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Home My WebLink Aboutbocc.con.095.2013A Rev. 08-30-Ws 11111,1r COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: 95.2013A ORIGINATING DEPARTMENT: Facilities PROCUREMENT OFFICER: Jodi Smith PHONE #: 9205396 PROJECT NAME: Upper Red Mountain Tower Repair Project CONTRACTOR: Grove Steelworks, Inc. DOLLAR AMOUNT: $1,426.00 LINE ITEM # 003.77.00754.82000 CONTRACT EXECUTION DATE: 12/26/2013 CONTRACT END DATE: 7/31/2014 AUTOMATIC RENEWAL: ❑ YES ® NO TERM: 9-month extention El BOCC AGENDA ITEM (Grants, IGA) ® STAFF AUTHORIZED SIGNATURE (Requires BOCC Signature) (Per Revised Procurement Code 7/2005) El OVER$50,000 (Requires Section Leader& County Manager's Signature) ✓ CHECK PROCUREMENT TYPE: El None El Informal El Formal El Sole Source ❑ Emergency El Outside Agency/State Bid ❑ Compliance with C.R.S. 8-17-5-101, 102 as amended(Immigration Form) ❑ Exempt ® Contract Renewal • ✓ CHECK CONTRACT TYPE: N Services/Maintenance El Employment El License/Use [' Intergovernmental Agreement(Resolution Required) ❑ Lease El Non-Profit El Construction ❑ Quasi-Public(e.g:AVH) El Goods, Equipment, Supplies El Grant Agreements(Notify Finance& Resolution Required) ❑ Other(e.g. revenue) ® Change Order/Contract Amendment (CO: 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: ✓ El No Pages Missing ✓❑ All Other Blanks Filled In ✓ El If Page Left Intentionally Blank—Note on Page ✓❑ All Exhibits Attached ✓ El Page numbered consecutively ✓❑ All Legal Descriptions attached (if applicable) ✓ El All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (if applicable) ✓ El All Dates Filled In ✓❑ Warranty(if applicable) ✓ El Special Instructions for Finance Department: ✓ El Authorized Procurement Officer's Name: BY CHECKING ABOVE AND ENTERING NAME,THE AUTHORIZED STAFF PERSON INDICATES THAT THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING. NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST! Contract#952013 Rev. 8.31.11 jaa js Budget Line Item#003.77.00754.82000 cjig ON rr T11 CHANGE ORDER/CONTRACT AMENDMENT Change Order Number: 95.2013A OWNER: Pitkin County Facilities Management 485 Rio Grande P1,#101 Aspen, Colorado 81611 CONTRACTOR: Grove Steelworks P.O. Box 185 New Castle, CO 81647 The Upper Red Mountain Tower Repair Project (the "Agreement") dated October 10, 2013 between the Board of County Commissioners of Pitkin County (the "Count}") and Grove Steelworks (the "Contractor"), is hereby amended as follows: Description of Change: The term of this contract is hereby extended from November 1,2013 to July 31,2014. Reason for Change The contract completion date has been extended due to weather conditions and no access to the site. Original Contract Price $ 1,426.00 Net Increase/Decrease in Contract Price(this change order) $ 0 *Total Adjusted Contract Price(including this change order) $ 1.426.00 This change order extends the time to complete work by July 31,2014. In all other—respects the Agreement is in full force and effect and remains unchanged by this Amendment. / � 4 !f.^ l.�l�it/,j Grow Stee rks,' .*• tor Date / / /0 . 6 • — Jodi Smith, Pitkin County Facilities Supenn endent Date N/A County Manager Date *Increases over$25,000 and/or 10% (single increase or accumulative)of original contract must have County Manager signature. GROVE-1 OP ID:CO A.CORE," CERTIFICATE OF LIABILITY INSURANCE OAT 10/11DIYYYY) 10111113 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. 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 Phone: 970-945-9161 CONTACT GIA Group/Glenwood Ins.Agency PHONE FAX P 0 Box 1270 Fax:970-945-6027 (A/C,No.Eal: I(A/C,No): Glenwood Springs,CO 81602-1270 E-MAIL Nanette R.Avery ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL Y • INSURER A:Progressive Insurance Company 24260 • INSURED Grove Steelworks,Inc. INSURER E:Acuity 14184 PO Box 185 New Castle,CO 81647 INSURER C: INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF ADOL SUER POLICY EFF POLICY EXP LIMITS LTR INSR V/VD POLICY NUMBER (MM/DOIYYYY) (MM/DDIYYVY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY K80879 12/01/12 12/01/13 DAMAGETORENTED 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) _ $ 5,000 PERSONAL&ADM INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CAMP/OP AGG $ 2,000,000 G 7 POLICY jE i 1-1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 300,000 (Es accident A ANY AUTO 01783092-0 08/09/13 08/09/14 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS ATOS ( r accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,II more space is required) • CERTIFICATE HOLDER CANCELLATION _ PITKI-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pitkin County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ty ACCORDANCE WITH THE POLICY PROVISIONS. 920-5230 to:jodi.smith @co.pitkin.co.us 530 E. Main AUTHORIZED REPRESENTATIVE Aspen, CO 81611 C)19888.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • Contract it zo 3 9/27/11 kj/lm Budget Line Remit 441) 11 N �QD�1N 'r' Workers' Compensation Waiver Sole Proprietorships or Partnerships 1, , as sole proprietor or partner of business name), represent that I have no person or persons in my employ, but that I shall obtain and maintain workers' compensation protection pursuant to those insurance requirements as set forth in the Workers' Compensation Act of Colorado (Articles 40 to 54 of Title 8 of the Colorado Revised Statutes)for any and all persons as I may employ in performing any work in the future. I shall also require any subcontractor as 1 may contract with or obtain for any work to maintain workers' compensation protection for its eniployees. Contractor Signature Date Print Name Corporations / . I e , in my capacity as e (title) of 6tc'. Vet iwo.,-u S ,t L(corporation name) represent that L vt S( aii-od,c.l:C, 7:P--L_ (corporation name) has no person or persons in its employ and that each stockholder of Lim r • zr c (corporation name) owns at least 10%ofL-1-t. + .-r) • 's(corporation name) stock, but that 64Ct9X S=kz-e rJ (corporation name) shall obtain and maintain workers' compensation protection pursuant to those insurance requirements as set forth in the Workers' Compensation Act of Colorado (Articles 40 to 54 of Title 8 of the Colorado Revised Statutes) for any and all persons as it may employ in performing any work in the future. (z-2 -t- S7-?-414-06 7Luc (55poration name) shall also require any subcontractor it may contract with or.obta- vier any work to maintain workers' compensation protection for its eniployees. , / i/r A3 Con tea* or Si„ Date yea C� iT_.ve Print Name