HomeMy WebLinkAbout20192457.tiffRESOLUTION
RE: APPROVE PROFESSIONAL SERVICES AGREEMENT AND AUTHORIZE CHAIR TO
SIGN - THE WEATHERED OAK, LLC, C/O LESLIE REEVES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Professional Services Agreement
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Fair Board, and The Weathered
Oak, LLC, c/o Leslie Reeves, commencing from the date of execution by the Board of County
Commissioners, for the 2019 Weld County Fair, and ending July 28, 2019, with further terms and
conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Professional Services Agreement between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of
the Weld County Fair Board, and The Weathered Oak, LLC, c/o Leslie Reeves, be, and hereby
is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 26th day of June, A.D., 2019.
BOARD OF COUNTY COMMISSIONERS
WEIrD COUNTY, COLO ' DO
ATTEST:.aC,rlo:�
Weld County Clerk to th Board
BY:
Deputy Clerk to the Boar
APPROVED AS TO FORM:
04ccF County Attorney
Date of signature: 7/419
Steve Moreno
arbara Kirkmeyer, i hair
ike Freeman, Pro -Tern
K. James
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9- ,3 -i 9
2019-2457
EX0030
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
RE: Contracts for 2019 Weld County Fair
DEPARTMENT: County Attorney Office and Weld County Fair Board DATE: June 17, 2019
PERSON REQUESTING: Karin McDougal and Jenn Eastwood
Brief description of the problem/issue:
Enclosed are 10 contracts for vendors at the Weld County Fair which will run from July 24 — July 28, 2019.
The contracts are as follows:
1. Corvettes West Car Club
2. Longs Peak Antique Tractor and Engine Association
3. Mountain Shadows Carriages by Darin Henry
4. Northern Colorado Draft Horse Association
5. JC McDowell DBA Young Guns Entertainment
6. Weld County Meat Goat Breeds Association
7. Mini Tractor Pullers of America - new
8. 5 Flat Productions
+9. The Weathered Oak - new
10. Airbound - new
What options exist for the Board? (Include consequences, impacts, costs, etc. of options)
Approve contracts for placement on the June 26th Agenda or request a work session.
Recommendation:
Approve contracts for placement on the Agenda for June 26, 2019 without work session. The contracts
are being reviewed by the County Attorney's Office and Jenn Eastwood will attend the June 26, 2019 meeting
to answer any questions.
Approve
Recommendation
Sean P. Conway
Scott James
Mike Freeman, Pro -Tern
Barbara Kirkmeyer, Chair
Steve Moreno
Schedule
Work Session
Other/Comments:
2019-2457
Le - o1 -co - /9
X 0000
Weld County Board of Commissioners
The Weathered Oak LLC
Professional Services Agreement 2019 Weld County Fair
THIS AGREEMENT is made this I$6' day of May 2019, by and between the Board
of County Commissioners of Weld County, Colorado, 1150 O Str&et, Greeley, Colorado 80632, hereinafter
referred to as "County," on behalf of the Weld County Fair Board, and The Weathered Oak LLC of 2920 Galway
Dr., Laporte, CO 80535, represented by Leslie Reeves, hereinafter referred to as "Contractor."
WITNESSETH, County and Contractor, for the mutual promises and consideration hereinafter set forth,
agree as follows:
SECTION I - SERVICES AND RESPONSIBILITIES OF CONTRACTOR
1. Contractor shall provide all necessary personnel, equipment, and materials to conduct The Weathered Oak
LLC (hereinafter "Event") at the 2019 Weld County Fair on July 25 — 28, 2019 at the Island Grove Park
in Greeley, Colorado. Hours of operation of the mobile photo booth to be provided by Contractor on each
day shall not exceed eight hours during daylight hours and shall be from 9:00 a.m. to 5:00 p.m. July 25th -
27th and 9:00 am — 3:30 pm on Sunday July 28th. Personnel, equipment, and materials to be provided by
Contractor are as follows:
a. Round Trip Transportation up to 30 miles (additional mileage will be charged to Weld County Fair at
a rate of $1 per mile);
b. Setup and takedown of the Booth;
c. Unlimited prints
d. A wide variety of props in the Booth;
e. Backdrops from Contractor's standard collection, to be chosen by County in advance of the event;
f. One custom photo template. Contractor will work with County to design a template in advance of
event.
g. Two full time attendants during the listed hours for the event.
h. Editing for photos taken at event
i. USB drive containing all edited photos from event, by August 15th
2. Insurance Requirements.
a. Commercial General Liability Insurance. Contractor shall furnish to County a certificate of insurance
for commercial general liability upon notification of award and prior to June 3, 2019. The commercial
general liability insurance policy shall, at a minimum, include coverage for property damage and
bodily injury covering injuries to Contractor, Contractor's employees, participants, audience
members, volunteers, or any other person in attendance at the Weld County Fair arising out of the
Event's activities. The comprehensive general liability insurance shall be in the following minimum
amounts:
Each Occurrence
General Aggregate
$1,000,000
$1,000,000
Contractor's comprehensive general liability insurance policy or certificate of insurance shall be
issued to include Weld County as an additional insured party and policy or certificate of insurance
shall be endorsed to state that coverage shall not be suspended, voided, or cancelled without thirty (30)
days prior written notice to the County by certified mail, return receipt requested. Contractor agrees
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that Contractor's comprehensive general liability insurance shall be the primary coverage for any and
all losses or injuries resulting from Contractor's activities pursuant to this Agreement. Work shall not
commence under this Agreement until Contractor has submitted to the County and received approval
thereof.
b. All insurers of Contractor must be licensed or approved to do business in the State of Colorado.
c. Contractor agrees to maintain automobile liability insurance as required by Colorado State statutes for
all automobiles associated with performance of the Contractor's obligations under this Agreement.
Where applicable, Contractor further agrees to maintain Workman's Compensation Insurance as
required by Colorado State statutes.
d. Any and all deductibles contained in any insurance policy referred to in this Agreement shall be
assumed solely by, and at the sole risk, of Contractor.
3. At any time during the term of this Agreement, the County may require Contractor to provide proof of the
insurance coverage or policies required herein. Upon failure of Contractor to furnish, deliver and/or
maintain such insurance as provided herein, this Agreement, at the County's election, may be immediately
declared suspended, discontinued, or terminated. Failure of Contractor to obtain and/or maintain any
required insurance shall not relieve Contractor from any liability under this Agreement, nor shall the
insurance requirements be construed to conflict with any of the Contractor's indemnification obligations.
SECTION II - RESPONSIBILITES OF COUNTY
County shall provide the following to facilitate the Event:
a. Access to location of Booth for two (2) hours prior and two (2) hours after the times set forth for setup
and takedown of booth;
b. Dedicated power outlet: Three prong, 110 volt, 15 amp power source within 40 feet of the Booth;
c. Safe / secure location to leave mobile unit for duration of event;
d. Site requirements as outlined in The Weathered Oak Booth Rental Agreement
• A thirty (30) foot radius to pull photo booth trailer into desired area.
• A level area for the trailer to park
• A minimum footprint area of 14' x 8' and a height of 10'
SECTION III — TERM
The term of this Agreement shall commence upon the date of execution by both the Contractor and the
County, and end after the completion of the Event and any associated clean up or post -Event activities.
Extension or Modification. Any amendments or modifications to this agreement shall be in writing signed by
both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless
and until Contractor has obtained written authorization and acknowledgement by County for such additional services.
SECTION IV — PAYMENT AND FEE SCHEDULE
1. Contractor shall receive a total payment of four thousand five hundred ($5092.00) for putting on the Event
pursuant to the terms of this agreement, including the additional $42.00 for additional transportation miles
(72 miles total, less 30 miles provided at no charge by contractor, for a total of 42 miles @ $1.00 per mile),
$50.00 fee for USB drive of photos taken at event, and $500 for photo editing. One-half or 50% of total
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payment ($2,546) will be made to contractor as a deposit in advance to secure dates within seven (7 days) of
the date rental agreement is submitted. Remaining one-half or 50% of payment shall be made no later than 30
days prior to the Event.
2. Apart from the compensation listed in this section, County shall not be obligated to pay any further costs or
expenses associated with Contractor or the Event.
3. Financial obligations are contingent upon funds being acquired and budgeted or otherwise made available.
SECTION V - INDEPENDENT CONTRACTOR
Pursuant to the Workers' Compensation Act 8-40-202(2)(b)(IV), C.R.S., as amended, Contractor
acknowledges that it is an independent contractor and that Contractor and its employees and servants are not
entitled to workers' compensation benefits from County. Contractor further understands that it is solely obligated
for the payment of federal and state income tax on any moneys earned pursuant to this Agreement. Contractor
shall be solely responsible for its acts and those of its agents and employees for all acts performed pursuant to
this Agreement.
SECTION VI - INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the Weld County Fair Board, its officers, agents,
employees, and volunteers, and County, its officers, agents, employees, and volunteers, from and against any and
all claims, suits, expenses, damages, or other injury to persons, entities, or property caused or sustained by any
person(s) during the term of this Agreement resulting from Contractor's Event or failure to perform pursuant to
the terms of this Agreement.
Notwithstanding the expiration of this Agreement upon the expiration of the term specified in Section III
of this Agreement, or termination of this Agreement pursuant to Section VII of this Agreement, this Section VI
regarding indemnification shall survive the expiration or termination of this Agreement.
SECTION VII - TERMINATION
Time is of the essence in the Event of this Agreement. If Contractor is unable to provide the services
required by this Agreement during the specified term of this Agreement, Contractor shall be deemed to have
breached this Agreement and County may obtain said services of another and pursue an appropriate remedy for
such breach pursuant to the laws of the State of Colorado. Either party may terminate this Agreement for cause.
An aggrieved party must first notify the other party of the outstanding issue and allow one day to cure or such
longer period of time as is mutually agreed upon by the parties. In the Event such issue is not cured within the
cure period, the aggrieved party may terminate the Agreement and pursue any remedy recognized by Colorado
law. County has the right to terminate this Agreement, with or without cause on thirty (30) days written notice.
SECTION VIII - MUTUAL UNDERSTANDINGS
1. Integration of Understanding. This Agreement and Exhibit A contain the entire understanding of the parties
hereto and neither it, no the rights and obligations hereunder, may be charged, modified, or waived except by
an instrument in writing that is signed by the parties hereto. Exhibit A is the TWO Rental Agreement and is
attached hereto and incorporated in by reference.
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2. Priority of Interpretation: The provisions of this Agreement shall govern the relationship between County
and Contractor. Should a conflict in any provisions of this Agreement and Exhibit A be identified, the terms
of this Agreement shall take precedence over conflicting terms in Exhibit A.
3. Parties Interested Herein. Nothing expressed or implied in this Agreement is intended or shall be construed
to confer upon or to give to, any person other than the parties to this Agreement, any right, remedy, or claim
under or by reason of this Agreement of any covenant, terms, conditions, or provisions hereof. All covenants,
terms, conditions, and provisions in this Agreement, by and on behalf of the County and Contractor, shall be
for the sole and exclusive benefit of the County and Contractor.
4. Severability. If any provision of this Agreement is determined to be unenforceable or invalid for any reason,
the remainder of this Agreement shall remain in effect, unless otherwise terminated in accordance with the
terms contained herein.
5. Authorization. Each party represents and warrants that it has the power and ability to enter into this
Agreement, to grant the rights granted herein and to perform the duties and obligations herein described.
6. Compliance with Law. Contractor shall strictly comply with all applicable federal and State laws, rules and
regulations in effect or hereafter established, including without limitation, laws applicable to discrimination
and unfair employment practices.
7. Choice of Law and Venue. Colorado law, and rules and regulations established pursuant thereto, shall be
applied in the interpretation, execution, and enforcement of this Agreement. Any provision included or
incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and
void. Venue for any legal dispute associated with this Agreement shall be in Weld County, Colorado. Should
the courts in Weld County not have jurisdiction over the legal dispute, the venue shall be the nearest court in
Colorado having jurisdiction.
8. Non -Assignment. The rights and responsibilities of either party pursuant to this Agreement are not assignable
without prior written permission from the other party.
9. Governmental Immunity. No term or condition of this contract shall be construed or interpreted as a waiver,
express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado
Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
10. Interruptions. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to
deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause
beyond its reasonable control,
11. Hiring practices. Successful bidder certifies, warrants, and agrees that it does not knowingly employ or
contract with an illegal alien who will perform work under this contract. Successful bidder will confirm the
employment eligibility of all employees who are newly hired for employment in the United States to perform
work under this Agreement, through participation in the E -Verify program or the State of Colorado program
established pursuant to C.R.S. §8-17.5-102(5)(c). Successful bidder shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that
fails to certify with Successful bidder that the subcontractor shall not knowingly employ or contract with an
illegal alien to perform work under this Agreement. Successful bidder shall not use E -Verify Program or State
of Colorado program procedures to undertake pre -employment screening or job applicants while this
Agreement is being performed. If Successful bidder obtains actual knowledge that a subcontractor performing
work under the public contract for services knowingly employs or contracts with an illegal alien Successful
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bidder shall notify the subcontractor and County within three (3) days that Successful bidder has actual
knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the
subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3)
days of receiving notice. Successful bidder shall not terminate the contract if within three days the
subcontractor provides information to establish that the subcontractor has not knowingly employed or
contracted with an illegal alien. Successful bidder shall comply with reasonable requests made in the course
of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and
Employment. If Successful bidder participates in the State of Colorado program, Successful bidder shall,
within twenty days after hiring a new employee to perform work under the contract, affirm that Successful
bidder has examined the legal work status of such employee, retained file copies of the documents, and not
altered or falsified the identification documents for such employees. Successful bidder shall deliver to
County, a written notarized affirmation that it has examined the legal work status of such employee, and shall
comply with all of the other requirements of the State of Colorado program. If Successful bidder fails to
comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this
Agreement for breach, and if so terminated, Successful bidder shall be liable for actual and consequential
damages.
Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Successful bidder
receives federal or state funds under the contract, Successful bidder must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-
76.5-103(4), if such individual applies for public benefits provided under the contract. If Successful bidder
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the
United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce
one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the
forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract.
In Witness Whereof, the parties hereto execute this contract on the day first above written.
ATTEST:
CHAIRMAN OF THE BOARD OF
WELD COUNTY COMMISSIONERS CONTRACTOR
6 ,i& - pA&‘ Ce4.t. auti
Barbara Kirkmeyer, Chair Leslie Reeves
The Weathered Oak LLC
Date:
JUN 2 0 2019
Date: 5-1-11
5
ATTEST: 1j,f
Weld County Clerk to the Board
BY:
Deputy Cle to the B
APPROVED AS TO FUND
Controller
APPROVED AS TO FORM:
ve4ty--
Coupty Attorney
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
arbara Kirkmeyer, Ch. rzum 2 6 ZDi9
APPROVED AS TO SUBSTANCE:
Elected OfficiaJ4' Department Head
6
020i9- a�57 6,
peotif,$)
the
Weathered Oak
PHOTO BOOTH RENTAL AGREEMMENT
This Photo Booth Rental Agreement ("Agreement") sets forth the terms and conditions
pursuant to which (referred to as "you" or
"Client") have agreed to rent U a photo booth trailer and/or U a selfie station (referred to as the
"Booth" whether you select a photo booth trailer, a selfie station or both) from The Weathered
Oak, LLC, a Colorado limited liability company (referred to as "TWO", "we", "us" or "our").
Date and Time: The Services (defined below) will be provided from to
on , 20 for your event. In addition, we require
access to the location(s) of the Booth for two hours prior and two hours after the times set forth
above for setup and takedown of the Booth. You are responsible for ensuring we have access to
the location(s) of the Booth during the times set forth above (including setup and takedown) and
will make any required arrangements with the event venue.
Price, Deposit and Payment: The "Price" for the event will be $ plus the
cost of all Additional Services and Costs selected by you and any other amounts due under this
Agreement. Such amount includes all Additional Services and Costs selected prior to contract
execution. All other costs or expenses incurred pursuant to this Agreement after the date it is
executed by you will be added to the Price. You must pay a non-refundable deposit of
$ within seven (7) days of the date you execute this Agreement. The deposit is
non-refundable except as specifically set forth in this Agreement. The remainder of the Price must
be paid no later than thirty (30) days prior to your event. If this Agreement is executed within thirty
(30) days of your event the entire Price is due within three (3) days of your execution of this
Agreement. No amounts are refundable except as specifically set forth in this Agreement. Any
amounts due under this Agreement which remain unpaid after your event are due within fifteen
(15) days of the date we email an invoice to you at the email address below your signature. Any
unpaid balance will accrue interest at a rate of 12% per annum if not paid within such fifteen (15)
day period. Failure to make any payments when due may result in cancelation of your event with
no refund of amounts previously paid. There will be an additional 2.9% charge added to any
amounts paid via credit card and a $50.00 fee for any returned checks.
Services: The following "Services" are included at no additional charge:
• Roundtrip transportation of the Booth to any event totaling thirty (30) miles from the
storage facility where the Booth is located (i.e. an event within 15 miles).
• Setup and takedown of the Booth
• Unlimited prints and social media uploads (client provided Wi-Fi required for uploads)
1
• All props in the Booth. We cannot guarantee specific props are available but will ensure a
wide variety are available for your event. Custom props are an additional charge
• Backdrops from our standard collection. You will choose a backdrop in advance of the
event. Custom backdrops are an additional charge
• One custom photo template. We will work with you to design a template in advance of
your event
Additional Services and Costs: You may select additional Services on the "Additional Services
and Costs" addendum attached to this Agreement. The cost of all additional Services selected by
you will be added to the "Price" set forth above. You must notify us in writing of any additional
Services requested at least thirty (30) days in advance of the event. We will do our best to
accommodate any requests for additional Services made less than thirty (30) days in advance but
cannot guarantee the availability of such additional Services.
Additional Time: Any requests by you to provide Services past the time stated in this Agreement
will be accepted or denied at our discretion. Any additional time will be charged in half hour
increments rounded up to the nearest half hour (i.e. 35 minutes is charged as one hour). An
additional fee of $250.00 per hour will be charged for additional time.
Site Requirements: NOTIFY YOUR VENUE EARLY OF THESE RQUIREMENTS: A
thirty (30) foot radius is required to pull the photo booth trailer into the desired area. The area the
trailer is parked in must be level and have a minimum footprint area of fourteen (14) feet by eight
(8) feet and height of ten (10) feet. The trailer cannot be towed up steep slopes nor can it go over
curbs or rough terrain. If we do not believe we can pull the trailer into the desired location without
damage no Services will be provided and no refunds will be given. A minimum space of
is required for the selfie station. Operation of the Booth will require a dedicated,
three prong, 110 volt fifteen (15) amp power source within forty (40) feet of the Booth. The power
source and circuit cannot be shared with other users. If a suitable power source is not available we
may use our generator at and additional cost to you of $150.00. You are responsible for marking
any buried obstacles including, but not limited to, utility lines, plumbing, and septic tanks. We will
not be responsible for any damage to buried obstacles. You are responsible for ensuring the site of
the Booth meets the Site Requirements set forth in this paragraph. Failure to do so may result in
no Services being provided or refunds given. Please provide your venue and contact information
on the sheet attached to this agreement if known.
Release: You agree and understand that all guests using the photo booth hereby give to TWO the
right and permission to copyright and use photographic portraits or pictures taken of any Booth
user, in whole or in part, made through any and all medial now or hereafter existing for illustration,
art, promotion, advertising, trade, or any other purpose.
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Additional Terms and Conditions: Access to the photo booth trailer is via three (3) steps and
may therefore not be handicap accessible. You will pay in advance or reimburse us for all parking
fees for the location of the Booth and our staff as well as for any tolls we pay on the way to your
event. Travel in excess of thirty (30) miles will be billed at a rate of one dollar ($1.00) per mile.
We reserve the right to deny Services to anyone at any time in our sole discretion. Reasons for
denying Services may include, but are not limited to, intoxication, aggressive behavior,
belligerence, inappropriate photos or for any other reason we deem prudent. Services will be
unavailable for short periods of time to change ink, reload paper or switch the computer or printer
and such unavailability will not be a breach of this Agreement. Additionally, we have backups to
our primary computer and photography equipment which may not be the same as our primary
equipment or what you have seen. Use of such backup equipment will not be a breach of this
Agreement.
Refunds and Force Majeure: If we cancel your event at any time or are unable to attend your
event for any reason you will receive a refund of all amounts paid. Reasons we may not be able to
attend your event include, but are not limited to, car breakdowns, weather, accidents, traffic,
equipment failure and natural disasters. You will receive a prorated refund based on the amount of
time Services were provided as compared to the time Services were supposed to be provided
pursuant to this Agreement in the following events which are caused by us or which are due to
equipment failure not caused by you or your guests: (i) if we are delayed by more than a half hour
in commencing Services or end Services more than a half hour early; (ii) if the Booth is not
operational for at least eighty percent (80%) of the time we are to provide Services due to
equipment failure; or (iii) if we are not able to provide services for at least eighty percent (80%)
of the time we are to provide Services. There will be no refunds except as specifically set forth
herein. In no event are we liable to you for more than the amounts you have actually paid us
nor are we liable for any emotional distress, special, consequential or punitive damages
regardless of whether you notify us of the possibility of such damages.
Failure to Comply: Your failure to comply with any provision of this Agreement may result in a
reduction of time the Services are provided or an inability to provide Services. There will be no
refunds and you are responsible for payment of all amounts due hereunder in the event you fail to
comply with your obligations under this Agreement regardless of any reduction of time the
Services are provided or a cancelation of Services.
Governing Law and Venue. This Agreement shall be construed according to the laws of the
State of Colorado without regard to conflict of law principles. The parties agree that this
Agreement was negotiated in Greeley, Colorado and any action or proceeding shall be brought in
the county or district courts of Greeley, Colorado to the exclusion of all other venues.
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Counterparts and Integration: This Agreement sets forth the full agreement of the parties,
supersedes all other written and/or oral agreements between the parties and may only be modified
by the parties in writing. This Agreement may be executed in counterparts and electronic, copies
and facsimile signature shall be considered originals.
Notice: Notices and other communication shall be sent via email to the email addresses below.
THE WEATHERED OAK, LLC, CLIENT:
a Colorado limited liability company:
By: Leslie Reeves, Member
leslie@theweatheredoak.com Name:
(970) 214-8864
Email:
Date:
Phone:
Date:
4
the
Weathered Oak
PHOTO BOOTH RENTAL AGREEMMENT
ADDITIONAL SERVICES AND COSTS
The following will be filled out at the time the Agreement is executed. Additional charges may
apply pursuant to the Agreement.
Item
Cost
Total
Specialty props
$
Specialty backdrops
$
Album
$
Mileage over 30 miles round trip
$1.00/mile
Additional Hours
$250/hr.
A USB drive containing all photos from your event
$50
Use of generator
$150
TOTAL
$
$
Additional Services and Costs
the
Weathered Oak
VENUE INFORMATION
Company
Contact Person
Address
City, State Zip
Type of Event
Contact Phone Number
Email Address
Est. Number of Guests
Venue Information
SCOTTSDALE INSURANCE COMPANY®
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUPPLEMENTAL DECLARATIONS
Policy No. CPS2982648
Named Insured THE WEATHERED OAK LLC
Effective Date 02/20/2019
Agent No.
12:01 A.M., Standard Time
05022
Item 1. Limits of Insurance
Coverage Limit of Liability
Aggregate Limits of Liability
Products/ Completed
$ 2,000,000 Operations Aggregate
General Aggregate (other than
$ 2,000,000 Products/ Completed Operations)
Coverage A - Bodily Injury and
any one occurrence subject
Property Damage Liability
to the Products/ Completed
Operations and General
$ 1,000,000 Aggregate Limits of Liability
any one premises subject to the
Coverage A occurrence and
the General Aggregate Limits
Damage to Premises Rented to You Limit
$ 100,000 of Liability
Coverage B - Personal and
any one person or organization
Advertising Injury Liability
subject to the General Aggregate
$ 1,000,000 Limits of Liability
Coverage C - Medical Payments
any one person subject to the
Coverage A occurrence and
$ 5,000 the General Aggregate Limits
Item 2. Description of Business
Form of Business:
• Individual • Partnership ■ Joint Venture ■ Trust A Limited Liability Company
Joint Venture or Limited Liability Company)
■ Organization including a corporation (other than Partnership,
Location of All Premises You Own, Rent or Occupy:
See Schedule of Locations
Item 3. Forms and Endorsements
Form(s) and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Item 4. Premiums
Coverage Part Premium: $ 5 0 0
Other Premium: $
Total Premium: $ 500
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND
THE POLICY PERIOD.
CLS-SD-1 L (8-01)
INSURED
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