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CONTRACT AGREEMENT AMENDMENT BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS (Core)
T§
This Agreement Amendment, made and entered into p�o day of 2016by and
between the Board of Weld County Commissioners, on behalf of the Weld unty Department of
Human Services, hereinafter referred to as the "Department", and Lutheran Family Services Rocky
Mountains, hereinafter referred to as the "Contractor".
WHEREAS the parties entered into an Agreement for Foster Parent Consultation, Home Based
Intensive Services, and Life Skills (the "Original Agreement") identified by the Weld County Clerk to the
Board of County Commissioners as document No. 2014-3046, approved on October 6, 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 amended for an additional term of June 1, 2015 -May 31, 2016. This
Agreement Amendment is identified by the Weld County Clerk to the Board of County
Commissioners as document No. 2015-1612(2), approved on June 1, 2015.
• The Amendment(s), 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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2016-1889
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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.
CO NTY:
ATTEST: re v• .40;4. BOARD OF COUNTY COMMISSIONERS
Weld • unty Clerk to the :oard WELD COUNTY, COLORADO
By.
Deputy ? erk to the B
Mike Freeman, Chair
JUN 2 0 2016
CONTRACTOR:
Lutheran Family Services Rocky Mountains
363 South Harlan, Suite 200
Denver, Colorado $O226
(3O3) 922-34
By:
J,aFn`es Barc
/President an
Date:
let Executive Officer
oz,,o/‘ - /119
Client#: 28814
LUTHSOC1
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
6/26/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
IMA, Inc. - Colorado Division
1705 17th Street, Suite 100
Denver, CO 80202
303-534-4567
CONTACT
PHONE FA3t
eAJC, , Eat): 303-534 4567 J A C, No) 303-5348600
ADDRESS: denaccounttechs@imacorp.com
INSURER'S( AFFORDING COVERAGE
NAIC 0
INSURER A Philadelphia Insurance Company
23850
INSURED
Lutheran Family Services of Colorado
363 South Harlan, Ste 200
Denver, CO 80226
INSURER B . Pinnacol Assurance
41190
INSURER C Zurich American Insurance Co(')
16535
INSURER 0
INSURER E
INSURER F: *Pinnacol Assurance
COVERAGES
CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POL CIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRR
TYPE OF INSURANCE
I�$R WVD POLICY NUMBER
(MM1DO/YYYYYI
( DIIYYYYY)
LIMITS
A
GENERALLtaBIUTY
X
COMMERCIAL GENERAL LIABILITY
PHPK1355790
07/01/2015
07/01/2016ppEAACCH��OCCURRENCE
51,000,000
PREMISES(EaEoNuv£nOence)
s1,000,000
CIAIMS•MADE I`X OCCUR
MED EXP (Any one person)
$ 20,000
PERSONAL d ADV INJURY
51,000,000
GENERAL AGGREGATE
5 3,000,000
53,000,000
GENT AGGREGATE LIMIT APPLIES PEN
—1 POLICY n JPEROUT• X LOC
PRODUCTS- COMPIOP AGG
s
A
AUTOMOBILE
X
^-••
X
LIABIUTY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
.,_,
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
PHPK1355786
07/01/2015
07/0112016
COMBINED SINGLE LIMIT
cEaecddent)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per aCCrdanl)
5
PROPERTY DAMAGE
_amaccuienil
S
S
UMBRELLA UAB
EXCESS LIAR
—
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
S
DEC) i I RETENTIONS
S
B
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFECEAIPRIETOREXRTNER/7ECUTIVEYN
(Mandatory in NH)
II yes. describe under
DESCRIPTION OF OPERATIONS below
N/A
4040538 -CO ONLY
03/01/2015
03/01/2016
X ( cWilMi ITS IPRH-
WC969160404-NM ONLY
03/01/201503/01/2016
EL EACH ACCIDENT
5500,000
E L DISEASE • EA EMPLOYEE
5500,000
E L DISEASE - POLICY LIMIT
5500,000
A
Professional
Liability
PHPK1355790
07/01/2015
07/01/2016
$1,000,000 Each Claim
$3,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD /0t, Additional Remarks Schedule. If note space a required)
Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and
agents are included as Additional Insureds on the General Liability Policy if required by written contract
or agreement subject to the policy terms and conditions.
CERTIFICATE HOLDER
CANCELLATION
Weld County Department of Social/Human Services
PO Box A
Greeley, CO 80632
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
//,./e
CI 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010(05) 1 of 1 The ACORD name and logo are registered marks of ACORD
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