HomeMy WebLinkAboutbocc.con.103.2012COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: �Q� . Zp J �.-
Rev. 08-30-11 jls
ORIGINATING DEPARTMENT: �� � �/1f'f�l p �
PROCUREMENT OFFICER�� �� PHONE #: � � � �
PROJECT NAME: ��� �� CONTRACTOR: � v L �i� � L� `�� S�
� fi���-� 5����c ��
DOLLAR AMOUNT: �$n� v(.,C� LINE ITEM #(' p/ 3 3'�j�j32� ^�d o 1 2-
CONTRACT EXECUTION DATE: �- 2�-�-CONTRACT END DATE: ��-- 3�— � 2--
AUTOMATIC RENEWAL: � YES ❑ NO TERM: L�J/ T� L�U KZ 1�� � d��e �
❑ BOCC AGENDA ITEM (Grants, IGA) � STAFF AUTHORIZED SIGNATURE
(Requires BOCC Signature) (Per Revised Procurement Code 7/2005)
❑ OVER $50,000 (Requires Section Leader & County Manager's Signature)
✓ CHECK PROCUREMENT TYPE:
❑ None ❑ Informal []'Formal ❑ Sole Source ❑ Emergency ❑ Outside Agency/State Bid
�-�ompliance with C.R.S. 8-17-5-101, 102 as amended (Immigration Form) ❑ Exempt
❑ Contract Renewal
✓ CHECK CONTRACT TYPE:
�rvices/Maintenance
❑ License/Use
❑ Lease
❑ Construction
❑ Goods, Equipment, Supplies
❑ Other (e.g. revenue)
� � �,a,�,e°` -�'r�L.
❑ Employment
❑ Intergovernmental Agreement (Resolution Required)
❑ Non-Profit
❑ Quasi-Public (e.g.-AVH)
❑ Grant Agreements (Notify Finance & Resolution Required)
❑ Change Order/Contract Amendment
(C/O: 10% or $25K whichever is the lesser must have County Manager signature)
All Contracts should be proofed and all exhibits and notices must be attached for the following:
✓ �Go Pages Missing
✓❑ If e Left Intentionally Blank Note on Page
✓ age numbered consecutively
✓ �All Original Signatures Afiixed
✓ 11 Dates Filled In
✓❑ S ial Instructions for Finance Department:
✓ uthorized Procurement Officer's Name:
✓ 11 Other Blanks Filled In
✓�411 Exhibits Attached
✓� All Legal Descriptions attached (fapplicable)
✓� Notice of Award/Notice to Proceed Attached (f applicable
✓❑ Warranty (if applicable)
I3Y CHECKING A�iQVE AND ENTET2INt; NAME, TH:E AUTIit}12IZEll STAFF PERSON I:�1UIC��i'ES TIiA'I'
THF ATTACHED DOCUMF..NT HAS I3FEN PRt}OFFD AND READY F(.)R SCANNiN(:..
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST!
Contract # j ��j • pI ��7►-- Rev. 8.31.1.1 jaa/js
Budget Line Item# �l6/2o121m
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C4NTRA.CT FOR PROVISION OF SER'VIC`ES
PITKI.N COUNTY JAII. MENTAL HEALTH SERVICES
T�iIS CONTRACT is made and entered by and between the Pitkin County Boazd of County
Commissioners ("County") and Colorado West Regional Mental Health, Inc. DBA Aspen Counseling
Center, 0405 Castle Cree�C Road, Suite, 9, Aspen, CO 81611 (hereinafter "Contxactor").
l. Term. The tezm of this contraet is from Fehruary 1, 2012 to � 31, 2012. At the
expiration of the initial term, the confract may be extended foz an additional te�rxn by the express
wzitten consent of both parties. .
2. Contractor's Obli at� io�s. - -
" • Contractor' shali �rovide and coordinate mental health evalua.iions and other
behavioral health services at the request of Pitkin County Jail administratian or duty
officer. E�aluations will iypically be requested. for inmates in acute psychiatric
- distress. - However, consaltation may also be requested for inmates with identified
mental health condations. These evalua.tions may include telephonic screening or
face tv-face evaluations on the dail premises as determined by coordination between
the 3ai1 and the Coniractor's Crisis Team Evaluator.
• The Pitkin County Jail staff will intervene as needed to address any safety concez�ns
regarding the referred individual or Contractor's staff.
3. Compensation and E�enses �nvaicing, Pavment and Offset. The County shall compensate
Con�tractor for its services in accordance with the Project Budget and Schedule set out in Paragraph 2.
It is expressly understood and agreed that in no event will the totat compensation and reimbursemeni
to be paid hereunder e�ceed the su�z of $24,000 annually for all services rendered. By contract or
amendment, the County and Contractor m�ay realiocate the budget among project tasks if the total
budget amount remains unchanged. Contractox sha.11 invoice for the project montbly based on hours
worked, with payment expected within th.irty (30) da.ys of invoice, but any payment by the County
may be offset by any amount the Contractor owes the County for any reason.
Invoices will be sent to the attention of Don Bird, Jail Administrator, 506 E. Main, Dept. J, Aspen,.
CO-81611. Invoice will be hased on the following rates:
• Emergency Mental Health Evaluation and Follor�v Up: $80.00 per hour
• Mental Health Diagnostic Interview: $80A0 per hour
• Individual Therapy: $80.OQ per hour
• Case Management: $17.50 per 15 minutes
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Budget Line Item# . . v62o121m
• Tele-Psycluatry Medication Ma.nagement :$80.00 per 20 minutes .
� Tele-Psychiatry Diagnostic Evaluation: $240.00 per hour
• Crroup Thera.py: $150.00 per session �
4. Coun 's Exclusive 4wnershi of Work Product. Drawings, specifications, guidelines and
o�lier documents p�repared by Contractor in connection with this contract shall be the pzoperfy of the
County. However, Contractor shall have the right to utilize such documents in the course of its
maz�keting, professional presentations, and for other business p�arposes. Contractar assigns to Counry
the copyrights to all work prepared, developed, or created pursuan.t to this contract, including the
right to: 1) reproduce the work; 2) prepare derivative works; 3) distrtri�bute copies to the public; 4}
perform the works publicly; and 5) to display the work publicly. Contractor sha11 have right to use
materials produced iun the course of this contract for marketing purposes and professional
presentations, articles, speeches and other busia�ess purposes.
5. Pitlaun Countv's Obligations. Pitkin County shall adminis#er this contract through a County
Representative. D.on � Bird; Jail Administratoir will manage the project as- the County's
Representa.tave. In the event that Don Bird is not available, Bev Caznpbell, Jail Administra�ive
Officer sha11- assuxne the Couzrty Representative's duties. The servi�ces provided and products
delivered by the Contractor under this contract will be subject to review by the County's
Representatives, or a designee, for compliance with Con.tractar's ob�gatio,ns prioi to final payment.
6. Termination Prior to Expira.tion of Contract Term. Both the County and the Con#ractor has
the right to terminate this contxact, with or without cause, by gir�ixig written notice to the Contractor
of such ternaination and s�ecifying the effective date thereof. Such notice shall be given at least ten
(10) days before the effective date of such termination. In such event all finished oz unfinished
documents, data, studies and reports prepared by the Contractor pursuant to this contract shall
become the County's property. Contractor shall be entitled to receive compensation in accordance
vv�th the contract for any sat�sfactory work completed pursuant to the terms of this contxact prior to
the date of termination. Notwithsfianding the above, Contractor shall not be relieved of liability to
the County for damages sustained by the County by viurtue of any bxeach of the contract by the
Contractor.
7. Tndepezi.dent Contractor Sta.tus.
A. •.The parties to this contract intend that the relationship between them contemplated by
the contract is that of independent contractor. Contractor, and any agent, employee, or servant of
Contractor shall not be deezned ta be an employee, agent, oz servant of Pitkin County.
B. Contractor is not required ta offer his services exclusively to Pitkixx County under this
contract. Contractor may choose to work for other individuals or entities during the term of this
coniract, provided that the basic services and deliverable products required under this contract are
submitted in the manner and on the schedule defined under this conixact.
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Budget Line Item# 2/62o121m
C. Contractor warrants that all work produced will conform to all applicable indushy
standard of care, skill and diligez�ce in the performance of Contractor's obligations under this
contract.
D. Contractor shall not attempt to oversee or supervise the work or actions of any Pitkin
County employee, servant or agent in the course of completing work under this contrac�
E. Contractor is not entitled to any Workers' Compensation benefits through Pi#kin
County and is responsible for payment of any federal, state, FICA and other i.ncome taxes.
8 Assi nabilitv. This coz�tract is not assignable by either party. Any use of subcontractors by
the Contractor for performance of this contract must be accepted in writing by the County.
9. Bindin� .Arbitration. Any disputes arising out af this contract sha11 be subject to binding
axbitration. The parkies agree that any disputes concerning the terms and conditions of this contract
shall be submitted and finally settled by arbitration. Arbitration shall be conducted pursuant to the
rules of the Ameri�an Arbitration Associatxon and_shall be presided over by the Pitkin Caunty
Hearing Officer appointed to arbitrate Pitkin County contract disputes. Costs of the arbitration sha11
be awarded to the substantially prevailing party. _ � -
10. Sevet�abilitv. In the event that any provision of this contract shall be held to be invalid or
unenforceable, iTie remaining provisions of this contract shall remain valid and bin�di.ng upon the
parties hereto
I 1. Integration and Modification.
A. This contract represents the entire and integrated contract between tlie County and the
Contra.ctor and supersedes all prior negotiations, representations, or cantract, either written or oral.
This coniract znay�be amended only by wzitten contract signed by both the County and the Contractor.
B. The County may, fiom time to time, request changes in the scope of services of the
Contractor to be performed hereunder. Such chaaages, including the increase or decrease in the
amount of the Contractor's compensation, which are m�tually agreed upon between the County and
the Contractor, shall be in writing and upon execution sha11 become part of this contract.
12. Indemni . .
A. The Contractor agrees to indemnify, hold harmless and, not excluding the County's right
to participate, defend the Co�nty, its subsidiary, parent, associated and/or a�'iliated entities, successors,
or assigns, its elected offcials, trustees, employees, agents, volunteers, and any ju.risdict�on or agency
issuing permits far any work inclucled in the project„ herei�aafter referred to as indeznnitee, from all
suits and claims, includiug attorney's fees and cost of litigation, actions, loss, damage, expense, cost or
claims of any character or any n�ature aris"vng o�t of the work done in fulfilIment of the terms of this
Contract ar o�a account of any act, clai.m or amount arising or recovered under workers' compensation
law or arising out of the failure of the Contractor to conform to any statutes, ozda.nances, regulation, Iaw
or court decree. It is agreed that the Contrac#or will be responsible for primary loss investigation,
defense and judgment costs where this contract of indemnity applies. in consideration of the award of
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this contract, the Contractor agrees to waive all rights of subrogation against the County its subsidaary,
paremt, associated andlor affiliated entities, successors, or assigns, its elected off.cials, trustees,
employees, agents, and volunteers for losses arising from the work performed by the Contractor for the
County.
B. The Contractor further shall investigate, process, respond to, adjust, provide defense for
and defen.d, pay or settJe all claims, demands, or lawsuits related hereto at its sole expense and shall
bear all other costs and expenses z�elated thereto, even if the claim, demand or lawsuit is groundless,
false or fraudulen�
13. Insurance. Contractor and subcontractors shall procure and maintain. until a1l of their
obligations have been discharged, includi.ng any warranty periods under fihis Contract are satisfied,
insurance against cla,ims for injury to persons or da.mage to properiy which may arise from or in
connection with the performance of the work hereunder by the Contractor, its agents, representativ�s,
employees or subcontractozs.
Th� insurance requirenaents herein are miun�imum requireexn.ents for tb�is Contract and in no way limit
the indemnity covenants contained in this Contract. ..
The County in no way warrants that the m�i�z��imum Iimits contauled herein aze sufficient to pro#ect the
Contractor frona. liabilities that might arise out of the perfomaarice of �lie work under this Contract by
the Contractor, its agents, representatives, employees, or subcon�ra.ctors. The Contractor shall assess
its own risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader
coverages. The Cantractor is not relieved of any liability or other obligations assumed or pursuant to
the Contract by reason of its failure to obtain ar mainiain insurance in suffcient amounts, duration,
or types.
A. Coverage and Limits of Insurance. Contractor sha11 provide coverage with limits of
liability not less than those staxed beiow_ An umbzella and/or excess liabiliiy policy zna.y be used to
meet the m;nimum liability requirements provided tha.t the coverage is wiritten on a"following form"
basis.
1. Sta.tutory'Wozkers' Compensation: Colorado statutory minimums
a. Policy shall contain a waiver of snbrogataon against the County.
b. This zequirement sball not apply when a contractor or subcontractor
is exempt under Colorado Workers' Compensarion Act., AND when such
contractor or subcontractor executes the appropriate sole proprietor waiver form.
Minimum Limits:
Coverage A {Workers' Compensation)
Coverage B (Employers Liability)
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Statutory
$ soo,00a
� saa,000
$ sao,000
Contract #
Budget Line Item#
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2. Commercial General Liability – IS41 CG 0001 form. or equivalent.
(With County named addiiional irrsured)
Mini�mum Limits:
General Aggregate $ 2,000,000
Products/Completed Opera.tions Aggregate
Each Occurrence Limit
Personal/Advertzsing Injury
Fire Damage (Any One Fire)
Medica.l Payxnents {Any One Person)
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 50,000
$ 5,000
Coverage ta include:
• Prexnises and Operation.s
• Explosions, Collapse-and Underground Hazards
• Perso�tal / Advertising Injury - _ _
• Products / Completed Operations
• Liability assumed under aa�. Insured Contract (including defense costs assumed under
contract) .
• independent Contractors
• Designated Construction Projects(s) General Aggregate Limit, ISO CG 2503 (1997
Edition or equivalent)
• Additional Insured—Owners, Lessees or Contractors Endorsement, ISO Form 2d10
(2004 Edition or equivalent) -
• Additional Tnsured---Owners, Lessees or Contractors Endorsement, ISO CG 2037
(2004 Edition or equivalemt)
•'The palicy shall be endorsed to include the following additional insured l.anguage on
the Additaonal Insured Endorsements specified above: "County, its subsidiary, parent,
associated and/or affiliated entities, successors, or assigns, its elected offcials,
trustees, employees, agents, and volunteers xiamed as an additional insured with
respect to Iiability and defexzse of suits arising out of the activities performed by, or on
behalf of the Contractar, including completed opexations".
3. Auto Liability: Bodily injury and property damage foz any owned, hized., aud
non-owned vebacles used in the perfo�xnance of this Contract.
Minimum Limits:
Bodily Injury/Property Damage (Each Accident) $ I,OOO,aoa
4. Special Coverages (check as appropriate and insert amount):
❑(1) Performance Bond $
❑ Labor and Ma.terial $
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Contract # Reu 8.31.11 jaa/js
BudgCt Line Item# 2/6/2o121m
❑ Pay�nent Bond $
❑ (2) Professional Exxors and Omissions
[](3) Aircraft Liability
❑(4} Owner's Protective
❑(5} Builder's Risk J
❑(� Boiler and Machinery
❑(7) Loss of Use T�nsurance
❑(8) Pollution Liability
❑(9) Crime, including Employee Dishonesty Coverage, or Fidelity Bond
B. Proof of Insurance:
1. Each iinsurance policy required by the insurance provisions of this Contract
sha11 provide the required coverage and shall not be. suspended, voided or canceled except
after thirty (30) days prior written notice has been given io the County, except when
cancellation is for non-payment of premium, fihen ten {10) days prior notice may be given.
Such notice shall be sent directly to (County Representa.tive's Na.me & Address}. Lf the
insurance carrier will not provide the required notice, the ConsultantlContra.ctor and or its '
insurance broker shall notify the County of a�y cancellation,. or reduction in coverage or
limits of any insurance within-severi (7} da,ys of receipt of insurers' notification to that effect.
2. In addition, these C�ertificates�f Insurance shall contain. the follovvin�g clauses:
a. The contractor's insuratice shall be primary and non-contributory with
any insurance ox self insurance parchased by the Cowaty.
b. The insuran.ce companies issuing the policy or policies hereunder shall
have no recourse against the County of Pitkin for pa.yment of any premiums or for
assessments under any farm of policy. �
c. Any and all deductibles or self insuzed retentions in the above-described
insurance policies shall be assumed by and be for the amount o� and at the sole expense
of the Contractor.
d. Location of operations shall be: "all operations and locations at which
work for the referenced. Project is being done."
3. Certificates of Insurance for all renewal policies shall be delivered to the
County's Represen.ta.tive at least fifteen (15} days prior to a policy's e�iration date except for
any policy expiring on. the expiration date of this contract or thereafter.
4. The County resezves the right to request and receive a copy of any policy aud
any policy endorsemeni ai any time during the term of this contract.
14. Exemptioris and Preferences. All pwrchases of consmuction or building or any other materials
far this contract shall not include Federal Excise Taxes or Colorado State or local sales ox use taxes.
Pitkin County is exempt from such taates under registration numbers 98-02624 and 84-78000-5K.
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Cozttract #
Bndget L'me Item#
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15. Records. The Contractor shall maintain comprehensive, complete and accwrate books, records,
and documents conceining its performauce relating to this cantract for a period of three (3) years after
fiiaal payment under the contract and the County shall have the righi within the three (3} year period to
inspect and audi�t these books, records and documents, upon demand, in a reasonable manx�er and at
reasonable times, for the purpose of detenoaiu�ing, by accepted accounting and auditing standards,
compliaxxce wi.th all provisions of the contract and applicable law.
16. Contract Made in Colorado. The parties agree that this contract was made in accordance with
the laws of the State of Colorado aud sha11 be so construed. Venue is agreed to be exclusively in the
courts of Pitkin County, Colorado.
17. Attorne 's Fees. In the event that legal action is necessary to enforce any of the provisions of
this contract beyond the arbitra.tion described in Paragraph 9, the substantially prevai�g party shall be
entitled to its costs and reasonable attorney's fees.
18. Goveznmental Tmmwnitv, Contractor agrees and understands that Pitkin Cou.nfiy is relyin�g on
and does not waive, by any provision of t�its contract, the m.onetary limitatians or terms (present�y
$150,000 per person and_ $600,Q00 per occurrence) or any other rigb�ts, immunities; and protections
provided by the Colorad.o Governmental Immunity Act, 24-10-101, et seq., C.R.S., as from time to
time amended, or otherwise available to Pitkin CounTy or any of its officers, agents or employees.
Further, nothing in this contract shall be construed or interpreted ta require or provide -for
indemnification of the Contxactor by the County for an.y injury tA any pezson or any properEy damage
whatsoever which is caused by the negligence or other misconduct of the County or its agent or
enaployees.
19. Current Year Obligatioas. • The parties acknowledge and agree that any payments provided
for hereunder or requirements for future appropriations shall constitute only currently budgeted
expenditures of Pitkin County. Pitkin County's obligations under this contract are subject to Pitkin
County's annual right to budget and appropriate the swns necessary to provide the services set forth
herein. No provisions of the contract shall constitute a mandatory charge or requirement in any
ensuing fiscal year beyond the then current fiscal yea�r of Pitkin County. No provision of the contract
shall be constru.ed or interpreted as creating a multiple-fiscal year direct or iu�direct debt or other
fiun.ancial obligation o� Pitkin County within ihe meaning of any constitutional or statutory debt
limitation. This contract sha.11 not directty or indirectly obligate Pitkin County to make any payments
beyond those appropriated for Pitkin Couniy's then current fiscal year. No provisions of this
comtract shall be construed to pledge or create a lien on any class or source of Pitkin County's
moneys, nor shall any provision of this contract restrict the future issuance of Pitkin Couuty's bonds
or any obligatio�as payahle from an� class or source of Fitkin County's money.
20. Notice. Any written notice required by this contract shall be dee�oaed delivered through any of
the following: (1) hand delivery to the pezsan at the addxess below; (2) delivery by facsimile with
confurmation of receipt to the fax number below; or (3) withiri three (3) days of being sent certified first
class mail, postage prepaic3, retuzv. receipt requested addressed as follows:
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Con�-act #
Budget Lin.e Item#
A. To Pitkin County
Don Bird, Jail Administrator
506 E. Main, Dept J
Aspen, Colorado 81611
Faa�: (970} 920-5489
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2/6/2o121m
with copies to:
Pitkin County Attorney's Office
530 E. Main Stxeet, #302
Aspen, Calorado 81611
Fax: (970) 920-5198
B. To Contractor:
Janis Noms, Co�atracts Manager
Colorado West Regional Menta.l Health, Tnc.
515 28 3/4 Road, Sldg. A
Grand Junction, CO 81501
F�: (970) 920-5557
21. Public Contracts for Services and Public Contracts with Natural Pexsons. Tn confoz�nance
with the provisions of C.R.S. § 8-17.5-101 and 102, as amended and C.RS. § 24-76.5-101, as
amended
PUBLIC CONTRACTS FOR SERVICES. CRS §8-17.5-101. [NotApplicable to agree�nents
relating to the offer, issuarice, or sale of securities, investment advisory services or fund
management services, sponsored projects, intergovern�nental agreements, or in�'ormation
technology services or producis and services] Contractor certifies, warra.uts, and agrees that it does
not knowingly employ or contract with an illegal alien who will perform wark under tlus contract
and will confirm the employxnezzt eligibility of all employees who are mewly hired for employment in
the United Sta.tes to per%rm work under this contract, through participation in tlie E-Verify Program
or the Department program established pursuant to CRS §8-17.5-102(5)(c), Contractor shall not
knowingly employ or cantract with an illegal alien to perform work under this contract or enter into a
�ontract with a subcontractor that fails to certify to Contractor that the subcontractor shall not
knowingly eznploy or contract with an illegaJ alien io perform work under this contract. Contractor
(a) shall not use E-Verify Program or Department prograna pzocedures to undertake pre-employment
screening of job applican�ts while ttus contract is being performed, {b} shall not.ify the subcontractor
and the contracting Sta.te agency within three days if Contractor has actual knowledge tha.t a
subcontractor is employing or contracting with an ill.egal alien for work under this contract, (C) shall
terminate the subcontract if a subcontra�tor does not stop employing or coutracting with the illegal
alien withiul three da.ys of receiving the no�ice, and (d) shall comply with reasonable reques#s made in
the course of an investigation, undertaken puxsuant to CRS §8-17.5-102(5), by the Colorado
Depaz�bment of Labox and Emplaynaent_ If Contractor participates in the Department program,
Contractor shall delivez to the cont�acting State agency, Ins-�itution of Higher Education or political
subdivision a wri.tten, notarized affirmatiozx, af6rming that Contractor has examined the legal wark
status of such employee, aud shall comply with all of the other requirements of the Depa�finent
program. If Contractox fails to comply with any requirebaent of this provision. or CRS §8-17.5-101 et
seq., the contracti�ng State agency, institution of higher education ox political snbdj�vision may
term.inate this contract for breach and, if so ternunated, Contractor shall be liable for �ages.
PUBLIC CONTRACTS V�TH NATIJRAL PERSONS. CRS §24-76.5-101. Contractor, if a naturai
person eighieen {18) years of age or older, herehy swears and affirms under penalty of perjury that he
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Contract # Rev 8.31.11 jaa/js
Budget Line Itezn# 2l6/LO12 tm
or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal Iaw, (b)
sha11 conaply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of
identification required by CRS §24-76.5-103 prior to the effective date of this contract.
IN WTTNESS WHEREOF, the parties have executed tbas contract as of the date first set out herein
above.
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PIT.,.$I,�I-..GQ T'Y, C�Q�pO: �
By: '`'' _ ��'' �- `2 � - / Z
Procurement Officer Date -
By
Section Le er Date
0
DATE (MMIDD/YWY)
CERTIFICATE OF LIABILITY INSURANCEIOnsi2oiz 2�24�ZO�2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
PRODUCER Lockton Companies, LLC Denver
8110 E. Union Avenue
Suite 700
Denver 80237
(303)414-6000
INSURER A :
'"'"""' Colorado West Regional Mental Health, IIIC. INSURER B:
1321975 p0 Box 40 iNSUrtert c: Travelers Property Casualty Co of America
Glenwood Springs, CO 81602 INSURER D:
COVERAGES COLWE03 EB CERTIFICATE NUMBER: 11669549 REVISION NUMBER: XXX?CXX?C
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 REOUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE ADD SUBR pOLICY NUMBER MM/DD EFF MOM,LDI p EXP ��M��
LTR
A GENERALl1ABILITY Y N W110F5100201 10/18/2011 . 10/18/2012
X MMERCIAL GENE ILITY DAMAGE TO RENTED
A Retro Date GL 10/18/2009 PREMISES Ea occunence) $ 50 �Q�
X CLAIMS-MADE �OCCUR MED EXP M one rson
� PERSONAL & ADV INJURY s Included
X Sexual Abuse $1M/$1M GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: ' PRODUCTS - COMP/OP AGG
X POLICY E�T LOC $
$ AUTOMOBILE LIABILITY � j�j N BA-7A398706-IND-11 10/18/2011 10/18/2012 �Ea accident) $
X ANY AUTO BODILY INJURY (Per person) 5
ALL OWNED SCHEDULED BODILY INJURY Per awident $�} �
X HI�R DSAUTOS X NON-OWNED PROPERTY DAMAGE $ XXX���XX
AUTOS
s )�XXXXXX
UMBRELLA LIAB pCCUR NOT APPLICABLE EACH OCCURRENCE $ XX}�' {}�X
EXCESS L�AB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION NOT APPLICABLE �
AND EMPLOYERS' LIABILITY Y� N TORY LIMITS ER
ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ N� A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED7
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ XXXXXXX
Ifyes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Prof.Liab. N N W110F5100201 10/18/2011 10/18/2012 $1MperIncident
Retro Date: 10/18/2007 $3M Aggregate
Claims Made $0 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space is required) �
Property coverage - Insuter C. $17,762,955 Buildings; $3,451,524 BPP; $23,266,000 BIEE; $1,524,303 EDP; RC 52,500 Deductible. The certificate holder and Pitkin County,
iPs subsidiary, parent, associated and/or a�liated entilies, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers are named as additional
insured with respect to liability and defense of suits arising out of the activities performed by, or on behalf of the contractor, mcluding completed operations.
,I_\IL�liJ
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
11669549
Pitkin County Boazd of Commissioners
530 E. Main St., 3rd Floor
Aspen CO 81611
/CS I'l. I -( Ca
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