation as required by law. Certificates of coverage are available upon request.
Cancellation Fee:
Old Growth Tree Service kindly requests that the authorizing party provide at least 24 hours advance notice of any full or partial work
cancellation. If a crew has been dispatched to the job site, the customer will be assessed a mobilization fee of $225.00 for incurred
expenses.
Completion of Contract:
Old Growth Tree Service agrees to do its best to meet any agreed upon performance dates, but shall not be liable in damages or otherwise
for delays because of inclement weather, labor, or any other cause beyond its control; nor shall the customer be relieved of completion for
delays.
Tree Ownership:
The authorizing party warrants that all trees listed are located on the customer’s property, and, if not, that the authorizing party has received
full permission from the owner to allow Old Growth Tree Service. to perform the specified work. Should any tree be mistakenly identified as
to ownership, the customer agrees to indemnify Old Growth Tree Service for any damages or costs incurred from the result thereof.
Safety:
Old Growth Tree Service warrants that all arboricultural operations will follow the latest version of the ANSI Z133.1 industry safety
standards. The authorizing party agrees to not enter the work area during arboricultural operations unless authorized by the crew leader
on-site.
Tree Pruning:
Tree pruning recommendations are written per ANSI 300 specifications.
Stump Removal:
Unless specified in the proposal, stump removal is not included in the price quoted. Grindings from stump removal are not hauled unless
specified in this proposal. Surface and subsurface roots beyond the stump are not removed unless specified in this proposal.
Concealed Contingencies:
Any additional work or equipment required to complete the work, caused by the authorizing party’s failure to make known or caused by
previously unknown foreign material in the trunk, the branches, underground, or any other condition not apparent in estimating the work
specified, shall be paid for by the customer on a time and material basis. Old Growth Tree Service. is not responsible for damages to
underground sprinklers, drain lines, invisible fences or underground cables unless the system(s) are adequately and accurately mapped by
the authorizing party and a copy is presented before or at the time the work is performed.
Clean-up:
Clean-up shall include removing wood, brush, and clippings, and raking of the entire area affected by the specified work, unless noted
otherwise on this proposal.
Lawn Repair:
Old Growth Tree Service will attempt to minimize all disturbances to the customer’s lawn. Lawn repairs are not included in the contract
price, unless noted otherwise on this proposal.
Terms of Payment:
Unless otherwise noted in this proposal, the customer agrees to pay the account in full upon receipt of the invoice. Failure to remit full
payment within the payment term will result in a finance charge of 3.00% per month.
Returned Check Fee:
There will be a $25.00 fee charged for all checks returned to our office for non-sufficient funds.
Miscellaneous Provisions:
2 of 3 pages
QUOTE #4254
SENT ON:
02/18/2021
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Notes Continued...
No Beneficiaries:
No third parties are intended to benefit by the covenants, agreements, representations, warranties, or any other terms or conditions herein.
Successors, Assigns, and Authority to Execute:
This contract shall be binding and inure to the benefit of the parties hereto and their respective heirs, representatives, successors, and
assigns. The person(s) executing this contract represents that it has the full power and authority to bind its principal hereunder.
Assignment:
The parties hereby represent that they have not assigned any claims, causes of action, or rights which are the subject matter of this
contract and that the rights and duties under this contract cannot be assigned without the prior written consent of all of the parties to this
contract and that each party will hold the other party harmless from any such claims or other demands and will indemnify the other party
with respect thereto.
Entire Agreement; Modification; Waiver; Severability:
This contract supersedes all prior oral discussions and agreements of the parties regarding the subject matter hereof. No waiver of any
term or condition shall constitute a waiver of any subsequent breach of such term or condition. If any term, condition, or provision of this
contract is found to be illegal or unenforceable for any reason, all remaining terms, conditions, and provisions will remain in full force and
effect.
Governing Law and Attorneys’ Fees:
This contract has been negotiated and accepted and shall be construed in accordance with, and all disputes hereunder shall be controlled
by, the laws of the State of Colorado. If a dispute or litigation concerning the enforcement or interpretation of this contract occurs, the
parties hereto agree that: (a) venue shall be proper and exclusive in the District Court in and for the County of Eagle, State of Colorado, (b)
the parties agree to and do hereby submit to the jurisdiction of the courts of the State of Colorado, and (c) the prevailing party in any
litigation, mediation, or arbitration shall be awarded their reasonable attorneys’ fees, costs, and all other expenses (including on appeal)
from the non-prevailing party with respect thereto.
Interpretation:
The parties acknowledge and agree that this contract shall not be construed or interpreted against any single party on the grounds of sole
or primary authorship.
Counterparts:
This Agreement may be executed in counterparts and/or by electronic transmission, each of which shall be considered the same as an
original, and all of which shall together constitute one document.
Number/Gender:
Words of any gender used in this contract will be held and construed to include any other gender, person or entity, and words in the
singular number shall be held to include the plural, and vice versa, unless the context otherwise requires.
Headings:
The descriptive headings of the several sections and paragraphs of this contract are inserted for convenience only and do not constitute a
part of this contract.
Payments:
All sums due under this contract shall be paid in lawful money of the United States of America.
3 of 3 pages
QUOTE #4254
SENT ON:
02/18/2021
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Golden Eagle General Services Final 5/14
EXHIBIT B
INSURANCE CERTIFICATE
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
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
4/3/2021
CCIG
155 Inverness Drive West
Englewood CO 80112
Shawn Richards
720-212-2061 720-212-2061
Denese.Brooks@thinkccig.com
License#:45339 Secura Insurance Companies 22543
OLDGROW-01 Pinnacol Assurance 41190OldGrowthTreeService,LLC
PO Box 927
Eagle CO 81631
Atlantic Specialty Ins.Compan 27154
1549722394
A X 1,000,000
X 100,000
10,000
1,000,000
2,000,000
X
Y Y 20CP00325118011 4/7/2021 4/7/2022
2,000,000
A 1,000,000
X
X X
Y Y 20A00325118111 4/7/2021 4/7/2022
A X X 1,000,00020CU003251182114/7/2021Y 4/7/2022
1,000,000
X 0
B X
N
Y 4191153 4/1/2021 4/1/2022
1,000,000
1,000,000
1,000,000
A
C
Pesticide/Herbicide
Leased and Rented Equipment 20CP00325118011
7900302740001
4/7/2021
4/7/2021
4/7/2022
4/7/2022
Deductible $1,000
Deductible $1,000
$1,000,000
$150,000
As required by written contract or written agreement,Golden Eagle Elderly Housing Corporation is included as Additional Insured for ongoing and completed
operations under General Liability and Automobile Liability on a primary and non-contributory basis.As required by written contract or written agreement,a
Waiver of Subrogation in favor of the Additional Insured applies to General Liability,Automobile Liability and Workers’Compensation.Umbrella coverage is
Follow Form to General Liability,Automobile Liability and Workers Compensation/Employers Liability.
Golden Eagle Elderly Housing Corporation
PO Box 850
Eagle CO 81631
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
20-CP-003251180-11
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
20-CP-003251180-11
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8
7501 E. Lowry Blvd.
Denver, CO 80230-7006
303.361.4000 / 800.873.7242
Pinnacol.com
Old Growth Tree Service LLC
PO Box 927
Eagle, CO 81631
CCIG
155 Inverness Drive West
Englewood, CO 80112
(303) 799-0110
7501 E. Lowry Blvd Denver, CO 80230-7006
Page 1 of 1 P LYSTERM - Underwriter 03/30/2021 14:44:14 4191153 57612106 359-B
NCCI #: WC000313B
Policy #: 4191153
ENDORSEMENT:Blanket Waiver of Subrogation
Effective Date:March 30, 2021 Expires on: April 1, 2022
Pinnacol Assurance has issued this endorsement March 30, 2021
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
To any person or organization when agreed to under a written contract or agreement, as defined above
and with the insured, which is in effect and executed prior to any loss.
DocuSign Envelope ID: B1681F9A-0B29-4FA1-930C-EAB27B7641D8