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CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND HELENE WURTH (Non -Core)
This Agreement Amendment, made and entered into
day . f - � 2016, by and between
the Board of Weld County Commissioners, on behalf of the Weld Cou ty Department of Human
Services, hereinafter referred to as the "Department", and Helene Wurth, hereinafter referred to as
the "Contractor".
WHEREAS the parties entered into an Agreement for Home Studies and Relinquishment
Counseling, (the "Original Agreement") identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2014-2476, approved on August 11, 2014.
WHEREAS the parties hereby agree to amend the term of the Original Agreement in
accordance with the terms of the Original Agreement, which is incorporated by reference herein, as
well as the terms provided herein.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as
follows:
• The Original Agreement ended on May 31, 2015.
• The Original Agreement was renewed for the term of June 1, 2015 -May 31, 2016. The
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-1610(1), approved on June 1, 2015.
• The Amendment, together with the Original Agreement, constitutes the entire
understanding between the parties. The following change is hereby made to the Contract
Documents:
1. Term
This agreement shall become effective on June 1, 2014, upon proper execution of this
Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein.
2. None
• All other terms and conditions of the Original Agreement remain unchanged.
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2016-1886
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month,
and year first above written.
COUNTY:
ATTEST: da/4/1/, BOARD OF COUNTY COMMISSIONERS
Weld County Clerk to the Board WELD COUNTY, COLORADO
By:
Deputy Cle
k to the B
Mike Freeman, Chair JUN 2 0 2016
NTRACTOR:
elene Wurth
306 Beaver Creek Drive
Fort Collins, Colorado 80526
(970) 631-6235
By:
Date:
Helene Wurth
Certificate of Insurance (Proof of Coverage) Date Issued: (7/8/2015)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.
Insured Name and Mailing Address*
Program Administrator
Name Helene Wurth
Street 4306 Beaver Creek Dr
City Fort Collins
State Colorado
Zip 80526
Administered By:
CPH and Associates
711 S. Dearborn, Suite 205
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
info@cphins.com
Underwritten By:
Philadelphia Indemnity Insurance Com an
*Additional insured locations are often requested by individual business owners who have more than one office.
Your covera, eis portable, meanin that you are covered at an, location or ractice under the occu ation(s) listed on our olio .
Coverage
Policy #: E180872 'Effective Date: (7/7/2015) 'Expiration Date: (7/7/2016)
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
Coverage Part
Each Occurrence
(Per individual claim)
Aggregate
(Total amount per policy year)
$1,000,000.00
$3,000,000.00
Professional Liabilit
N/A
N/A
General Liability
Includes: General Liability, Fire & Water Legal Liability and
Personal Liabilit
N/A
N/A
Property Coverage
$1,000,000.00
$3,000,000.00
Supplemental Liability
Unlimited
Unlimited
Defense Expense Coverage
$35,000
$35,000
State Licensing Board Investigation Defense Coverage
$15,000
$15,000
Assault Coverage
$10,000
$35,000
Deposition Expense Benefit
$5,000/person
$50,000
Medical Expense Coverage
$15,000
$15,000
First Aid Coverage
Description/Special Provisions:
Certificate Holder
Cancellation
Weld County DHS
315 A N. 11th Ave
Greeley, CO 80632
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
Holder has also been added to the policy as an
additional insured:**
XYes / No
**If the certificate holder is an ADDITIONAL INSURED, the
policy(ies) must be endorsed. A statement on this certificate does
not confer rights to the certificate holder in lieu of such
endorsement(s).
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i
Authorized Representative
C. Philip Hodson
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate
holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREFULLY
Additional Insured Endorsement
This endorsement modifies insurance provided under the following:
ALLIED HEALTHCARE PROVIDERS PROFESSIONAL
AND SUPPLEMENTAL LIABILITY POLICY
In consideration of the premium paid, this policy is amended as follows:
Weld County DHS is hereby added as an Additional Insured, solely for Damages arising out of a Professional Incident covered under this
policy. The Professional Incident must arise out of services provided by the Insured, under contract with Weld County DHS.
Additional Insured Name and Mailing Address:
Weld County DHS
315 A N. 1 I th Ave
Greeley, CO 80632
All other terms and conditions of this policy remain unchanged. This endorsement is part of your policy and takes effect on the effective date of
your policy unless another effective date is shown below.
Policy: E 180872
Effective on and after: 7/7/2015
Issued to: Helene Wurth
Expiration date: 7/7/2016
PI -MCP -03(03/01)
By:
Robert O'Leary, Authorized Representative
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