No preview available
HomeMy WebLinkAboutC21-412 WAGES DornDocuSign Envelope ID: 5B0088F6-37D2-45E6-A80B-3B2DDB978CA7 FIRST AMENDMENT TO AGREEMENT BETWEEN EAGLE COUNTY, COLORADO AND Phyllis Dorn THIS FIRST AMENDMENT ("First Amendment") is effective as of 11/29/2021 by and between Phyllis Dorn, an Independent contractor (hereinafter "Consultant" or "Contractor") and Eagle County, Colorado, a body corporate and politic (hereinafter "County"). RECITALS WHEREAS, County and Consultant entered into an agreement dated the February 28`h, 2021, for certain Services (the "Original Agreement"C21-064); and WHEREAS, the term of the Original Agreement expires on the 31 st day of December, 2021, and the parties desire to extend the term for an additional year, and WHEREAS, this First Amendment memorializes these modifications. FIRST AMENDMENT NOW THEREFORE, in consideration of the foregoing and the mutual rights and obligations as set forth below, the parties agree as follows: 1. The Original Agreement shall be amended to extend the term to the 31 st day of December, 2022. 2. The total compensation shall not exceed $10,450 and the Contractor shall be compensated for performance of assigned services for which the County agrees to pay Contractor $2,612.50 quarterly. 3. The new amended Capitalized terms in this First Amendment will have the same meaning as in the Original Agreement. To the extent that the terms and provisions of the First Amendment conflict with, modify or supplement portions of the Original Agreement, the terms and provisions contained in this First Amendment shall govern and control the rights and obligations of the parties. 4. Except as expressly altered, modified and changed in this First Amendment, all terms and provisions of the Original Agreement shall remain in full force and effect, and are hereby ratified and confirmed in all respects as of the date hereof. 5. This First Amendment shall be binding on the parties hereto, their heirs, executors, successors, and assigns. DocuSign Envelope ID: 5B0088F6-37D2-45E6-A80B-3B2DDB978CA7 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Original Agreement the day and year first above written. COUNTY OF EAGLE, STATE OF COL ORAD0, By and Through Its COUNTYMANAGER [3� Signed by: By: Sl ra Jeff Shroll, Co tun7MdPftWF4... CONSULTANT By: rDocuSigned by: KWWS V6M 91 EBA7EAMD1442... Print Name: Phyl l i S Dorn Title: coach 2 Eagle County Amend Term Scope Comp Final 5/14 DocuSign Envelope ID: 5B0088F6-37D2-45E6-A80B-3B2DDB978CA7 PHYLLIS M DORNSEIF PO BOX 9707 AVON, CO 81620 Auto Insurance Coverage Summary This is your Renewal Declarations Page Policy Number: 939017648 Underwritten by: Progressive Direct Insurance Co April 26, 2021 Policy Period: Jun 2, 2021 - Dec 2, 2021 Page 1 of 3 progressive.com Online Service Make payments, check billing activity, update policy information or check status of a claim. 1-800-776-4737 For customer service and claims service, 24 hours a day, 7 days a week. The coverages, limits and policy period shown apply only if you pay for this policy to renew. Your coverage begins on June 2, 2021 at 12:01 a.m. This policy expires on December 2, 2021 at 12:01 a.m. Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for a vehicle may not be combined with the limits for the same coverage on another vehicle, unless the policy contract or endorsements indicate otherwise. The policy contract is form 9611 D CO (12/14). The contract is modified by forms 4884 (10/08) and A294 CO (02/20). Drivers and resident relatives Additional information .................. .... ................................................................. ...... ............... ............................................ I................ Phyllis M Dornseif Named insured ..... I................................................................................................................................................................... Henry W Dornseif SR ......................................................................................................................................................................... Jenna E Dornseif Outline of coverage General policy coverage Limits Deductible ........................................................................................................................................................ Uninsured/Underinsured Motorist Bodily Injury $100,000 each person/$300,000 each accident ... ..................................................................................................................................................... Total premium for general policy coverage 2005 CHRYSLER PACIFICA 4 DOOR WAGON VI N : 2C4GF48455R461400 Garaging ZIP Code: 81620 Primary use of the vehicle: Commute Length of vehicle ownership when policy started or vehicle added: 5 years or more Limits .. ......................................................................................................... Liability To Others Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability $100,000 each accident .... ..................................................................................................................................... Medical Payments $5,000 each person ......................................................................................................................................... Comprehensive Actual Cash Value Comprehensive Window Glass ......................................................................................................................................... Collision Actual Cash Value ......................................................................................................................................... Total premium for 2005 CHRYSLER Deductible Premium ................... $89 ................... $89.00 Premium $142 IT, $500 68 $100 glass ................................. $500 45 ................................. $267 Form 6489 CO (08/18) in Continued DocuSign Envelope ID: 5B0088F6-37D2-45E6-A80B-3B2DDB978CA7 Policy Number: Phyllis M Dornseif Page 2 of 3 2005 VOLKSWAGEN BEETLE 2 DOOR HATCHBACK VIN: 3VWCK31 C35M417051 Garaging ZIP Code: 81620 Primary use of the vehicle: Commute Length of vehicle ownership when policy started or vehicle added: 5 years or more Limits Deductible Premium ............................................................................................................................................................................. Liability To Others $99 Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability .................................................. $100,000 each accident .... ...e..... . ...m... Payents. ... Mdical.. $..5.,..................................................................................... 000 e..ach person.. ... ... 6 ........................................................................................................................................................................... Comprehensive Actual Cash Value $500 72 Comprehensive Window Glass $100 glass ............................................................................................................................................................................. Collision Actual Cash Value $500 48 ............................................................................................................................................................................. Total premium for 2005 VOLKSWAGEN $225 2014 VOLKSWAGEN TIGUAN 4 DOOR WAGON VIN: WVGBV3AX7EW590981 Garaging ZIP Code: 81620 Primary use of the vehicle: Pleasure/Personal Length of vehicle ownership when policy started or vehicle added: At least 3 years but less than 5 years Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium. Limits Deductible Premium ...................................................................................................................................................... Liability To Others ..... 143 Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability $100,000 each accident Medical Payments ............................................................................. $5,000 each person 12 n ............................................................................................................................................................................ Comprehensive Actual Cash Value $S00 119 Comprehensive Window Glass $100 glass o o ....................................................................... Collision ............................ ........ ....................... Actual Cash Value ................. $500 123 0 ....................... ........................... Total premium for 2014 VOLKSWAGEN .................. .................. .......................... ................................. $397 o 2016 LAND ROVER DISCOVERY SPORT 4 DOOR WAGON VIN: SALCR2BG7GH591781 N Garaging ZIP Code: 81620 0 Primary use of the vehicle: Commute Length of vehicle ownership when policy started or vehicle added: At least 1 month but less than 1 year a Limits Deductible Premium a ........................................................................................................................................................................ Liability To Others $146 Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability ............................................................................................................................................................................. $100,000 each accident Medical Payments $5,000 each person 12 ....... r'e'h-................................................................................................................................................................ Comprehensive Actual Cash Value $500 127 Comprehensive Window Glass $100 glass ............................................................................................................................................................................. Collision Actual Cash Value $500 211 I.............................................................................................................................................................. Total premium for 2016 LAND ROVER ..................... ....... I ............ I .......... ......... ........... .............. $496 I—,... .................. ................................... ......................... Subtotal policy premium $1,474.00 ................................................................................................................................................. Colorado Auto Theft Prevention Authority fee 2.00 ............................................................................................................................................................................. Total 6 month policy premium and fees $1,476.00 ............................................................................................................................................................................. Discount if paid in full -261.00 ............................................................................................................................................................................. Total 6 month policy premium if paid in full and fees $1,215.00 Form 6489 CO (08118) Continued DocuSign Envelope ID: 5B0088F6-37D2-45E6-A80B-3B2DDB978CA7 Policy Number: 939017648 Phyllis M Dornseif Page 3 of 3 Important notice Colorado state law requires you to carry, at a minimum, the following coverages: Bodily Injury Liability - $25,000 for one person per accident, $50,000 for all persons per accident; Property Damage Liability - $15,000 per accident; Medical Payments - $5,000 for one person per accident, unless rejected in writing; Uninsured/Underinsured Motorist - $25,000 for one person per accident, $50,000 for all persons per accident, unless rejected in writing; All other coverages listed on this Declarations Page, or any liability coverage limits exceeding those stated above and listed on this Declarations Page are optional, non -mandatory coverages selected by you. Premium discounts Policy 939017648 Multi -Policy, Home Owner, Multi -Car, Continuous Insurance: Diamond and Paperless Driver ........................................ ......................... ................ ....................... .............................. ....................... I....... Henry W Dornseif SR Mature Driver Vehicle ...................................................................................................................................................................... 2014 VOLKSWAGEN Smart Technology Discount TIGUAN 2016 LAND ROVER Smart Technology Discount DISCOVERY SPORT Smart Technology Discount "m is a service mark of Progressive Casualty Ins. Co. Lienholder information Vehicle .......... ................. I ...... .......... 2014 VOLKSWAGEN TIGUAN WVGBV3AX7EW590981 2016 LAND ROVER DISCOVERY SPORT SALCR2BG7GH591781 Company officers Secretary Lienholder ....................................... CARMAX AUTO FINANCE KENNESAW, GA 30160 ............I ..................... ... I... 21st Mortgage Corp KNOXVILLE, TN 37901 Form 6489 CO (08/18)