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Home My WebLink About20153965.tiff WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 i (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WELD COUNTY ASSESSOR 1400 N 17TH AVE GREELEY, CO$0632 RE ��`�D �� $ �� VirELC� CtJ�iP�`�`Y��5E�SQR C3R��Y, .,t�L�l•�A�C? This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/01/2016 Policy No. 00377430 16 1 Endorsement No. Insured Martindale Consultants Inc Premium Insurance Company Countersigned by CompSource Mutual Insurance Company �� r WC 00 03 13 (Ed.4-84) nOO 1983 National Council on Compensation Insurance. p�O/� �7� l..�omrrw.n i�,O 3-1(.-Zc�l b �'..O��J 8 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 01 (Ed.4-84) ALTERNATE EMPLOYER ENDORSEMENT This endorsement applies only with respect to bodily injury to your employees while in the course of special or temporary ernployment by the alternate employer in the state named in the Schedule. Part One (Workers Compensation insurance) and Part Two (Employers Liability Insurance) will apply as though the alternate employer is insured. Under Part One (Workers Compensation Insurance)we will reimburse the alternate employer for the benefits required by the workers compensation law if we are not permitted to pay the benefits directly to the persons entitied to them. The insurance afforded by this endorsement is not intended to satisfy the alternate employer's duty to secure its obligations under the workers compensation law. We will not file evidence of this insurance on behalf of the alternate employer with any government agency. We will not ask any other insurer of the alternate employer to share with us a loss covered by this endorsement. Premium will be charged for your employees while in the course of special or temporary employment by the alternate employer. The policy may be canceled according to its terms without sending notice to the alternate employer. Part Four(Your Duties If Injury Occurs) applies to you and the alternate employer.The alternate employer will recognize our right to defend under Parts One and Two and our right to inspect under Part Six. Schedule State of Special or I Alternate Employer Address Temporary Employment WELD COUNTY ASSESSOR 1400 N 17TH AVE CO GREELEY,CO 80632 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/01/2016 Policy No 00377430161 Endorsement No. Insured Martindale Consultants Inc Premium ' Insurance Company Countersigned by Comp5ource Mutual Insurance Company �� E�. ;.� i%��2/�----- � _' G%G�� 0� r� �� ' wc o0 03 oi MAR 0 8 Zp�� (Ed.4-84) 1NELD CU�t�:'�'Y i�SSESSOR O1983 National Council on Compensation Insu��LEY, 4,;C�.Y�,Q�A�Q ��" T � DATE(MM/DD/YYYY) A�coR'D' CERTIFICATE OF LIABILITY INSURANCE 03/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONIY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIHMATIVELY OH NEGATIVELY AMEND, EXTEND OR AITER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TFIE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoider is an ADDITIONAL INSURED,the policy(ies} must be endorsed. If 5UBfiOGATiON IS WAIVED, subject to the terms and conditions of the poilcy,certain policies may require an endorsement. A statement on this certificate does nat confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NpMgA ,,,,,,,Gomp5ource Mutual Insurance Company PNbNE {405)232J663 ext.5102 FAX�" �� LAtG.�st�Eatl;_.. �__�, _ �INC Nttl. _� E-MAIL � AbClRESS• . .. . ..._ ._.._..-- ttJ6tlfiER(S�AFFORDING COVERAGE NAIC N ._.. � _ tN5uREA A:CompSource Mutual Insurdnce Company 36188 INSURED fNSURER$: .�._.,.,..._..._.....�. ._._. - Martindale Consultants Inc �N�uAEst C; 4242 N Meridian rN5u�tEp a: _ .� Oklahoma City,OK 73112-2457 INSUR£R E: .... .- - INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THfS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IfVSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA7ED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT�FICATE MAY BE ISSUED OR MAY PERTAIN. 7HE INSURANCE AFFORDED BY THE POLICtES DESCRlBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY FiAVE BEEN REDUCED BY PAID CLAIMS. ..INSfi �'l�Obl.5. __..._. POl.ICY EFI�T POLICY EJ(P �... .._... ...._ ---. ��p TYPE OF INSURANCE POLICY NUMBER MMtpQ YY MM/�D/VYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURFlENCE 5 �fi�A�E'fC�mR�(3T�'� $ CLAIMS-MADE � � OCCUR _.��EM15ES iE8 pr�@«#�1_ ��—._.e_._. MED EXP(An one erson $ �. _.._.,._..___ �_..____— _�. : ' � PERSONAL&ADV INJURY $ __.._ ._._�_._.... ". . G`EN'L AGGREGAT�.LIMIT APPLI6S PEFi: GENERAL AGGAE6ATE 5 ._... _ PC7LICY� PRp � LOC PRODUCTS-COMPlOP AGG 5 JECT 8 OTHER: AUTOMOBILE LIABILITY CL3MBINED SINGLE LIMIT � �acc��{enf�_ �� ANY AUTO BODI�Y INJURY(Per person) $ � _.___ . .._,-.--.._...._.. �W AL.L OWNED SCHEDULED BODILV INJURY(Per ar.r,ident) 5 �_...-._...�� AUTOS NON•OWNED PR{3PER7Y DAMAGE � P6t 9 S n HIRED AUTOS AUTOS � �$ UMBRELLA LIA6 OCCUR EACH OCCURRENCE � � � EXCESS LIAB C�pIMS•MADE AGGREC�ATE $ ___....... . ....._ ......... ..... .........._.._.,,...� DF� RETENTION$ � $ WORKERS COMPENSATION X �'ER OTH- ; AN�EMPLOYEpS'LIA8ILJTY .. $TATU7E ER ,..,. V!N �E,LEACNACCI�ENT $1,000,000.00 ANV PROPPoETORIPARTNER/EXECUTIVE ' A OFFtCEwMEMeEREXCLUDEo? �N/A X 0�377430161 03/01/2016 03/Ol/2017 -- --' ✓` (ManOatory In NH) . G.L.OISEASE-EA EMPLOYE $1,000,000.00 � �._......._.__..............__.. If yes,describe under . E.L DISEASE•POLICY LIMIT $1,000,000.00 DESCRIPTIQN OP OPEflATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AtlAltfonal Remarks Schatlule,may be attached 11 more apace ia required) Alternate Employer Endorsed CERTIFICATE HQI.LtER CANOEl.LATION WEID COUNTY ASSESSOR x SHOULD ANY OF THE ABOVE�ESCRI9E0 POLICIES BE CANCEILED BEPORE 1400 N 17TH AVE ��t �1 � ACCORDANCEIW TH HE POLICY PROVISIONSE WILL BE DELIVERED IN GREELEY,CO 80632 � * _ __.. � AUTHORIZED REPRESENTATIVE MAR o 8 2016 � �� :f'f rr t.y�� 1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(20i4/01) G��L�T�e Afi��a?►d{ogo are registered marks of ACORD �' ) � DATE(MANOD/YVYY� ��R'c' CERTIFICATE OF LIABILITY INSURANCE 03/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEFi. 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 lNSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFfCATE HOIDER. IMpORTANT: If the certificate holder is an qDDi71ONA�INSURED,the pol€cy(ies) must be endorsed. If SUBfi�GAT1ON IS WAIVED, subject to the terms a�d 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 endarsement{s. PRODUCER h,��Ea _Comp5ource Mutual Insurance Company PHONE �d051232-7663 ext.5102� �A�� _tAl�.,:N.4.�asU; _ a�l��... __ .. E-MAIL .-,.--�--_.._- ApDR��_ _..W� _..�_.�� _..mm.�_._-... 1NSURER S AFFORDING COVERAGE _,,, NAIC M _.�_._.� _._ _. INsuaEa a:CompSource Mutual I�surance Company 36188 INSURED INSURER B: ......____..�.�__.�----�-. --� -- __.........�____W_......_.._.._.._.... Martindale Consultants Inc INSURea C: _.� _..._—..--- — 4242 N Meridian INSURER D: --- Oklahoma City,OK 73112-2457 utsut��ae: .._ --- INSURER F: � COVERAGES CER7IFICATE NUMBER: ��u��t��R� I THIS IS TO CERTIFY THAT THE POLICIES OF IN5URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA7ED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, � EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �N�� .—•�- ...... . �"�fis'�j�$"`�. . '.— . .POUCY EFF POLICY EXP � LIMITS {fip TYPE�OFIN5URANCE POLICYNUMBER MMI lYMY MMlDD/VYYY COMMERCIAL GENERAL IIABILITY EACH OCCURRENCE $ �. �, -��--mm�� ClAIM5•MADE ��OCCUR PR�MISfi (Fn4cGuttpnC�__.,_��r$_, . ___ MED EXP(A�ry one porsan) $ ._ _____,_._ PERSONAL&ADV INJURY_ g ,� .� GEN'L AGGREGATE LIMIT APPLIES PER: ��GENERAL AGGREGATE. � _,�„_ I PQLICY ARO• LOC PRODUCTS-COMP/OP AGG $ _f �JECT � $' �tJiH�F3 Ci"JM�lNE�51NGLE L1MIT � AUTOMOBILE LIABILITY f E�tat�k5��n�_,� .. BODILY�NJURY(?or person) $ ANYAUTO ---.._._______..,_,..._....._.__...._...._.... ---_ ALL OWNED SCHEDU'_ED �� BODILY INJURY(Per accidentj $ AUTOS AUTOS pNppERTY DAMAGE �� NON-OWNED paracc9d�� HiRED AUTOS AUTOS $ UM9RELLA LIAB QCCUP EACH OCCURRENCE $ , __._._.,.- �� EXCESS LIAB CLAIMS-MADE AGGREGATE $ __.__.....__.._._� .._____.._......_...................._.._�, DED RE7^NTICN$ � WORKERS COMPENSATiON X $7ATUTE �ERH• AND EMPLOYERS'1IA81LITY ��N A ANY PROPRIETOR/PARTNER/EXF..CUTIVE E.L.EACH ACCIDENT $1,000,000.00 U`rFIGERlaAEMBEREXCLUDED? � N/A 00377430161 03/Ol/2016 03/Ol/2017 ---- � (Mandatory in NH) E.L,DISEASE�EA EMPLOYE S 1�000,OOOAO Y If yes,describe under E.L.DISEASE•POLICY LIMIT 51.000,000.00 RESCRIP710N OF OPERATIONS below OESCRIPTION OF OPERATIONS/LOGATIONS/VEHICLES (ACOFD 101,Additional Remarka Schetlula,may be attached it more apace is required) GERTIFICATE HOLDER C��T�a� ;,� WELD CQUNTY ASSESSOR � �; �� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1400 N 17TH AVE ,• , $„;� ,.. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVHRED IN ACCORDANCE WITH THE POUCY PROVISIONS. GREELEY,CO 80632 Q __. ___._.__. MA� � (} 2p�� AUTHORIZED REPRESENTATIVE VUELD C�€.=s��'r'� �v�SESSOR � � ''��`'— ' ,,,t , �1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD RESOLUTION RE: APPROVE AMENDMENT TO PURCHASE OF PROFESSIONAL SERVICES AGREEMENT FOR OIL AND GAS AUDITS AND EVALUATION SERVICES AND AUTHORIZE CHAIR TO SIGN - MARTINDALE CONSULTANTS, INC. 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 an Amendment to the Purchase of Professional Services Agreement for Oil and Gas Audits and Evaluation Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, and Martindale Consultants, Inc., commencing January 21, 2016, and ending January 20, 2017, with further terms and conditions being as stated in said amendment, and WHEREAS, after review, the Board deems it advisable to approve said amendment, 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 Amendment to the Purchase of Professional Services Agreement for Oil and Gas Audits and Evaluation Services between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, and Martindale Consultants, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said amendment. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of December, A.D., 2015. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO , ATTEST: Weld County Clerk to the Bo BY: Deputy Cler County Attorney Date of signature: ///f//�i Julie A. Cozad Steve Moreno 1_026 - /6 2015-3965 BC0048 AMENDMENT TO PURCHASE OF PROFESSIONAL SERVICES AGREEMENT OIL AND GAS AUDITS AND EVALUATION SERVICES This AMENDED PURCHASE OF PROFESSIONAL SERVICES AGREEMENT ("Agreement") is made this 16th day of December, 2015, by and between County of Weld, a body politic and corporate of the State of Colorado, by and through the Board of County Commissioners of the County of Weld whose address or principal place of business is 1150 "O" Street, Greeley, Colorado 80631, and on behalf of the Weld County Assessor, (hereinafter 'BOCC'), and Martindale Consultants, Inc. an Oklahoma corporation whose principal office is located at 4242 North Meridian Avenue, Oklahoma City, Oklahoma 73112, registered in the State of Colorado, with a registered agent, InCorp Services, Inc., located at 36 South 18`" Street, Brighton, Colorado 80601, and with Colorado offices located at 4581 Julian, Denver, Colorado 80211, (hereinafter Contractor"). WHEREAS, on the 3rd day of December, 2012, BOCC entered into an Agreement with Contractor to provide professional audit services to assist the Weld County Assessor in the evaluation of appeals of the ad valorem assessments on oil and gas production and on the personal property used in the production process made by made by oil and gas production operators, and WHEREAS, the said agreement has been amended twice to extend the Agreement to January 20, 2016, and WHEREAS, BOCC has now determined that additional professional audit and consulting services would continue to assist the Weld County Finance Department in the evaluation of the accuracy of the records of royalty payments made to Weld County, and WHEREAS, BOCC has determined that additional professional audit and consulting services would also continue to assist the Weld County Assessor in the evaluation and assessment of oil and gas production for as valorem tax purposes, and WHEREAS, Contractor has the expertise to perform the audits required, to provide the consulting services, has the time available to timely perform those services, and is willing to perform the services according to the terms of this Agreement and in accordance with the applicable policies of BOCC and the Weld County Assessor, and WHEREAS, BOCC has authority to acquire the services described in this Agreement pursuant to the provisions of §30-11-101, et seq., C.R.S., as amended, and. WHEREAS, the Weld County Assessor wishes to and has authority to acquire the services of a Contractor to assist it in the examination and analysis of the records of the operator(s) of oil and gas leaseholds as described in this Agreement pursuant to the provisions § 39-5-120, § 39- 21-109 and § 39-7-105, et seq., C.R.S., as amended, and 2015-3965 WHEREAS, BOCC and Contractor now wish to amend the term of the Agreements of December 3, 2012, from January 20, 2015 to January 20, 2016, and include the new schedule of fees to be charged during the extended term. NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth hereinafter, BOCC and Contractor agree as follows: Term of Agreement: Services of the Contractor shall commence on the 21° day of January, 2016, and shall be completed by the 20th of January, 2017. This Agreement will terminate on the date set forth above unless renewed in writing at least thirty (30) days prior to the date of completion. The attached Exhibit A shall be the schedule of fees charged during this extended term. All other terms and conditions of the agreement remain the same. IN WITNESS WHEREOF, BOCC and Contractor have set their hands and seals. CONTRACTOR: ATTEST: Martindale Cons (an Oklah W. Patri • " Martinda "" - ' = = tdent SEAL (if any) FEIN: 73-1249823 The foregoing issirument was acknowledged before m this g day of 2015, by W. , as iWel d") C- Martindale Consultants, Inc. JO, Ink— commissiius atciMmian: Notary Public State of Oklahoma Commission ! 04005005 My Commission Expires Sep 2.2016 ATTEST: Weld • u ,Clerk to the Bo. rd WELD COUNTY, COLORADO BY: tho BOARD OF COUNTY COMMISSIONERS do/tot) Deputy Cler to the Boar bara Kirkmeyer, C Ne. keinba_, of DEC 6 2015 go/5-39e, APPROVED AS TO FUNDING: Controller APPROVED AS TO FORM: County Attorney APPROVED AS TO SUBSTANCE: Elected Official or Department Head IA Director of General Services Weld County Contract Period: 2016 Hourly Rate Amendment The 2016 rates for compensation under this contract shall be: W. Patrick Martindale $ 200.00 / hour Todd Attalla $ 150.00 / hour Project Manager $ 125.00 - 150.00 / hour Experienced Project Lead $ 100.00 - 125.00 / hour Assisting Staff (based on experience level) $ 80.00 -100.00 / hour Other Support Staff $ 50.00 - 90.00 / hour Hello