Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutC23-279 Mozingo Code GroupAGREEMENT FOR SERVICES
BETWEEN EAGLE COUNTY, COLORADO
AND
THE MOZINGO CODE GROUP LLC
THIS AGREEMENT (“Agreement”) is effective as of June 26th, 2023 by and between The Mozingo
Code Group, a Colorado limited liability company (hereinafter “Contractor”) and Eagle County,
Colorado, a body corporate and politic (hereinafter “County”).
RECITALS
WHEREAS, the County desires to engage a contractor to provide code consulting services to Eagle
County Staff for the purpose of assisting the County in adopting a new edition of the Building and
Energy Codes; 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” 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 June 26, 2024 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. County’s Representative. The Community Development Department’s designee shall be
Contractor’s contact with respect to this Agreement and performance of the Services.
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
2
Eagle County General Services Final 8/15/2022
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 26th
day of June, 2024.
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
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 $10,800.00. 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 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.
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).
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
3
Eagle County General Services Final 8/15/2022
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.
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.
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
4
Eagle County General Services Final 8/15/2022
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 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
Attention: Bill Gibson
500 Broadway
Post Office Box 850
Eagle, CO 81631
Telephone: 970-328-8624
E-Mail: bill.gibson@eaglecounty.us
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
5
Eagle County General Services Final 8/15/2022
With a copy to:
Eagle County Attorney
500 Broadway
Post Office Box 850
Eagle, Co 81631
Telephone: 970-328-8685
E-Mail: atty@eaglecounty.us
CONTRACTOR:
Shaunna Mozingo
Mozingo Code Group
8522 E 133rd Dr
Thorton, CO 80602
sdmozingo@mozingocodegroup.com
11. Termination. County 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
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
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.
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
6
Eagle County General Services Final 8/15/2022
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.
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.
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
7
Eagle County General Services Final 8/15/2022
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.
15. Data Security.
a. Definitions:
i. “County Data” means all data created by or in any way originating with County
and End Users, and all information that is the output of any computer processing, or other electronic
manipulation, of any information that was created by or in any way originating with County and End
Users, in the course of using and configuring the Services provided under this Agreement, and includes
all records relating to County’s use of Contractor Services and Protected Information.
ii. “End User” means the individuals (including, but not limited to employees,
authorized agents, students and volunteers of County; Third Party consultants, auditors and other
independent contractors performing services for County; any governmental, accrediting or regulatory
bodies lawfully requesting or requiring access to any Services; customers of County provided services;
and any external users collaborating with County) authorized by County to access and use the Services
provided by Contractor under this Agreement.
iii. “Protected Information” includes, but is not limited to, personally-identifiable
information, student records, protected health information, criminal justice information or individual
financial information and other data defined under C.R.S. §§ 24-72-101 et seq., and personal information
that is subject to local, state or federal statute, regulatory oversight or industry standard restricting the use
and disclosure of such information. The loss of such Protected Information would constitute a direct
damage to the County.
iv. “Security Incident” means the potentially unauthorized access by non-authorized
persons to personal data or non-public data the Contractor believes could reasonably result in the use,
disclosure or theft of County Data within the possession or control of the vendor. A Security Incident
may or may not turn into a data breach.
b. During the course of Contractor's performance of the Work, the Contractor may be
required to maintain, store, process or control County Data. The Contractor represents and warrants that:
i. Contractor will take all reasonable precautions to maintain all County Data in a
secure environment to prevent unauthorized access, use, or disclosure, including industry-accepted
firewalls, up-to-date anti-virus software, and controlled access to the physical location of the hardware
containing County Data;
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
8
Eagle County General Services Final 8/15/2022
ii. Contractor’s collection, access, use, storage, disposal and disclosure of County
Data shall comply with all applicable data protection laws, as well as all other applicable regulations and
directives;
iii. Contractor will notify County of any Security Incident as soon as practicable, but
no later than 24 hours after Contractor becomes aware of it;
iv. Contractor will provide information sufficient to satisfy County’s legal and
regulatory notice obligations. Upon notice of a Security Incident, County shall have the authority to
direct Contractor to provide notice to any potentially impacted individual or entity, at Contractor’s
expense, and Contractor shall be liable for any resulting damages to County.
v. Where Contractor has been contracted to maintain, store or process personal
information on behalf of the County, it shall be deemed a “Third-Party Service Provider as defined in
C.R.S. § 24-73-103(1)(i), and Contractor shall maintain security procedures and practices consistent with
C.R.S §§ 24-73-101 et seq.; and
vi. Contractor will promptly return or destroy any County Data upon request from
the County Representative.
c. Contractor’s indemnification obligations identified elsewhere in this Contract shall apply
to any breach of the provisions of this Paragraph.
[REST OF PAGE INTENTIONALLY LEFT BLANK]
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
9
Eagle County General Services Final 8/15/2022
IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first set forth above.
COUNTY OF EAGLE, STATE OF COLORADO,
By and Through Its COUNTY MANAGER
By: ______________________________
Jeff Shroll, County Manager
CONSULTANT
The Mozingo Code Group, LLC
By: _____________________________________
Print Name: ______________________________
Title: ___________________________________
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
Shaunna Mozingo
Owner-Member
10
Eagle County General Services Final 8/15/2022
EXHIBIT A
SCOPE OF SERVICES, SCHEDULE, FEES
The Mozingo Code Group (“MCG”) is pleased to provide a proposal for code consulting services to Eagle
County staff for the purpose of assisting the County in moving to a new edition of their Building and
Energy Codes. This consulting shall include any or all of the following:
1. Provide significant change summaries for all adopted codes within and referenced by the
International Code Council’s family of I-Codes.
2. Review jurisdiction’s current code amendments and make recommendations for changes,
including deletion of items no longer needed, addition of items that would fix any known
conflicts within the codes, and amendments that may be needed based on jurisdiction goals and
needs.
3. Prepare a new amendment package for publication based on approved changes.
4. Conduct or attend stakeholder meetings and training on proposed changes.
5. Attending County Commissioner work sessions or meetings, preparing meeting packets as
necessary, to assist in the understanding of proposed changes.
6. Meet with Staff and stakeholders to understand the needs and goals of the jurisdiction to come
up with proposed amendment package.
7. Provide a standardized set of amendments that are recommended to all jurisdictions moving to
the same edition of the codes in hopes of gaining more consistency with neighboring
jurisdictions.
8. Insert Cohort language for EV, PV, Solar Ready into the amendment package to satisfy State of
Colorado requirements under HB 22-1362.
9. Attend and/or moderate any public hearings or meetings if the jurisdiction allows the public to
submit proposed changes to their codes.
10. Determine if any Energy Code amendments to prescriptive requirements will affect any other
paths of compliance, such as Total UA or performance paths.
11. Work with Pacific Northwest National Laboratories (PNNL) to ensure all Energy Code
amendments are in alignment with proper U-Factor and R-Value conversions.
12. Reach out to Fire department/s to gain consensus on proposed Fire Code amendments.
13. Provide Cost/Savings analysis on moving to the newer codes.
14. Reporting on implementation needs for the County, if any, to move to the newer codes.
15. Additional support may be provided as MCG meets with staff and stakeholders to understand
the goals and needs of the jurisdiction.
After initial conversations with County staff, the estimate of hours to complete these initial tasks would
be 80 hours, which would include some travel time to meet with staff and attend meetings. Any
contract, if awarded, should state a “not to exceed” limit of 80 hours. It is likely that the work could be
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
11
Eagle County General Services Final 8/15/2022
done in less hours, with less trips, with proper planning. The MCG hourly rate is $135.00 for this
proposal, with a not to exceed of $10,800.00.
MCG proposes to complete the majority of this work, including the first draft for County staff review,
within 2 months of contract award and signature. Any final amendments or changes due to staff review
may not fall within that 2 month process, depending on the timing of staff review.
MCG also proposes that if there are any hours left over in the contract, that it could be used for MCG to
hold local training for code officials, contractors, designers, raters, building owners, and other
stakeholders in the community.
Thank you for the opportunity to submit this proposal. I hope that we will be able to work together to
get your new codes adopted.
Respectfully submitted,
Mozingo Code Group
8522 E 133 rd Dr
Thornton, CO 80602
(303) 907-7009
sdmozingo@mozingocodegroup.com
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
12
Eagle County General Services Final 8/15/2022
EXHIBIT B
INSURANCE CERTIFICATE
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3
08/23/2023
Brown & Brown of Colorado, Inc.
1125 17th Street, Suite 1450
Denver CO 80202
Susan Tellis
(720) 963-4244 (720) 962-5142
Susan.Tellis@bbrown.com
The Mozingo Code Group LLC
13933 Jackson St
Thornton CO 80602-8778
Hiscox Insurance Company Inc.10200
23/24 Master
A P1000409285 01/11/2023 01/11/2024
1,000,000
0
5,000
1,000,000
2,000,000
2,000,000
A P1000409285 01/11/2023 01/11/2024
1,000,000
A Professional Liability P1000403385 01/11/2023 01/11/2024 Each Claim Limit $1,000,000
Aggregate Limit $1,000,000
All policy terms, conditions and exclusions apply.
Eagle County Government
PO 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-MAILADDRESS:
PRODUCER
(A/C, No, Ext):PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$
$
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
EROTH-STATUTEPER
LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED $PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
DocuSign Envelope ID: C53DFF54-BFA9-48C3-8326-0E26D0C033D3