HomeMy WebLinkAboutbocc.con.408.2016 CONTRACCITTN 44/al
RESOLUTION OF THE BOARD OF COUNTY C 44/ Lka
COMMISSIONERS OF PITKIN COUNTY,COLORADO,
APPROVING A LEASE AGREEMENT BETWEEN
PITKIN COUNTY ("COUNTY")AND ASPEN
HOMELESS SHELTER FOR SPACE AT THE
MICHAEL W. SCHULTZ HEALTH AND HUMAN
SERVICES BUILDING("HHS")
RESOLUTION NO. NG , 2016
RECITALS:
1 Pursuant to Section 2.8 (Actions) of the Pitkin County Home Rule Charter, the
Board of County Commissioners is authorized to approve matters of significant
importance, not requiring ordinance power, by Resolution.
2. Pitkin County("County") is the owner of the premises knows as the Michael W.
Schultz Health and Human Services Building ("HHS"), located at 405 Castle Creek
Road. Aspen, Colorado
3. The County has provided space as an in-kind contribution to local non-profit entities
on a yearly lease basis since 1992 The County desires to continue this practice.
4. Aspen Homeless Shelter desires to continue to lease space at the HHS.
5. The County supports the Community Non-Profit Lessees for uses that have been
established since 1992 and desires to continue such use by accommodating space for
Aspen Homeless Shelter at HHS
6. The BOCC finds that it is in the best interests of the citizens of Pitkin to approve
a lease agreement with Aspen Homeless Shelter for space at HHS
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Pitkin County, Colorado that-
1. It adopt and authorize the Chair to sign the Resolution and to execute the lease
agreement in Attachment A in its present fomt or in a substantially similar form
approved by the County Attorney
2. It further authorizes the County Manager to sign any future amendments or
extensions to the lease agreement in a form satisfactory to the County Attorney.
INTRODUCED AND FIRST READ ON THE / DAY OF 121 L3< ✓ ,2016
AND ET FOR SECOND READING AND PUBLIC HEARING ON THE g/4 DAY
OF t✓fd[41?PV 2016.
NOTICE OF PUBLIC HEARING AND TITLE AND SHORT SUMMARY OF THE
RE UTION PUBLISHED IN THE ASPEN TIMES WEEKLY ON THE -e DAY
O tJ yy , 2016
NOTICE OF PUBLIC HEARING AND THE FULL TEXT OF THE RESOLUTION
POSTED ONN/ITHE OFF(_FYAL)PITKIN COUNTY WEBSITE (www pitkineounty.com)
ON THE It& DAY OF ..e p jy 2016.
ADOPTWIFTER FINAL READING AND PUBLIC HEARING ON THE ',/
DAY OF I✓.4 L..¢ ✓ 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY, TER ADOPTION, IN THE
ASPEN TIMES WEEKLY ON THEA.4 DAY OF C ✓ , 2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFpC4AL PITKIN COUNTY
WEBSITE (www.pitkincounty.com ) ON THE 13 ue DAY OF \ .cec-1,2n v 2016.
ATTEST. BOARD OF COUNTY COMMISSIONERS
1
By : � . r, Ld14,v By �� i e110)
Deane Jones aI N,che) E Ric �ards, Chair
Depu0 County Clerk `i
Date: 19 ., /- �O/6
APPROVED AS TO FORM MANAGER APPROVAL l I
John Ely,Coun tomcy Jon P a ock, County Mana r
Al TKIN
COUNTS CONTRACT ���L
LEASE AGREEMENT BETWEEN
ASPEN HOMELESS SHELTER
AND PITKIN COUNTY, COLORADO
Contract Number f/n3-)6(6,Ledger Number
This lease agreement is made and entered into on the 1st day of January, 2017, by and
between Aspen Homeless Shelter, hereinafter referred to as "Lessee/Agency", and the County of
Pitkin in the State of Colorado hereinafter referred to as the "County/Lessor'.
Whereas, Aspen Homeless Shelter desires to rent an office space in the Michael W. Schultz Health
and Human Services Building, (hereinafter referred to as the Schultz Health and Human Services
Building) 0405 Castle Creek Road, Aspen, CO, more fully described as Aspen Valley Hospital Sub
Lot: 1 Parcel A Health & Human Services Bldg., of approximately 1,298.5 square feet for the 2017
calendar year.
Now, therefore, in consideration of the mutual covenants and promises contained herein, the parties
agree as follows:
1) Term and Renewal of Agreement: The County/Lessor hereby leases and demises for calendar
year 2017 to Aspen Homeless Shelter the area designated as Suites 107, 108 and 109 in the
Schultz Health and Human Services Building. Absent any termination for cause under paragraph
16 of this Agreement, this Agreement shall be for a period of one (1) year unless either party
elects to terminate this Agreement by serving a written notice to terminate this Agreement on the
other party no later than thirty (30) days.
2) No Waste or Damage Covenant: During the period of this lease agreement Aspen Homeless
Shelter shall maintain these offices in good shape and repair and return them to the County/Lessor
in substantially the same condition received normal wear excepted.
3) Damage to property: In the event of damage to the lessee's offices or to any part of the building,
the lessee will be responsible for all repair costs. Assessment of damage and assignment of entity
to provide the repair shall be the responsibility of Pitkin County Facilities. Negotiation of
remediation of each incident shall occur with Pitkin County Facilities.
4) Payment: The rent is $25.75 per square foot per year for the space rented by Aspen Homeless
Shelter totaling $33,436.38; however, the County/Lessor shall provide an in-kind rent
contribution of$33,436.38 to Aspen Homeless Shelter.
5) Governing Law and Venue: This lease agreement has been entered into in the State of Colorado,
and the validity, interpretation and legal effect of this agreement shall be governed by the laws of
the State of Colorado. Jurisdiction for any disputes hereunder shall be in the courts in and of
Pitkin County and the State of Colorado.
1
6) Remodels To Premises: No remodeling or painting is to be done to premises without the written
consent of the County/Lessor. This includes any alterations to the walls and ceilings to
accommodate phone and data lines, cable service, electrical outlets and light fixtures. Remodels
will be done at the Lessee/Agency's cost unless the remodel is addressing a health or safety issue.
County/Lessor must approve any credit of cost of remodeling before work commences.
7) Responsibilities:
A.The Facilities Department of the County/Lessor is NOT responsible to move,build, haul, repair
or dispose of office furnishings (including but not limited to bookshelves, desks, appliances,
cabinets, etc.)owned by nonprofits leasing space within the county buildings. In the event that
the facilities staff is asked to move, re-build, build, haul, repair or dispose of said office
furnishings the nonprofit may be billed for work, including time, materials, travel time and
landfill fees. The Facilities Department will be responsible for moving the nonprofit in the
event that the County/Lessor has a need for the office space occupied by the nonprofit.
B. The Facilities Department is responsible for carpets, building repairs, capital upgrades,
heating/cooling, plumbing, and electrical (infrastructure), internal painting on a set schedule,
daily trash removal and common area cleaning. Requests for additions to the infrastructure
such as new or relocated outlets, moving cables, etc. shall be evaluated by the Facilities
Manager on a case by case basis. Lessee/Agencies will be asked to pay for upgrades.
8) Building Concerns and Complaints: For issues regarding the physical operation of the building
contract facilities at the following:
• All non-emergency requests should be sent as work order requests through Cartegraph
at https://cartegraph.pitkincounty.com/Cartegraph/InternalRequest.
• For emergency issues please contact facilities at (970) 920-5377 during regular
business hours.
• Between hours of 6pm-6am call our standby technician at(970)471-8392 (emergencies
after-hours only).
9) Non-Assignment: This lease agreement and the rights arising under it shall not be assigned or
transferred by Aspen Homeless Shelter.
10) Occupancy Requirement: Pitkin County leases space in the Schultz Health & Human Services
Building to non-profit agencies that help further the community's access to health and human
services. In order to best meet community needs, the County holds the right to cancel any lease
agreement with a tenant that does not occupy their space and actively provide services to the
community on an ongoing basis. Any lease for office space that is not actively used over the
period of three months will be reviewed and the lease may be revoked by the County.
11) Binding Effect: This lease agreement shall be binding upon the parties hereto, their respective
heirs, successors and assigns.
12) Covenant of Non-Interference: Aspen Homeless Shelter agrees to undertake its activities in the
2
leased premises in a manner which will not interfere with other tenants and activities in the
building.
13) Utilities: The County/Lessor shall supply heating and electricity to the leased premises at no
additional charge.
14) Phones and data: Aspen Homeless Shelter shall provide its own phone service and Internet
connections.
15) Use of Photocopier: The County/Lessor shall supply an operating photocopying machine and
copying paper for the use of tenants at a cost of$0.02 per copy. This will be billed quarterly.
16) Termination for Cause and Unsuitability: In the event that the Lessee/Agency shall default by
failing to perform, keep and observe any of the terms, covenants or conditions herein contained on
its part to be performed, as determined by the County, or the building or leased premises become
damaged or un-tenantable for any reason during the term hereof, the County/Lessor shall have the
right to declare this lease terminated and require Aspen Homeless Shelter to vacate the premises,
whereupon the parties shall have no further obligations hereunder.
17) Indemnification: Lessee/Agency shall indemnify, hold harmless and, not excluding the
County/Lessor's right to participate, defend the County/Lessor and its officers, officials, agents,
and employees (hereinafter referred to as "County/Lessor') from and against any and all
liabilities, claims, actions, damages, losses, or expenses including without limitation reasonable
attorneys' fees and costs, (hereinafter referred to as "claims") for bodily injury or personal injury
including death, or loss or damage to tangible or intangible property caused, or alleged to be
caused, in whole or in part, by the negligent or willful acts or omissions of Lessee/Agency or any
of its County/Lessor's, officers, directors, agents, employees or contractors, arising out of or
related to Lessee/Agency's occupancy and use of the Leased Premises. It is the specific intention
of the parties that the County/Lessor shall, in all instances, except for claims arising solely from
the negligent or willful acts or omissions of the County/Lessor, be indemnified by Lessee/Agency
from and against any and all claims. It is agreed that Lessee/Agency will be responsible for
primary loss investigation, defense and judgment costs where this indemnification is applicable.
In consideration for the use and occupancy of the Leased Premises, the Lessee/Agency agrees to
waive all rights of subrogation against the state, its officers, officials, agents and employees for
losses arising from the use, occupancy or condition of the Leased Premises.
18) Non-Waiver: The parties hereto understand and agree that the County/Lessor is relying on, and
does not waive or intend to waive by any provision of this Contract, the monetary limitations or
any other rights, immunities, and protections provided by the Colorado Governmental Immunity
Act et seq., as from time to time amended, or otherwise available to the County/Lessor, its
subsidiary, associated and/or affiliated entities, successors, or assigns; or its elected officials,
employees, agents, and volunteers.
19) Insurance Requirements: Lessee/Agency shall procure and maintain for the duration of the Lease,
insurance against claims for injury to persons or damage to property which may arise from or in
3
connection with this Lease.
The insurance requirements herein are minimum requirements for this Lease and in no way limit
the indemnity covenants contained in this Lease. The County/Lessor in no way warrants that the
minimum limits contained herein are sufficient to protect the Lessee/Agency from liabilities that
might arise out of this Lease. Lessee/Agency is free to purchase such additional insurance as
Lessee/Agency determines necessary.
A. Minimum Scone and Limits of Insurance: Lessee/Agency shall provide coverage with
limits of liability not less than those stated below. An excess liability policy or umbrella
liability policy may be used to meet the minimum liability requirements provided that the
coverage is written on a"following form"basis.
a. Commercial General Liability — Occurrence Form Policy shall include bodily
injury, property damage and liability assumed under an Insured Contract including
defense costs.
i.The policy shall be endorsed to include the following additional insured
language: " County/Lessor, its subsidiary, parent, associated and/or affiliated
entities, successors, or assigns. its elected officials, trustees. employees,
agents, and volunteers shall be named as additional insureds with respect to
liability arising out of the activities performed by, or on behalf of the
Contractor".
ii.A Waiver of Subrogation shall apply in favor of the County/Lessor, its
subsidiary, parent, associated and/or affiliated entities, successors, or assigns,
its elected officials, trustees, employees, agents, and volunteers.
Minimum Limits:
General Aggregate $ 2,000,000
Products/Completed Operations Aggregate $ 2,000,000
Each Occurrence Limit $ 1,000,000
Personal/Advertising Injury $ 1,000,000
Fire Damage Expense $ 1,000,000
Premises Medical Expense (Each Person) $ 5,000
b.Property Insurance
i.Tenant shall be responsible for insuring its own property.
ii.The County/Lessor shall be named as a loss payee on property coverage for
tenant improvements and betterments.
iii. Property insurance shall be written on a Covered Cause of Loss-Special Form,
replacement cost coverage, including coverage for flood and earth movement.
iv.A waiver of subrogation applies in favor of the County/Lessor for any Lessor
Property.
4
Coverage for Lessee/Agency's Tenant 100%replacement cost
Improvements, Fixtures
Coverage for Loss of Rents Amount equal to all Minimum
Annual Rent and other sums payable
under the lease
c.Worker's Compensation and Employers' Liability
Minimum Limits:
Coverage A (Workers' Compensation) Statutory
Coverage B (Employers Liability) $ 100,000
$ 100,000
$ 500,000
B. Additional Insured Requirements: The policies shall include, or be endorsed to include,
the following provisions:
a.On insurance policies where the County/Lessor is named as an additional insured, the
County/Lessor shall be an additional insured to the full limits of liability purchased by
the Lessee/Agency even if those limits of liability are in excess of those required by
this Lease.
C. Notice of Cancellation: Each insurance policy required by the insurance provisions of this
Contract shall provide the required coverage and shall not be suspended, voided or canceled
except after thirty (30) days prior written notice has been given to the County/Lessor, except
when cancellation is for non-payment of premium, then ten (10) days prior notice may be
given. Such notice shall be sent directly to:
Jodi Smith, Facilities Director
485 Rio Grande Place, Unit#101
Aspen, Colorado, 81611
Fax (970) 920-5285
iodi.smithi2i pitkincounty.com
If any insurance company refuses to provide the require notice, the Contractor or its
insurance broker shall notify the County/Lessor of any cancellation, suspension, non-renewal
of any insurance within seven (7) days of receipt of insurers' notification to that effect.
D. Acceptability of Insurers: Insurance is to be placed with insurers duly licensed or authorized
to do business in the state of Colorado and with an "A.M. Best" rating of not less than A-
VII. The County/Lessor in no way warrants that the above-required minimum insurer rating
is sufficient to protect the Contractor from potential insurer insolvency.
5
E. Verification of Coverage: Lessee/Agency shall furnish the County/Lessor with certificates
of insurance(ACORD form or equivalent approved by the County/Lessor) as required by this
Lease. The certificates for each insurance policy are to be signed by a person authorized by
that insurer to bind coverage on its behalf
All certificates and any required endorsements are to be received and approved by the
County/Lessor before the Lease commences. Each insurance policy required by this Lease
must be in effect at or prior to commencement of this Lease and remain in effect for the
duration of the Lease. Failure to maintain the insurance policies as required by this Lease or
to provide evidence of renewal is a material breach of contract.
All certificates required by this Lease shall be sent directly to:
Jodi Smith, Facilities Director
485 Rio Grande Place, Unit#101
Aspen, Colorado, 81611
Fax (970) 920-5285
jodi.smith@,pitkincounty.com
The Pitkin County Facilities Department, Lease agreement number, and location description
are to be noted on the certificate of insurance. The County/Lessor reserves the right to
require complete, certified copies of all insurance policies and endorsements required by this
lease at any time. DO NOT SEND CERTIFICATES OF INSURANCE TO THE
COUNTY/LESSOR's RISK MANAGEMENT DEPARTMENT.
F.Approval: Any modification or variation from the insurance requirements in this Agreement
shall be made by Risk Management, whose decision shall be final. Such action will not
require a formal contract amendment, but may be made by administrative action.
20)Termination: This agreement may be terminated at any time for any cause by either party by 30-
day written notice to the other party at the addresses set forth below.
21)Removal of Property: It shall be the responsibility of the Aspen Homeless Shelter at its own sole
cost and expense, within five days after the expiration of this Agreement, to remove office
equipment from the premises. Any equipment not removed within this period of time shall be
conclusively deemed to be abandoned by Aspen Homeless Shelter and shall become the property
of the County/Lessor.
22) Attorney's Fees: In the event legal action is necessary to enforce any of the provisions of this
Agreement, the substantially prevailing party shall be entitled to its costs and reasonable
attorney's fees.
23)Grant Award Contingency: The Aspen Homeless Shelter acknowledges that occupancy of the
6
premises is contingent upon satisfactory and timely compliance with the terms, obligations and
provisions set forth in the Gram Award Agreement and that the parties' rights and obligations
pursuant to this Lease Agreement will terminate automatically upon termination or cancellation of
the Grant Award Agreement between Pitkin County and the Aspen Homeless Shelter.
Termination of this Lease Agreement shall occur upon thirty (30) days written notice to the
address set forth below. Upon termination of this Lease Agreement, Lessee/Agency shall vacate
the premises. Lessee/Agency shall be responsible to County/Lessor for the cost of repairs, legal
fees, advertising and any other costs incurred in preparing the premises for re-renting.
24)Notice. Any notice required or permitted under this Agreement shall be in writing and shall be
hand-delivered or sent by registered or certified regular mail, postage pre-paid to the addresses of
the parties as follows. For the purpose of counting days for the notice period, the period shall
commence three days from the date of the postmark of the letter as mailed. Each party by notice
sent under this paragraph may change the address to which future notices should be sent.
Electronic delivery of notices shall also be deemed sufficient and considered delivered upon
receipt of confirmation of delivery on the part of the sender. The address for the Lessor and the
Lessee for notice are as follows:
To Lessor: With a Copy To:
Board of County Commissioners of Pitkin County John M. Ely, Esq.
C/O Facilities Director Pitkin County Attorney's Office
485 Rio Grande Place#101 123 Emma Rd. Ste.204
Aspen, Colorado 81611 Basalt, Colorado 81621
To Lessee/Agency:
Vince Savage, Director
405 Castle Creek Rd., Suite 107
Aspen, CO 81611
25)Severability: If any provision of this lease shall be declared invalid or unenforceable, the
remainder of the lease shall continue in full force and effect.
7
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed as of the
latest date written below.
LESSEE: ASPENHOMEELLESS SHELTER
ByVince .i age i_..------- 19-,0-16
Vince Savage 4 Date
Executive Director,Aspen Homeless Shelter
PITKIN COUNTY, COLORADO:
B a
11-171k
Jodi Smith Date
Pitkin County acilitiesitDirector
By f UL 1Y-- ir.c1 .P lz -Zp'`co
Jo
137:S
acock, Date
County Manager_. -- --,
By /3b/G
John EI Date
CIMO Attorney J ' ,
i Al
Wide/
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8
oA SECURA INSURANCE, A Mutual Company
S ECU RA P. 0. BOX 819 APPLETON, WI 54912-0819
,...,.,.,.o.,..11 COMMON POLICY DECLARATIONS
RENEWAL DECLARATION
POLICY NO. 20-CP-003216965-7/000
RENEWAL OF 20-CP-00321696S-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: From 01/02/2017 tO 01/02/2018 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
ATTACH THIS RENEWAL DECLARATION TO YOUR POLICY.
THIS POLICY IS BEING RENEWED AT RATES IN EFFECT ON THE DATE OF RENEWAL.
PROGRAM: HUMAN SERVICES
THE MANED INSURED 1S : MON PROFIT BUSINESS DESC : NONPROFIT HOMELESS SHELTER
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, WE AGREE WITH YOU TO PROVIDE INSURANCE AS STATED IN THIS
POLICY.
THIS POLICY CONSISTS OF TAE FOLLOWING COVERAGE PARTS FOR WHICH A
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
PREMIUM
COMMERCIAL PROPERTY NOT COVERED
COMMERCIAL GENERAL LIABILITY 2,360
COMMERCIAL CRIME NOT COVERED
COMMERCIAL INLAND MARINE NOT COVERED
ESTIMATED TOTAL PREMIUM $2,360
This is not a bill - Invoice to follow.
Total premium is payable in monthly installments.
FORMS AND ENDORSEMENTS APPLICABLE TO ALL COVERAGE PARTS
PLI4001 1501* IL0917 (11-98) IL0228 (04-06) ALD9999 0711 1L80020 0304 ILE7000 0301
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMIT POLICY CONDITIONS,
COVERAGE FORK(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED AT: DATE: BY:
AUTHORIZED REPRESENTATIVE
origi net 1500DM
IL 0019 9601 11-23-16 AMT 1D202 Page 1 of 3
5N SECURA INSURANCE, A Mutual Company
SECURA P. O. BOX 819 APPLETON, Wi 54912-0819
,..•.«_••>.,.«•, COMMERCIAL GENERAL LIABILITY
RENEWAL DECLARATION
POLICY NO. 20-CP-003216965-7/000
RENEWAL OF 20-CP-003216965-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: From 01/02/2017 to 01/02/2018 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
ATTACH THIS RENEWAL DECLARATION TO YOUR POLICY.
LIMITS OF INSURANCE
GENERAL AGGREGATE $ 2, 000, 000
PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ 2, 000, 000
PERSONAL INJURY & ADVERTISING INJURY $ 1, 000, 000
EACH OCCURRENCE $ 1, 000, 000
DAMAGE TO PREMISES RENTED TO YOU $ 1, 000, 000 ANY ONE PREMISES
MEDICAL EXPENSE $ 10, 000 ANY ONE PERSON
STATE-1
LOCATION OF ALL PREMISES YOU OWN, RENT OR OCCUPY:
LOC N 1: 405 CASTLE RD, ASPEN, CO 81611
PMS PDTS
LOC CLASSIFICATION CODE PREMIUM BASIS RATE RATE
1 HUNAN SERVICES PREMISES IOC - HIGH 20003 TOTAL EXPEND 180,000 4.194 INCL
PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT
SGE 2001 1001 : HUMAN SERVICES
SGE 2010 1001 : PROFESSIONAL LIABILITY COVERAGE
Each WfongfUL Act 51,000,000
Aggregate 52,000,000
SPECIFIED PROFESSION: COUNSELING
CGT1000 1001 : GENERAL LIABILITY WRAP
Original
CPP 4506 9601 11-23-16 ANT 10207 Page 2 of 3
V SECURA INSURANCE, A Mutual Company
S EC U RA P. O. BOA 819 APPLETON, WI 54912-0819
COMMERCIAL GENERAL LIABILITY
RENEWAL DECLARATION
POLICY NO. 20-CP-003216965-7/000
RENEWAL OF 20-CP-003216965-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: Frog 01/02/2017 to 01/02/2018 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
ATTACH THIS RENEWAL DECLARATION TO YOUR POLICY.
SGE 2015 1001 : ABUSE AND MOLESTATION COVERAGE
Each Incident $1,000,000
Aggregate $2,000,000
SGE 1000 1001 : HUMAN SERVICES LIABILITY WRAP
TERRORISM RISK INSURANCE ACT (ANNUAL) CHARGE IS $46
GENERAL LIABILITY ADVANCE PREMIUM $2,360
FORMS AND ENDORSEMENTS
APPLYING TO COMMERCIAL GENERAL LIABILITY COVERAGE PART AND RADE PART OF THIS POLICY AT TIME OF ISSUE:
11.0021 (02-02) C60067 (03-05) 060001 (12-04) C62107 (05-14)* C62147 (02-98) 1E0125 (11-13)
1LE0196 9309 11.1.0195 9812 SIE 1000 1001 C62157 (09-981 C62146 (07-98) C62162 (12-041
11E0197 9910 SGE 2001 1001 SGE 2010 1001 002426 (07-04) CGT1000 1001 SGE 2015 1001
SGE 1000 1001 ILE 0465 1009 SGE 2103 1001 SGE 2104 1001 SGE 2105 1001 SGE 2106 1001
56E 2401 1001 SGE 2137 1001 C62170 (01-15) CG2169 (01-02) CO2187 (01-15)
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, If APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS,
COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, If ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED AT: DATE: 0Y:
AUTHORIZED REPRESENTATIVE
Original
CPP 4506 9601 11-23-16 ANT ID202 Page 3 of 3
C SECURA INSURANCE, A Mutual Company
S E C U R A P. 0. 00% B19 APPLETON, N1 56912-0819
COMMON POLICY DECLARATIONS
EXTENDED NAMED INSURED
POLICY NO. 20-CP-003216965-7/000
RENEWAL OF 20-CP-003216965-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: Fro* 01/02/2017 to 01/02/2010 AT 12:01 A.M. STANDARD TIME AT YOUR NAILING ADDRESS SHOWN ABOVE.
AUTHORIZED REPRESENTATIVE
Original
11-23-16 ANT ID202 Page 1 of 1
SECURA INSURANCE, A Mutual Company
S ECU RA P. 0. DON 819 APPLETON, VI 54912-0819
im.eaacA co. .wm FORMS SCHEDULE
POLICY NO. 20—CP-003216965-7/000
RENEWAL OF 20-CP-003216965-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: from 01/02/2017 to 01/02/2018 Al 12:01 A.N. STANDARD TINE AI YOUR NAILING ADDRESS SUM ABOVE.
COMMON POLICY FORMS
PLI4001 1501* DISCLOSURE PURSUAN TO TRIA — TERRORISM COV NOTICE
IL0017 (11-98) COMMON POLICY CONDITIONS
IL0228 (04-06) COLORADO CHANGES — CANCELLATION & NONRENEWAL
ALD9999 0711 OFFICER SIGNATURE PAGE
ILE0020 0304 MUTUAL COMPANY PARTICIPATION PROVISIONS
ILE7000 0301 MULTIPLE DEDUCTIBLE COORDINATION
COMMERCIAL GENERAL LIABILITY FORMS
IL0021 (07-02) NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT
CG0067 (03-05) EXCLUSION —VIOLATION OF STATUTES THAT GOVERN EMAIL
CG0001 (12-04) COIMIERCIAL GENERAL LIABILITY COVERAGE FORM
CG2107 (05-14)* EXCL—ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PEASE
CG2147 (07-98) EMPLOYMENT—RELATED PRACTICES EXCLUSION
IL0125 (11-13) COLORADO CHANGES — CIVIL UNION
ILE0196 9309 LEAD LIABILITY EXCLUSION
ILE0195 9812 ASBESTOS EXCLUSION
SIE 1000 1001 HUMAN SERVICES AMENDATORY
CG2157 (07-98) EXCLUSION — COUNSELING SERVICES
CG2146 (07-98) ABUSE OR MOLESTATION EXCLUSION
CG2167 (12-04) FUNGI OR BACTERIA EXCLUSION
ILE0197 9910 PUNITIVE DAMAGES EXCLUSION
SGB 2001 1001 PROFESSIONAL LIABILITY SCHEDULE — HUMAN SERVICES
SGE 2010 1001 PROFESSIONAL LIABILITY COVERAGE FORM
CG2426 (07-04) AMENDMENT OF INSURED CONTRACT DEFINITION
CGT1000 1001 GENERAL LIABILITY WRAP
SGE 2015 1001 ABUSE AND MOLESTATION COVERAGE
SGE 1000 1001 HUMAN SERVICES LIABILITY WRAP
ILE 0465 1009 TWO OR MORE COVERGE FORMS OR POLICIES ISSUED BY US
SGE 2103 1001 EXCLUSION — LIQUOR LIABILITY
SGE 2104 1001 EXCLUSION — ASSAULT AND BAIKBRY
SGE 2105 1001 EXCLUSION — FIREWORKS
SGE 2106 1001 EXCLUSION — AMUSEMENT DEVICES
SGE 2401 1001 EXCESS PROVISION
SGE 2137 1001 EXCLUSION — MEDICAL PAYMENTS FOR VOLUNTEERS
CG2170 (01-15) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
CG2169 (01-02) WAR OR TERRORISM EXCLUSION
CG2187 (01-15) CONDITIONAL EXCL OF TERRORISM(RELATING TO DISPOSTN
* Forms revised during the previous policy term or added as part of the renewal.
current editions of these forms are included with the Original copy of the Renewal.
Original
11-23-16 ART 10202 Page 1 of 2
SECURA INSURANCE, A Mutual Company
S ECU RA P. 0. BOX 819 APPLETON, WI 56912-0819
FORMS SCHEDULE
POLICY NO. 20-CP-003216965-7/000
RENEWAL OF 20-CP-003216965-6
ACCOUNT NUMBERz 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND NAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: Fro. 01/02/2017 to 01/02/2018 AT 12:01 A.N. STANDARD TINE AT YOUR NAILING ADDRESS SHOWN ABOVE.
AUTHORIZED REPRESENTATIVE
Original
11-23-16 ANT 1D202 Page 2 01 2
V' SECURA INSURANCE, A Mutual Company
S E C U RA P. O. BOX 819 APPLETON, WI 54912-0819
COMMON POLICY DECLARATIONS
RENEWAL DECLARATION
POLICY NO. 20-CP-003216966-7/000
RENEWAL OF 20-CP-003216966-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: Fret 01/02/2017 to 01/02/2018 AT 12:01 A.R. STANDARD TIME AT YOUR NAILING ADDRESS SHOWN ABOVE.
ATTACH THIS RENEWAL DECLARATION TO YOUR POLICY.
THIS POLICY IS BEING RENEWED AT RATES IN EFFECT ON THE DATE OF RENEWAL.
THE NAMED INSURED IS : NON PROFIT BUSINESS DES : DEO
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, WE AGREE WITH YOU TO PROVIDE INSURANCE AS STATED IN THIS
POLICY.
THIS POLICY CONSISTS OF TRE FOLLOWING COVERAGE PARTS FOR WHICH A
PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
PREMIUM
COMMERCIAL PROPERTY NOT COVERED
COMMERCIAL GENERAL LIABILITY 416
COMMERCIAL CRIME NOT COVERED
COMMERCIAL INLAND MARINE NOT COVERED
ESTIMATED TOTAL PREMIUM $416
This is not a bill - Invoice to follow.
Total premium is payable in monthly installments.
FORMS AND ENDORSEMENTS APPLICABLE TO ALL COVERAGE PARTS
PL14001 1501* 1L0225 (04-06) ALD9999 0711 ILE0020 0304
MESE DECLARATIONS AND TME CONFWN POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE CONION POLICY CONDITIONS,
COVERAGE FORMS) AND FORKS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED AT, DATE: BY:
AUTHORIZED REPRESENTATIVE
Original 150001
IL 0019 9601 11-23-16 AMT ID202 Page 1 of 2
SECURA INSURANCE, A Mutual Company
SECURA P. 0. BOX 819 APPLETON, WI 54912-0819
�_•�•�___>•:•�.= COMMERCIAL GENERAL LIABILITY
RENEWAL DECLARATION
POLICY NO. 20-CP-003216966-7/000
RENEWAL OF 20-CP-003216966-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 61611 CARBONDALE CO 81623
POLICY PERIOD: Fro. 01/02/2017 to 01/02/2018 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
ATTACH THIS RENEWAL DECLARATION TO YOUR POLICY.
STATE-1
LOCATION OF ALL PREMISES YOU ONN, RENT OR OCCUPY:
LOC R 1: 405 CASTLE CREEK RD STE 15, ASPEN CO 81611
PMS PDTS
LOC CLASSIFICATION CODE PREMIUM BASIS RATE RATE
NFP ORGANIZATION DIRECTORS AND OFFICERS COVERAGE
AGGREGATE LIMIT 51,000,000 EACH CLAIM LIMIT 51,000,000
DEDUCTIBLE EACH CLAIM $1,000 RETROACTIVE DATE 01/02/2014
NOT FOR PROFIT DSO CLASS A SDE 1000 1001 77009 OTHER [�
TERRORISM RISK INSURANCE ACT (ANNUAL) CHARGE IS $5
GENERAL LIABILITY ADVANCE PREMIUM $416
FORMS AND ENDORSEMENTS
APPLYING TO COMMERCIAL GENERAL LIABILITY COVERAGE PART AND MADE PART OF THIS POLICY AT TINE OF ISSUE:
SDA 2000 002107 (05-14)* SDE 1000 1001 1L0125 (11-13) 1LE0196 9309 ILE0195 9812
ILE 0465 1009 C62170 (01-15) CO2169 (01-02) C62187 (01-15)
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS,
COVERAGE FORM(S) AND FORMS ANO ENDORSEMENTS, 1F ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED AT: DATE: BY:
AUTHORIZED REPRESENTATIVE
Original
CPP 4506 9601 11-23-16 ANT 10202 Page 2 of 2
SECURA INSURANCE, A Mutual Company
SECURA P. 0. BOX 819 APPLETON, WI 5012-0819
„rn.,=r=o.r..m COMMON POLICY DECLARATIONS
EXTENDED NAMED INSURED
POLICY NO. 20-CP-003216966-7/000
RENEWAL OF 20-CP-003216966-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALE CO 81623
POLICY PERIOD: Prom 01/02/2017 to 01/02/2018 AT 12:01 A.M. STANDARD TINE AT YOUR NAILING ADDRESS SHOWN ABOVE.
AUTHORIZED REPRESENTATIVE
Ori GinaL
11-23-16 ANT ID202 Page 1 of 1
SECURA INSURANCE, A Mutual Company
S ECU RA P. O. 90X 819 APPLETON, WI 54912-0819
Hary u.a wn..n< FORMS SCHEDULE
POLICY NO. 20-CP-003216966-7/000
RENEWAL OF 20-CP-003216966-6
ACCOUNT NUMBER: 00007282974
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 050071 01
ASPEN HOMELESS SHELTER PETER J MARTIN INS LLC
405 CASTLE CREEK RD STE 15 995 COWEN #202
ASPEN CO 81611 CARBONDALF CO 81623
POLICY PERIOD: From 01/02/2017 to 01/02t2o18 AT 12:01 A.N. STANDARD TIME AT YOUR NAILING ADDRESS SHOWN AOOVE.
COMMON POLICY FORMS
PLI4001 1501* DISCLOSURE PURSUAN TO TRIA - TERRORISM COV NOTICE
IL0228 (04-06) COLORADO CHANGES - CANCELLATION & NONRENEWAL
ALD9999 0711 OFFICER SIGNATURE PAGE
ILE0020 0304 MUTUAL COMPANY PARTICIPATION PROVISIONS
COMMERCIAL GENERAL LIABILITY FORMS
SDA 2000 NOT FOR PROFIT DIRECTORS & OFFICERS RENEWAL LIAB
CG2107 (05-14) * EXCL-ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSN
SDE 1000 1001 NOT FOR PROFIT DIRECTORS & OFFICERS LIABILITY COV
IL0125 (11-13) COLORADO CHANGES - CIVIL UNION
ILE0196 9309 LEAD LIABILITY EXCLUSION
ILE0195 9812 ASBESTOS EXCLUSION
ILE 0465 1009 TWO OR MORE COVERGE FORMS OR POLICIES ISSUED BY US
CG2170 (01-15) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
CG2169 (01-02) WAR OR TERRORISM EXCLUSION
CG2187 (01-15) CONDITIONAL EXCL OF TERRORISM(RELATING TO DISPOSTN
* Pons revised during the previous policy term or addedas part of the rn evaL.
Current editions of these fora are included with the Original copy of theRenewal.
AUTHORIZED REPRESENTATIVE
Original
11-23-16 ANT ID202 Page 1 of 1
A� CERTIFICATE OF LIABILITY INSURANCE DATE 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
IMPORTANT: If the certmcate holder Is an ADDITIONAL INSURED,the policy(tss)must be endorsed. If SUBROGATION IS WAIVED,sublets 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).
PROGULER MASE=CT Kelly Cain
Martin Insurance Group HONrIEa EN. (990)963-6161 I' ��976)963-4331
995 Cowen Drive Suite 202 Apeman:
Apeman: Y agzp.com
ISURER(S)AFF0 0eIO COVERAGE NBC
Carbondale CO 81623 INSIRBlA Secure 22543
RIMMED INSURER a:
Aspen Homeless Shelter INSURER C:
405 Castle Creek Rd- suite 12 INSURER D:
INSURES E:
Aspen CO 81611 INSURERF:
COVERAGES CERTIFICATE NUMBERCL16429083B4 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. NOTWTHSTANDING 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.
WEIR AC POUCY EFF PERKY EXP
LTB TYPE OF NSMNICE MD MID POUCY NUIIRIMYmdnYY11WjwyYYYI LIMITS
X COMMERCIAL GENERAL UARIUTY _EACH OCCURRENCE 1,000,000
A f OWMSMADE I X I OCCUR PPgMIIKSESEeENTED oaT.oal 1,000,000
C23216965 i 1/2/2016 1/2/2017 MED DP Mos we prim) 10,000
PERSONAL 6ADV INJURY 1,000,000
GENT AGGREGATE Ulan'APPLIES PER: GENERAL AGGREGATE 2,000,000
X PCUCT L.1 JFER& L_J L6 PRODUCTS-CCMPAP FGG 2,000,000
OTHER. EmpAHF SeaN
Ai npWOeaELAaynY COMBINED SINGLE LIMIT
SEA SWANME
ANY AUTO BODILY INJURY(Per pgvm
ALL OWNED in-SCHEDULED BODILY INJURY(Per=adorn):
AUTOS c AUTOS
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS I AUTOS (PerxSMna
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS UAB CLAIMS-MADE I AGGREGATE
LED RETENTIONS I S
WORKERS COMPENSATION I I PER I OT14
AImnetnYERS'LYBXITY Y/N LI STATUTE IER _
ANY PROPRIETORIPARTNERIEXECUTNEI E L EACH ACCIDENT $
OFFICERMEMBER EXCLUDED? f 1 NIA
(LMnYL.,y Ni NM) EL.0SEASE.EA EMPLOYEE$
xy awON LOAD l i E L.DISEASE.POUCY LIMIT S
OFOCRIPTICN C£OPERATIONS below
A Directors 6 officers I 4432169661/2/2016 1/2/2017 IEnmCIun $1,000,000
•
.'AG • $1,000,000
1 •
DESCRIPTION OFeholOPERATORS I LOCATIOISI VEHICLES(ACORotionaTIonal Remarks Smhere Aattached quiredlby riten
Certificate holder is listed as additional insured where required by written contract or agreement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
INE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTIORIZEO RPPIESENTATVE
I Sarah Coxsey/SEC !O'-z- -
01988-2014 ACORD CORPORATION. All rights reaeryed.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
INS025 amen
EXHIBIT A
MICHAEL W. SCHULTZ •
HEALTH AND HUMAN SERVICES BLDG.
FIRST FLOOR
m '
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•
•
N ,o.., eni a Ni
411in . a op - 1 . TM 01 .. '
AR , •
' C - • -' ASPEN HOMELESS SHELTER •
J 1,298.50 SQ.FT.
Ct • . •
."
' 4
I •