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01-01-2014 Safebuilt AgreementSAFEbuilt. PLAN REVIEW AND INSPECTION SERVICES AGREEMENT This agreement ( "Agreement ") is made between Safe Built Colorado, Inc., ( "SAFEbuilt "), and the Town of Avon, a Colorado home rule municipal corporation ( "Municipality "). This Agreement sets forth the services SAFEbuilt will provide to the Municipality as well as sets forth other terms including but not limited to fees, invoicing, and payment structure. Scope of Services: SAFEbuilt will provide plan review and inspection services to the Municipality on an as needed basis as directed by the building official of the Municipality ( "Building Official "). The reviews will encompass foundation, structural, plumbing, mechanical, accessibility, energy code and life safety provisions - excluding electrical. SAFEbuilt will not provide electrical inspections and the parties expect that electrical inspections will be provided by the State of Colorado. SAFEbuilt will perform inspections and plan reviews per the Municipality's adopted codes. SAFEbuilt is not obligated to perform services beyond what is contemplated by this Agreement. Any changes or additions to the scope of services shall be done only in writing and shall specifically state the additional fees, if any, for such changes. SAFEbuilt is under no obligation to perform and will not perform any inspection services relating to site infrastructure including roads, parking lots, landscaping, drainage or other matters not included as building code issues. This Agreement is not designed to include complete project support services. Standard of Performance: In performing the services, SAFEbuilt shall use that degree of care, skill, and professionalism ordinarily exercised under similar circumstances by members of the same profession practicing in the State of Colorado. SAFEbuilt represents to the Municipality that the SAFEbuilt is, and its employees performing such Services are, properly licensed and /or registered within the State of Colorado for the performance of the services (if licensure and /or registration is required by applicable law) and that SAFEbuilt and employees possess the skills, knowledge, and abilities to competently, timely, and professionally perform the services in accordance with this Agreement. Fee Structure: SAFEbuilt fees for this Agreement will be as follows: Inspection Services: 0 to 2 hours at $200.00 2 to 4 hours at $360.00 4 to 8 hours at $640.00 After Hours /Emergency at $100.00 an hour — 2 hour minimum Plan Review Services: Residential (IRC) — 60% of Town of Avon plan review fee Commercial (IBC) — 70% of Town of Avon plan review fee* Revision to Approved Plans - $90.00 an hour —1 hour minimum * This fee does not include engineered review fees for larger more complex projects. These fees will be billed at cost + 10% but shall not to exceed $120.00 per hour. Time tracked shall include travel time from SAFEbuilt's "Eagle" office to the Town but shall not include travel time from Town back to SAFEbuilt's Eagle office. Rates are all inclusive and SAFEbuilt shall not separately charge for mileage, vehicle expenses, materials or other expense. Duration: This Agreement shall commence on January 01, 2014 and continue until December 31, 2014. This Agreement shall automatically renew on an annual basis for a 12 month term unless either elects to not renew the Agreement and provides notice to the other party on or before October 31 preceding expiration of the current term. In the absence of written documentation, this Agreement will continue in force until such time as either party notifies the other of its desire to terminate this Agreement pursuant to the terms and conditions herein. Time of Performance: SAFEbuilt will be available to perform the services commencing upon execution of this Agreement. All plan review and inspections will be performed during normal business hours (8:00 a.m. — 5:00 p.m., Monday — Friday). Inspection Services: A minimum of 72 hours lead time is required to guarantee availability, however SAFEbuilt will always do our best to provide inspection services if notice is less than 72 hours. Torn of Avon; CO ! SAFEbuilt Agreement P, q, of Plan Review Services: We are able to commit to the following plan review schedule: Plan Review Type First Comments Second Comments Residential projects 5 working days or less 5 working days or less Multi- family projects _ 10 working days or less 5 working days or less Small commercial projects (< $2M in valuation) 10 working days or less 5 working days or less Large commercial projects ( >$2M in valuation) 20 working days or less 10 working days or less Invoice & Payment Structure: SAFEbuilt will invoice the municipality on a monthly basis and will include all supporting documentation. All payments are due to SAFEbuilt within 30 days of invoice date. Invoice Milestones: _ FEE TYPE ! { MILESTONE Plan Review Fee First comment submittal _ — Plan review completion Inspection Fee Monthly inspection services % of SAFEbuilt's Fee to be Invoiced 50% 50% 100% Municipality Obligations: The Municipality shall timely provide all data information, plans, specifications and other materials required by SAFEbuilt to perform the Scope of Services. Insurance: SAFEbuilt has provided insurance in accordance with the certificates of insurance previously submitted that name the Town of Avon as additional insured. Insurance Generally: SAFEbuilt shall obtain and shall continuously maintain during the term of this Agreement insurance of the kind and in the minimum amounts specified in this Section. The Required Insurance shall be procured and maintained with insurers with an A- or better rating as determined by Best's Key Rating Guide. All Required Insurance shall be continuously maintained to cover all liability, claims, demands, and other obligations assumed by SAFEbuilt. SAFEbuilt shall secure and maintain the following ( "Required Insurance "): A. Worker's Compensation Insurance in the minimum amount required by applicable law for all employees and other persons as may be required by law. Such policy of insurance shall be endorsed to include the Municipality as a Certificate Holder. B. Comprehensive General Liability insurance with minimum combined single limits of One Million Dollars ($1,000,000.00) Dollars each occurrence and of One Million Dollars ($1,000,000.00) aggregate. The policy shall be applicable to all premises and all operations of the Contractor. The policy shall include coverage for bodily injury, broad form property damage (including completed operations), personal injury (including coverage for contractual and employee acts), blanket contractual, independent contractors, products, and completed operations. The policy shall contain a severability of interests provision. Coverage shall be provided on an "occurrence" basis as opposed to a "claims made" basis. Such insurance shall be endorsed to name the Municipality as Certificate Holder and name the Municipality, and its elected officials, officers, employees and agents as additional insured parties. C. Comprehensive Automobile Liability insurance with minimum combined single limits for bodily injury of not less than of One Hundred Thousand Dollars ($100,000.00) each person and each accident and for property damage of not less than Fifty Thousand Dollars ($50,000.00) each accident with respect to each of SAFEbuilt's owned, hired and non -owned vehicles assigned to or used in performance of the services. The policy shall contain a severability of interests provision. Such insurance coverage must extend to all levels of subcontractors. Such coverage must include all automotive equipment used in the performance of the Agreement, both on the work site and off the work site, and such coverage shall include non - ownership and hired cars coverage. Such insurance shall be endorsed to name the Municipality as Certificate Holder and name the Municipality, and its elected officials, officers, employees and agents as additional insured parties. Town of Avon; CO 1 SAFEbuilt Agreement Page 2 of 5 D. Professional Liability (errors and omissions) Insurance with a minimum limit of coverage of One Million Dollars ($1,000,000.00) per claim and annual aggregate. Such policy of insurance shall be obtained and maintained for one (1) year following completion of all services under this Agreement. Such policy of insurance shall be endorsed to include the Municipality as a Certificate Holder. Additional Requirements for All Policies: In addition to specific requirements imposed on insurance by the preceding section and its subsections, insurance shall conform to all of the following: A. For Required Insurance, all policies of insurance shall be primary insurance, and any insurance carried by the Municipality, its officers, or its employees shall be excess and not contributory insurance to that provided by SAFEbuilt; provided, however, that the Municipality shall not be obligated to obtain or maintain any insurance whatsoever for any claim, damage, or purpose arising from or related to this Agreement and the services. SAFEbuilt shall not be an insured party for any Municipality- obtained insurance policy or coverage. B. For Required Insurance, SAFEbuilt shall be solely responsible for any deductible losses. C. For Required Insurance, no policy of insurance shall contain any exclusion for bodily injury or property damage arising from completed operations. D. For Required Insurance, every policy of insurance shall provide that the Municipality will receive notice no less than thirty (30) days prior to any cancellation, termination, or a material change in such policy. Failure to Obtain or Maintain Insurance: SAFEbuilt's failure to obtain and continuously maintain policies of insurance in accordance with the preceding sections and its subsections shall not limit, prevent, preclude, excuse, or modify any liability, claims, demands, or other obligations of SAFEbuilt arising from performance or non - performance of this Agreement. Failure on the part of SAFEbuilt to obtain and to continuously maintain policies providing the required coverage, conditions, restrictions, notices, and minimum limits shall constitute a material breach of this Agreement upon which the Municipality may immediately terminate this Agreement. Insurance Certificates: Prior to commencement of the services, SAFEbuilt shall submit to the Municipality certificates of insurance for all Required Insurance. Insurance limits, term of insurance, insured parties, and other information sufficient to demonstrate conformance with the preceding sections and its subsections shall be indicated on each certificate of insurance. The Municipality may request and SAFEbuilt shall provide within three (3) business days of such request a current certified copy of any policy of Required Insurance and any endorsement of such policy. The Municipality may, at its election, withhold payment for services until the requested insurance policies are received and found to be in accordance with the Agreement. Indemnification and Hold Harmless: To the fullest extent permitted by law, SAFEbuilt shall be liable for and shall defend, save, indemnify, and hold harmless the Municipality, its elected and appointed officials, employees and volunteers and others working on behalf of the Municipality, from and against any and all claims, demands, suits, costs (including reasonable legal costs), expenses, and liabilities by reason of personal injury, including bodily injury or death and /or property damage to the extent that any such injury, loss or damage is caused by the negligence or breach of duty of SAFEbuilt or any officer, employee, representative, or agent of SAFEbuilt. To the fullest extent permitted by law, the Municipality shall be responsible for and shall defend, save, indemnify, and hold harmless SAFEbuilt, its officers, employees, representatives, and agents, from and against any and all claims, demands, suits, costs (including reasonable legal costs), expenses, and liabilities by reason of personal injury, including bodily injury or death and /or property damage to the extent that any such injury, loss or damage is caused by the Municipality's intentional or negligent acts, errors or omissions or that of its agents, officers, servants and employees, whether contractual or otherwise. If either party becomes aware of any incident likely to give rise to a claim under the above indemnities, it shall notify the other and both parties shall cooperate fully in investigating the incident. Assignment: SAFEbuilt may not assign this Agreement without the consent of the Municipality. Any assignment of this Agreement without the consent of the Municipality shall be null and void. SAFEbuilt is permitted to subcontract portions of the services to be provided. SAFEbuilt remains responsible and liable for any subcontractor's performance. Subcontractors will be subject to the same performance criteria expected of SAFEbuilt. Performance clause verbiage will be included in contracts with all subcontractors to assure quality levels and agreed upon schedules are met. Third Party Reliance: Nothing contained in this Agreement is intended to or shall create a contractual relationship with, cause of action in favor of, or claim for relief for, any third party, including any agent, sub - consultant or sub - contractor of Town or County. Absolutely no third party beneficiaries are intended by this Agreement. Any third -party receiving a benefit from this Agreement is an incidental and unintended beneficiary only. Town of Avon: CO / SAFEbuilt Agreement Page 3 of 5 Independent Contractor: SAFEbuilt shall perform the Services as an independent contractor and shall not be deemed by virtue of this Agreement to have entered into any partnership, joint venture, employer /employee or other relationship with the Municipality other than as a contracting party and independent contractor. The Municipality shall not be obligated to secure, and shall not provide, any insurance coverage or employment benefits of any kind or type to or for SAFEbuilt or the SAFEbuilts's employees, sub - consultants, contractors, agents, or representatives, including coverage or benefits related but not limited to: local, state, or federal income or other tax contributions; insurance contributions (e.g., FICA); workers' compensation; disability, injury, or health; professional liability insurance, errors and omissions insurance; or retirement account contributions. Termination of Agreement: Either party may terminate this Agreement without cause by provide at least thirty (30) days written notice of election to terminate to the other party. If either party cancels this Agreement, SAFEbuilt will immediately invoice Municipality, and Municipality agrees to pay, for all services rendered to Municipality prior to termination date of this Agreement. Services rendered will be determined by monthly progress reports in a format agreed upon between the parties. Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado and all services to be provided will be provided in accordance with applicable federal, state and local law. Prohibition Against Employing Illegal Aliens: Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract. Contractor shall not enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract. Contractor will participate in either the E- verify program C.R.S. § 8 -2 -122 or the Department program, as defined in C.R.S. § 8- 17.5- 101(3.3) and 8- 17.5- 101(3.7), respectively, in order to confirm the employment eligibility of all employees who are newly hired for employment to perform work under the public contract for services. Contractor is prohibited from using the E- verify program or the Department program procedures to undertake pre - employment screening of job applicants while this contract is being performed. If Contractor obtains actual knowledge that a subcontractor performing work under this contract for services knowingly employs or contracts with an illegal alien, Contractor shall: A. Notify the subcontractor and the Municipality within three days that the Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and B. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this paragraph the subcontractor does not stop employing or contracting with the illegal alien; except that the Contractor shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien Contractor shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the Department is undertaking pursuant to the authority established in C.R.S. § 8- 17.5- 102(5). If Contractor violates a provision of this Contract required pursuant to C.R.S. § 8- 17.5 -102, Municipality may terminate the contract for breach of contract. If the contract is so terminated, the Contractor shall be liable for actual and consequential damages to the Municipality. Ownership of Documents: Any work product, materials, and documents produced by SAFEbuilt pursuant to this Agreement shall become property of the Municipality upon delivery and shall not be made subject to any copyright unless authorized by the Municipality. Public Records: SAFEbuilt acknowledges that records, inspections, documents and other materials created in connection with the performance of services in this Agreement may constitute public records under the Colorado Open Records Act. SAFEbuilt agrees to cooperate with the Municipality to comply with the requirement to provide public records in response to a public records request as may be required by the Colorado Open Records Act. No Waiver of Governmental Immunity: Nothing in this Agreement shall be construed to waive, limit, or otherwise modify any governmental immunity that may be available by law to the Municipality, its officials, employees, contractors, or agents, or any other person acting on behalf of the Municipality and, in particular, governmental immunity afforded or available pursuant to the Colorado Governmental Immunity Act, Title 24, Article 10, Part 1 of the Colorado Revised Statutes. Affirmative Action: SAFEbuilt will not discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin. SAFEbuilt will take affirmative action to ensure applicants are employed, and employees are treated during employment without regard to their race, color, religion, sex or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Toarn of Avon; CO / SAFEbuilt Agreement Page 4 of 5 Article X, Section 201TABOR: The parties understand and acknowledge that the Town is subject to Article X, § 20 of the Colorado Constitution ( "TABOR "). The parties do not intend to violate the terms and requirements of TABOR by the execution of this Agreement. It is understood and agreed that this Agreement does not create a multi - fiscal year direct or indirect debt or obligation within the meaning of TABOR and, therefore, notwithstanding anything in this Agreement to the contrary, all payment obligations of the Municipality are expressly dependent and conditioned upon the continuing availability of funds beyond the term of the Municipality's current fiscal period ending upon the next succeeding December 31. Financial obligations of the Municipality payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted, and otherwise made available in accordance with the rules, regulations, and resolutions of Town of Avon, and other applicable law. Upon the failure to appropriate such funds, this Agreement shall be terminated. IN WITNESS WHEREOF, the Municipality caused this Agreement to be signed by its representative. Likewise, an officer of the Corporation has subscribed to this Agreement by affixing their signatures all on the day and year first written below. Town of Avon Signature 0 J Name: ✓I �'9� h R -e4q�- Title: -107V t e7114 HV6i. Date: / I e7 l 13 Safe Built Colorado, Inc. Signature Name: �nvi� ��ho�sen Title: N t eQ Date: '` \ / Town of Avon. CO / SAFEbuilt Agreement Page 5 of 5 SAFEB -1 OP ID: LD ,a►��R° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/15/13 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 -482 -7747 Brown & Brown Inc Fax: 970 484 4165 4532 Boardwalk Dr, Suite 200 - Fort Collins, CO 80525 Karen E. Siwek, CPA NAME: CONTACT PHONE A A/C No Ext No E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Great Northern Insurance Co. 20303 INSURED Safebuilt, Inc. Safe Built Colorado, Inc. 3755 Precision Drive, St.140 INSURER B: Evanston Insurance Company 35378 INSURER C: Evanston Insurance Company 35378 X COMMERCIAL GENERAL LIABILITY Loveland, CO 80538 INSURER D: 09/15/13 INSURER E: AG To PREMISES Ea occurrence $ 100,00 INSURER F: $ 10,00 rnvccnr_cc CERTIFICATE NI IMBED- 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 LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN POLICY NUMBER MMIDDI,YYYY MM DD / /YYYY LIMITS P. O. Box 975 GENERAL LIABILITY Avon, CO 81620 EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY 3C51072 09/15/13 04130114 AG To PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 CLAIMS -MADE lxl OCCUR PERSONAL& ADV INJURY $ 1,000,00 X $25,000 Ded GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 $ POLICY X PR0 LOC AUTOMOBILE LIABILITY INED (CEO, aBciden SINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO 73575355 04130113 04/30/14 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 X AGGREGATE $ 5,000,00 B EXCESS LIAB CLAIMS -MADE MAXA3EC50000940 09/15113 04130/14 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE WC LIMIT TORY LIMIT E ER R E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N / A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liab E0854884 09115/13 04/30/14 Ea Claim 5,000,00 Claims Made $50,000 DEDUCTIBLE Aggregate 5,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Town of Avon & its elected officials, officers, employees & agents are included as additional insureds, coverage is primary /noncontributory per forms and conditions on page 2.. !`COTICICATC unl nER CANCFI I.ATION TOWNAVO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Avon P. O. Box 975 AUTHORIZED REPRESENTATIVE Avon, CO 81620 ©1988 -2010 AGORD CORPORA I IUN. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD I ® . 6C CERTIFICATE OF LIABILITY INSURANCE �_ DATE (MMIDD /YYYY) F 11118/13 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 Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131 -4937 CONTACT Aon Risk Services, Inc Of Florida NAME: PHONE FAX A /C, No Ext : 800- 743 -8130 A/C Noy 800- 522 -7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Ins Co 23841 $ INSURED INSURER B: ADP TotalSource III, Inc. 10200 Sunset Drive INSURER C: INSURER D: COMMERCIAL GENERAL LIABILITY Miami, FL 33173 ALTERNATE EMPLOYER INSURER E: SafeBuilt Colorado Inc 3755 Precision Drive Suite 140 INSURER F: PREMISES Ea occurrence Loveland, CO 80538 rr1%1= _GC RFRTIFICATF NIIMRFR• 7nnnRR KtViblUN NUIVIbtK: 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. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE F-1 OCCUR PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ $ POLICY PROJECT LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ BODILY INJURY Per person) $ ANY AUTO BODILY INJURY Per accident $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAS CLAIMS -MADE DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC 015685231 CO 07/01/13 07/01/14 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 2,000,000 ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All worksile employees working for the above named client company, paid under ADP TOTALSOURCE, INC: s payroll, are covered under the above stated policy. The above named client is an alternate employer under this policy. rFRTIFIr'ATF HC11 r1FR CANCELLATION ko Iy88 -LU IU A%,UKL7 to Ur[r'URAI IUIV. r%u I lynlD ICJGI VCU. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Avon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 975 avon, CO 81620 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE oqon Disk i6ezviees, qnc of tflotidac ko Iy88 -LU IU A%,UKL7 to Ur[r'URAI IUIV. r%u I lynlD ICJGI VCU. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD :orm -9 Request for Taxpayer Give Form to the Rev. December 2011) v. December 2011)wy Identification Number and Certification requester. Do not send to the IRS. le ntemal Revenue Service Name (as shown on your income tax return) SAFEbuilt Colorado, Inc. Business name /disregarded entity name, if different from above N m m CL C ° Check appropriate box for federal tax classification: ❑ Individual /sole proprietor ❑ C Corporation Q S Corporation ❑ Partnership 0 Trust/estate N CL o ❑ Exempt payee 0 ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► ------------------------------- o c n IL o ,a_ ❑ Other (see instructions)► Address (number, street, and apt. or suite no.) Requester's name and address (optional) ° 3755 Precision Dr, Suite 140 City, state, and ZIP code Loveland, CO 80538 List account number(s) here (optional) • Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number to avoid backup withholding. For individuals, this is your social security number However, for a - m - resident alien, sole proprietor, or disregarded entity, see the Part I instructions on n page 3. For other ...:a if .,,,,, rin not hnun a ni imhar- sae Haw to aet a TIN on page 3. Note. If the account Is In more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. 8 4 - 1 4 9 5 5 0 7 Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S, citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interestpnd dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature Here I U.S. oarsc General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected Income. Cat. Date ► u /1X/ / .t-- Note. If a requester gives you a form other than Form W -9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W -9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W -9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. No. 10231X Form W -9 (Rev. 12 -2011)