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Home My WebLink About20171933.tiffRESOLUTION RE: APPROVE PROFESSIONAL SERVICES AGREEMENT AND AUTHORIZE CHAIR TO SIGN - INFLATABLE FUN ZONE 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 Inflatable Fun Zone, commencing from the date of execution by the Board of County Commissioners, for the 2017 Weld County Fair, and ending July 31, 2017, 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 Inflatable Fun Zone, 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 28th day of June, A.D., 2017. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLOF3QDO ATTEST: �/,,i '&k. Weld County Clerk to the Board BY: APPR ount • ttorney Date of signature: 1 ( l c ( t Julie A. Cozad, Chair Sean P. Conway TAAlk 31t.s..- ike Freeman Steve Moreno, Pro-Tem ce £XCJK(Knn) 'Wet ( 7 arbara Kirkmeye 2017-1933 EX0029 BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW RE: Contracts for 2017 Weld County Fair DEPARTMENT: County Attorney Office and Weld County Fair Board DATE: June 16, 2017 PERSON REQUESTING: Karin McDougal and Janet Konkel Brief description of the problem/issue: Enclosed are 12 contracts for vendors at the Weld County Fair which will run from July 26 -June 30, 2017. Only two of the vendors are new, the rest have previously provided services at the fair. The contracts are as follows: 1. Mountain Shadows Carriages by Darin Henry 2. Weld County Meat Goat Breeds Association - 3. Prehistoric Adventures - New 4. Inflatable Fun Zone - New , 5. Corvettes West Car Club 6. Miniature Horse Association 7. Ranch Sorting National Championship 8. 5 Flat Productions 9. Northern Colorado Draft Horse Association 10. Young Guns Entertainment Corp 11. Colorado Garden Tractor Pullers Association 12. Longs Peak Antique Tractor and Engine Association What options exist for the Board? (Include consequences, impacts, costs, etc. of options) Approve contracts for placement on the June 28th Agenda or request a work session. Recommendation: Approve contracts for placement on the Agenda for June 28, 2017 without work session. The contracts are being reviewed by the County Attorney's Office and Janet Konkel will attend the June 28, 2017 meeting to answer any questions. Approve Recommendation Sean P. Conway Julie A. Cozad, Chair Mike Freeman Barbara Kirkmeyer Steve Moreno, Pro-Tem Schedule Work Session Other/Comments: 020 / 7 - / fgo/e -e-L- 020/7- /9,14/ Weld County Board Of Commissioners Inflatable Fun Zone Professional Services Agreement 2017 Weld County Fair THIS AGREEMENT is made this ct day of u ,L-�� 2017, by and between the Board of County Commissioners of Weld County, Colorado, 1150 treet, Greeley, Colorado 80632, hereinafter referred to as "County," on behalf of the Weld County Fair Bard, and Inflatable Fun Zone, 926 S. Arizona, Butte, MT 59701, represented by Corey and Jen Plute, 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 Inflatable Fun Zone (hereinafter "Event") at the 2017 Weld County Fair on July 26, 27, 28, 29 and 30, 2017 at Island Grove Park in Greeley, Colorado. Hours of operation of the activities 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. Personnel, equipment, and materials to be provided by Contractor are as follows: a. 4 Bounce House Units; b. Laser Tag outdoor arena; c. Water Walkerz hamster balls; d. Supervision of the Event Inflatable Fun Zone employees at all times; e. Shall operate the Event in a safe and professional manner at all times; f. Shall exercise sound judgement for the operation of equipment in the event of inclement weather to provide for the safety of the public. 2. Contractor retains the right to sell merchandise at the Event and to retain all proceeds. Contractor shall not charge any member of the public for participating in the activities provided by Contractor and the only compensation Contractor shall receive from County is detailed in Section IV of this Agreement. 3. 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 Event. 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 that Contractor's comprehensive general liability insurance shall be the primary covers,- 4.-- 1 1 2017-1933 C O 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. e. Weld County shall be listed as an also insured on the policy. 4. 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. Advertise Inflatable Fun Zone with a description of the Event and the specific times and dates; b. Provide an adequate area for the Event, staking, and storage trailer behind the Event; c. Provide access to electrical outlets with adequate amp service to meet the requirements of the Contractor; d. Provide water to fill the pool for Water Walkerz; e. Provide double queen hotel accommodations for the duration of the event plus one day before and one day after the fair for Contractor and employees not to exceed 3 rooms. 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. 2 SECTION IV — PAYMENT AND FEE SCHEDULE 1. Contractor shall receive a total payment of eight thousand dollars ($8,000.00) for putting on the Event pursuant to the terms of this Agreement. A deposit of %2 of the total amount ($4,000) is due upon acceptance of this agreement by all parties realizing that acceptance shall occur prior to April 30, 2017. Final payment shall be made upon satisfactory completion of the last day of the Event on July 30, 2017, and any associated clean up or post -Event activities. In the event Contractor does not perform the Event as specified in this Agreement for the full five days, July 26, 27, 28, 29, and 30, 2017, Contractor shall be paid $1000.00 for each full day upon which the Event was performed pursuant to the terms of this Agreement. Contractor shall not be paid for partial days. 2. County may cancel this Agreement by giving at least 120 days advance written notice to Contractor prior to July 30, 2017. Contractor may cancel this Agreement by giving at least 120 days advance written notice to County prior to July 30, 2017. 3. 4. County, at its sole expense and choosing, shall provide Contractor with non-smoking lodging equipped with double queen beds. Check in shall be on July 25th and check out shall be on July 31St pursuant to standard check in and check out procedures for the chosen establishment. County shall be responsible only for the costs of lodging. Contractor shall be responsible for all incidental costs of lodging, any damage to the lodging, and any other costs associated with the lodging. 5. 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. 6. 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. 3 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 contains 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. 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. 4 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 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. 5 The terms of this agreement shall supersede any other agreements that may be signed between parties. In Witness Whereof, the parties hereto execute this contract on the day first above written. ATTEST: CHAIRMAN OF THE BOARD OF WELD COUNTY COMMISSIONERS CON CTOR G-—)-ite; Julie Cozad Chair Date: JUN 2 8 2017 Corey nd Jen Flute President, Inflat ble Fun Zone Date: v1\3\\ lr1 6 020 /7- /9536) Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank: Bounce Off The Wallz LLC 2 Business name/disregarded entity name, II different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: • Individual/sole proprietor or • C Corporation ■ S Corporation • Partnership ■ Trust/estate single -member LLC Limited liability company. Enter the tax classification (C=C corporation, S=S F=partnership) D,Exempt 4 Exemptions (codes apply only to certain entitles, not individuals; see instructions on page 3): payee code (if any) corporation, Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate g box in the line above for the tax classification of the single -member owner. Exemption from FATCA reporting code (if any) ❑. Other (see fnstruotiona) I. (Applies to accounts maintaitred outside Me U.S.) S Address (number, street, and apt. or suite no.) 926 S Arizona Requester's name and address (o(rtlanai) 6 City, state, and ZIP code Butte, MT 59701 7 List account numbers) hers (optional} liZgli Taxpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to .qet a — - TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. or Employer identification number 4 6 2 0 0 2 0 5 6 Part II Certification 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. I 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. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt Certification Instructions. You must cross out Item 2 above if you have been because you have failed to report all interest and dividends on your tax return. interest paid, acquisition or abandonment of secured property, cancellation of generally, payments other than Interest and dividends, you are not required to Instructions on page 3. Sign Here from FATCA reporting is correct. notified by the IRS that you are currently subject to backup withholding For real estate transactions, item 2 does not apply. For mortgage debt, contributions to an individual retirement arrangement (IRA), and sign the certification, but you must provide your correct TIN. See the Signature of U.S. person ► General Instructio S Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an Information retum with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer Identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns Include, but are not limited to, the following: • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) Date ► ok t , '`! L mortgage tntereat-10 -E stu • Form 1098 (homey, (student loan Interest), 1098-1 (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What /s backup withholding? on page 2. By signing the filled -out form, you: 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, and 4. Certify that FATCA code(s) entered on this form (If any) Indicating that you are exempt from the FATCA reporting, Is correct, See What Is FATCA reporting? on page 2 for further information. Cat. No. 10231X Form W-9 (Rev. 12-2014) ® ACO R© �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 11/29/2016, 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 Northeast Insurance Center P O Box 151868 Cape Coral FL 33915 CONTACT Erin Nealeigh AMT: PHONE / NNs Ext): (239) 244-9777 I jA/C,Np EMAIL ErinN@neinscenter.com ADDRESS: G .cocom : (860) 627-8695 NAIC,# 21113 ._--- INSURER(S) AFFORDING COVERAGE -- INSURERA: UNITED STATES FIRE INS. CO INSURED SHOOTZ AND LASERZ, LLC; BOUNCE OFF THE WALLZ, LLC 926 S ARIZONA Butte MT 59701-2931 INSURER B : INSURER C: INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: USP227260 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DDIYYYY) I LIMITS A X COMMERCIAL GENERAL LIABILITY - CLAIMS -MADE [Xl OCCUR SRPGP-101-0716 11/15/2016 I EACH OCCURRENCE $ 1,000,000 11/15/2017 I DAMAGE TO RENTED IPREMISES_(Eaoccurrence) ........._._$._._300,000 MED EXP (Any one person) PERSONAL&ADVINJURY GENERAL AGGREGATE PRODUCTS COMP/OP AGG $ 5,000 $ 1,000,000 $ 2,000,000 $ 2,000 000 GEN'L X AGGREGATE LIMIT APPLIES POLICY r 1 PRO JECT OTHER: PER: LOC I $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS r SCHEDULED I COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ I $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE I EACH OCCURRENCE $ I AGGREGATE $ I $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE r OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER F- E.L EACH ACCIDENT -- .-------------- t E.L. DISEASE - EA EMPLOYEE I ........-------. ............. I E.L. DISEASE - POLICY LIMIT $ . I- ---- $ _.___._-- _--_ __......... $ A Accident AH-GA26932-002/US505759 11/15/2016 I Max Medical Benefit Amount: $10,000 11/15/2017 I 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Laser Tag And Inflatables Certificate Holder ( Event Sponsor) is listed as an additional insured with respects to the general liability in regards to the named insured's operation. Event Date: 07/24/2017-07/31/2017 Event Location: 525 n 15th ave Greeley, Colorado 80631 R CANCELLATION Weld County 525 N. 15th Ave Greeley, Colorado 80631 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RE: APPROVE PROFESSIONAL SERVICES AGREEMENT AND AUTHORIZE CHAIR TO SIGN - INFLATABLE FUN ZONE ATTEST: Weld .� BY: Yerktot he Board Deputy Cl:jk to the Boa APPgD ' S TF Controller APPROVED AS TO FORM: ounty Attorney 1861 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLOFj,QDO Julie A. Cozad, Chair (d 2 8 2017 APPROVED AS TO SUBSTANCE: x�Ft Elected Official or Del ment Head 02017-/933() Hello