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Home My WebLink About12- Archery Contract 2.pdfWOR; FRS' COMPENS. _TION INSURANCE COVERAGE EMPLOYEE NOTICE BIG SKY ARCHERY INC Date: 07/19/2011 77 LAURA LOUISE LN Policy Number: 03- 339279 -6 BOZEMAN MT 59718 Team: 1 The above -named employer's workers' compensation insurance coverage is active and in good standing for the period of 08/03/2011 to 08/03/2012, provided the employer meets all premium and reporting requirements. IF YOU ARE INJURED You should report any on- the -job injury to your supervisor, employer, or insurer as soon as possible. You must report the accident within 30 days. A sole proprietor, partner, manager of a manager- managed limited liability company, member of a member - managed limited liability company, or corporate officer covered under the Montana Workers' Compensation Act must report an accident to the insurer within 30 days. Report minor injuries to your employer whether or not you receive medical treatment. After you report the injury, your employer has 6 days to notify their insurer. You must submit a written First Report of Injury within 12 months from the date of the accident or within one (1) year from the knowledge of an occupational disease. You can submit this form to your employer, insurer, or the Department of Labor and Industry. All employees sustaining a compensable work related injury or occupational disease, other than those who are exempted by statute (Section 39 -71 -401, MCA), are covered for medical and wage -loss benefits. Prior to the Insurer's designation or approval of a Treating Physician you may choose your initial Health Care Provider. You may continue to receive treatment from your initial health care provider unless the insurer designates a treating physician other than your initial health care provider. After providing you with a notice of a designated or approved treating physician, the insurer is no longer liable for treatment provided by other health care providers unless authorization is obtained to continue treatment. For specific information about this policy, call or write your employer's insurance carrier: AAnntana StRta Fiend OMU2012 15 12 1 7EST Page 1 of $ NOTICE OF PROPOSED CLASS ACTION SETTLEMENT IF YOU RECEIVED UNSOLICITED ADVERTISING FAXES FROM ENGINEERING SERVICES AND PRODUCTS COMPANY (-ESPC-), PLEASE READ THIS NOTICE CAREFULLY. IF YOU WISH TO BE PAID BENEFITS UNDER THIS SETTLEMENT, SUBMIT A CLAIM FORM BY OCTOBER 5, 2012. To All Members of the Following Class: All persons and entities with fax numbers, who in December, 2011, were sent faxes by Engineering Services and Products Company, promoting its goods or services for sale, and who were not provided with an "opt out" notice as described in 47 U.S.C. § 227. I. WHY IS THIS NOTICE BEING SENT? This notice is being sent to let people know that they may be eligible to receive their pro rata share of a Settlement Fund described below under a proposed settlement of a class action lawsuit if they submit a claim form by OCTOBER 5, 2012. The lawsuit is pending in federal court in Chicago, Illinois. The hearing to approve the settlement will be held on NOVEMBER 9. 2012 at 1:30 a.m. before Judge Bucklo, Courtroom 1441 of the U.S. District Court for the Northern District of Illinois, 219 S. Dearborn St., Chicago, IL 60604. II. WHAT IS THE LAWSUIT ABOUT? Plaintiff Richard Wade Architects, P.C. ("Plaintiff') sued ESPC, alleging that it received an unsolicited facsimile advertisement from ESPC and that the sending of this fax violated federal law, called the federal Telephone Consumer Protection Act. Plaintiff sought to represent a class of persons to whom ES PC sent unsolicited advertising facsimiles. ESPC denies these allegations but has agreed to settle to avoid the costs and uncertainties of litigation. ESPC will vigorously defend the lawsuit if the proposed settlement is not approved. III. WHAT IS THE PROPOSED SETTLEMENT? The parties to the lawsuit have agreed to settle after extensive negotiations. Under the proposed settlement, ESPC has agreed to pay a Settlement Fund in the amount of $215,000. The Settlement Fund will cover an award to the plaintiff ($3,000, in addition to its recovery as a class member), attorney's fees (in the amount of $64,500 or 30% of the Settlement Fund), plus reimbursement of reasonable costs of notice and administration incurred. After these amounts are deducted, each Class Member who submits a valid claim by OCTOBER 5, 2012 will receive an equal share of the remaining funds. Your share of the settlement fund depends on how many Class Members submit claim forms. This notice is being sent to approximately 50,000 persons or entities. Therefore, if 10% of the Class Members submit a valid claim, you may expect to recover approximately $26.00. If 15% of the Class Members submit a valid claim, you may expect to recover approximately $17.00. If 20% of the Class Members submit a valid claim, you may expect to recover approximately $13.00. The recovery to the Class Members is estimated and is subject to change based on the costs of notice and administration. Defendant has sent its advertisements to some Class Members with whom it has had an established business relationship or from whom it had obtained prior permission to receive fax communications. These persons are estimated to comprise at least 85% and as many as 95% of the Class. IV. HOW DO I GET A PAYMENT? If you are part of the class described above, complete and submit the claim form to EDELMAN, COMBS, LATTURNER & GOODWIN, LLC (26407), 120 S. LaSalle St., 18`h Floor, Chicago, IL 60603, class- settlement@edcombs.com or 866 -834 -3504 (FAX). Claim forms must be faxed, emailed or postmarked by OCTOBER 5. 2012. V. WHAT AM I GIVING UP? If the settlement becomes final, you will be releasing ESPC of any claims relating in any way to their sending of unsolicited advertising facsimiles in December, 2011. This release is more fully explained in paragraph 11 of the Settlement Agreement. You will need to reference case number 11 C 9251. The Settlement Agreement is available at www.edcombs.com or at the Clerk's Office, U.S. District Court for the Northern District of Illinois, 219 S. Dearborn St., Chicago, IL 60604 or from Settlement Class Counsel during regular business hours. VI. EXCLUDING YOURSELF FROM THE SETTLEMENT You will be a member of the Settlement Class unless you exclude yourself from the Settlement Class. You need not take any action to remain in the Settlement Class but you need to submit a Claim Form by OCTOBER 5. 2012 to be eligible to receive a payment. If you want to keep the right to sue ESPC over the legal issues in this case, then you must take steps to get out of the settlement. This is called asking to be excluded from — or sometimes called "opting out" of— the class. To exclude yourself from the settlement, you must send a letter saying that you want to be excluded from Richard Wade Architects, P.C. v. Engineering Services and Products Company, 11 C 9251, class action settlement. Be sure to include your name, address and the number for the facsimile machine on which you were sent a fax advertisement and your signature by OCTOBER 5. 2012. Send the letter to Class Counsel at the address provided in paragraph VIII. If you opt out, you will not receive any payment from the Settlement Fund, you cannot object to the Settlement and you will not be bound by anything that happens in this lawsuit. VII. OBJECTING TO THE SETTLEMENT. Either on your own or through an attorney you hire, you can tell the Court that you don't agree with the settlement or some part of it. You must explain why you think the Court should not approve the settlement. To object, you must send a letter saying that you object to the settlement in Richard Wade Architects, P.C. v. Engineering Services and Products Company, 11 C 9251. Be sure to include your name, address and the telephone number for the facsimile machine on which you were sent the fax advertisements, a statement of your objection, an explanation of the reasons you object to the settlement and documentation, if any, to support your objection by OCTOBER 5, 2012. The Court will consider your views if you properly submit an objection on time. Objecting is simply telling the Court that you don't like something about the Settlement. You can object ONLY if you stay in the class. If you exclude yourself, you can't object. Any objections or appearances must be filed with the Court and reference 11 C 9251 and sent to Class Counsel at the address provided in paragraph VIII and Defendant's Counsel at the following address: Norman K. Beck, WINSTON & STRAWN LLP, 35 W. Wacker Drive, Chicago, IL 60601 (312) 558- 5700 (FAX), www.winston.com. VIII. WHO REPRESENTS THE CLASS? The Court has appointed the following law firm to represent you and other members of the Settlement Class in this lawsuit: EDELMAN, COMBS, LATTURNER & GOODWIN, LLC (26407) 120 S. LaSalle St., 181h Floor Chicago, IL 60603 (312) 917 -4504 866 - 834 -3504 (FAX) www.edcombs.com class-settlement(@,edcombs.com This firm represents your interests in this lawsuit. You may contact them with any questions that you have about the lawsuit or the Settlement. You do not have to pay the fees of Class Counsel. You may also hire your own attorney at your own cost to appear on your behalf. IX. CAN I GET MORE INFORMATION? This notice is intended only as a summary ofthe lawsuit and proposed settlement. It is not a complete statement of the lawsuit or the proposed settlement. You may inspect the pleadings and other papers 33AX51 M2 F 1 a7ES 'age 2oW3 (including the proposed Settlement Agreement) that have been filed in 11 C 9251, at the office of the Clerk of the Court, U.S. District Court for the Northern District of Illinois, 219 S. Dearborn St., Chicago, IL 60604. If you have questions about this notice or the proposed settlement, you may contact Settlement Class Counsel at the address and phone number listed above. DO NOT CONTACT THE COURT OR DEFENDANT FOR INFORMATION. BY ORDER OF THE U.S. DISTRICT COURT, N.D. Ill. 0=612012 16 12 1 7EST Page 3 013 CLAIM FORM RICHARD LL' 4DE ARCHITECTS. P.C. v ENGINEERING SERVICES AND PRODUCTS COMP.4NE (N.D. Ill. 11 -C: -9251) TO RECEIVE A PAYMENT UNDER THIS SETTLEMENT AGREEMENT, THIS CLAIM FORM MUST BE FAXED, EMAILED OR POSTMARKED ON OR BEFORE OCTOBER 5, 2012 TO THE FOLLOWING: EDELMAN, COMBS, LATTURNER & GOODWIN, LLC (26407) 120 S. LaSalle St., 18th Floor Chicago, IL 60603 866 - 834 -3504 (FAX) class - settlement a.,edcombs.com Please print or type the following information: NAME OF PERSON OR ENTITY THAT SUBSCRIBED TO THE FAX LINE: CURRENT MAILING ADDRESS OF SUBSCRIBER OF FAX LINE: ADDRESS: CITY/STATE.- ZIP CODE: FAX NUMBER: IT IS YOUR RESPONSIBILITY TO KEEP A CURRENT ADDRESS ON FILE WITH THE CLASS ADMINISTRATOR. 406 - 582 -2292 RRAw4j Farmers Union Mutual Insurance Company 300 River Drive North P.O. Boa 2169 COMORCIAL UMBRELLA POLIC' h1ll�lRifCe Great Falls, MT 59403 -2169 ww.fumico.net RENEWAL DECLARATION Policy Number Policy Period _ Agent No. -- From To CB00001261 04/04/12 04/04/13 12:01 AN MOUNTAIN STANDARD TIME MT00230 Named Insured and Address: Agent Name and Address: BIG SKY ARCHERY INC BELGRADE INSURANCE AGENCY, INC 77 LAURA LOUISE LANE 201 W. MADISON AVE. SUITE 200 BOZEMAN MT 59718 BELGRADE MT 59714 -3906 PHONE: (406) 388 -6774 INSURED IS: CORPORATION BUSINESS DESCRIPTION: ARCHERY SHOP PREMIUM FOR THE TERM OF THIS POLICY: ADDITIONAL /RETURN PREMIUM: LIMIT OF LIABILITY: $4,000,000 SELF - INSURED RETENTION: $10,000 $2,700 ANY ONE OCCURRENCE OR OFFENSE SCHEDULE OF UNDERLYING INSURANCE AND LIMITS OF LIABILITY UNDERLYING INSURANCE POLICY NUMBER/ COMPANY NAME POLICY PERIOD G NERAL LIABILITY FARMERS UNION MUTUAL INSURANCE COMPANY BP00004736 04/04/12 - 04/04/13 GENERAL AGGREGATE PRODUCTS /COMPLETED OPERATIONS AGGREGATE PERSONAL AND ADVERTISING INJURY EACH OCCURRENCE LIMITS $2,000,000 $2,000,000 $1,000,000 $1,000,000 ,yam Farmers Union Mutual Insurance Company N� 300 River Drive North BQSINZSSONNSRS POLICY p.0. Box 2169 Arrd!lQ44". Great Falls, MT 59403 -2169 RENEWAL DECLARATION www.fuajco.net Bp00004736 04/04/11 04/04/12 12:01 AM MOUNTAIN STANDARD TINS RT00230 BELGRADE INSURANCE A E SUITE 200 BIG SKY ARC�tY INC 201 W. MADISON AVE. 77 LAURA LOUISE LANE BELGRADE MT 59714 -3906 BOZZIAN MT 59718 pgpNE: (406) 388 -6774 CORPORATION FORM OF BUSINESS: IN RETURN FOR THE PAYMENT OF THE PREMIUM, IN URANCEEAS STATED INETHISMPOLICY. THIS POLICY, WE AGREE TO PROVIDE YOU NSURED PREMISES: LOC # BLDG # ADDRESS p,RCHERY SHOP BUSINESS DESCRIPTION: 1 1 77 LAURA LOUISE LANE BOZEMAN MT 59718 POLICY DEDUCTIBLE: SPECIAL WINDSTORM AND RAIL DEDUCTIBLE: APPLICABLE TO BUILDINGS GLASS DEDUCTIBLE COVERAGE EXTENSIONS/ OPTIONAL COVERAGES / * * ** PROPERTY * * ** LIMITS LOC. 1 BLDG. 1 200,000 USINESS PERSONAL PROPERTY $50,000 USINESS INCOME / EXTRA EXPENSE OVERAGE EXTENSIONS INCLUDED 10,000 ,ERSONAL PROPERTY OFF PREMISES $$1,000 'ALUABLE PAPERS & RECORDS $1,000 ACCOUNTS RECEIVABLE $1,000 $1,000 ** OPTIONAL COVERAGES INCLUDED MONEY AND SECURITIES NOT COVRD NOT COVRD EMPLOYEE DISHONESTY NOT COVRD ��..w� LIMITS ** ** $5000 $5000 $5000 ON PREMISES OFF PREMISES ON PREMISES OFF PREMISES 1 OATE(MM'DO/YWY) AL --- CERTIFY ATE OF LIABILITY INSURr__ SCE 9/18/2012 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 CONSTRUTE 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 pollcy(les) must be endorsed. N SUBROGATION IS WANED, 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 Ilou of such endorsoment(s). PRODUCER CONTACT NAME BELGRADE INSURANCE AGENCY PHONE (406) 388 -6774 Arc Na (406) 388 -67 201 N Madison Ave Ste 200 ,em Belgrade, MT 59714 An gs caarker @bel grade insurancea ency.Com MURER(S) AFFORDING COVERAOE NAIC0 INSIIRERA Farmers Union Mutual Ins Co 28436 INSURED INSURER R Big Sky Archery Inc INSURER C: 77 Laura Louise Lane INSURER D Bozeman, MT 59718 INSURER E COVERAGES CERTIFICATE NLJMRFR RFVISION 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 UM Ejp TYPE OF INSURANCE ADOL ono GUM nn,t, POLICY NUMBER i1MMIDD/YYYYI A4d43D/YYYYI LIMITS GENERAL LIAB(LrTY EACH OCCURRENCE S 1.000.000 COMWERCIAL GENERAL LIABILITY CLNMS4EADE ® OCCUR PRF611SFS /En emnr 11 $ 50.000 MED EXP (Any one parson) S 5.000 A % BP00004736 04/04/12 04/04/13 PERSONAL aADvINJURY s 1,000,000 GENERAL AGGREGATE S 2,000,000 GEITL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG s 2,000,000 POLICY PRO LOC ECT S AUTOMOBILE LIABILITY cc Ma awdimll S BODILY INJURY (Per Person) S ANYAUTO ALL ONMEO SCHEDULED AUTOS AUTOS BODILY INJURY (Per nmdeM) S NON -OWNED HIRED AUTOS AUTOS Par easd(u+n S S A UMBRELLA LWB EXCESS LIAB OCCUR CLAIMS-MADE CB00001261 04/04/12 04/04/1 EACH OCCURRENCE 1 4,000,000 X AGGREGATE $ DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROVrtIEtoRIPARTNUMDMCURIVE OFFICfRII/DMIMI ply Q MIA TnRy�wrrs Fq E L EACH ACCIDENT S E L DISEASE - EA EMIPLOYEI. S PVedsMy be I" O desmbeands. DESCRIPTION OF OPERATIONS help. E L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (AnaW ACORD 101, AdCW" Rernmirlu Sohodu o. d more spaoo n roq-Md) BP00004736: Certificate Holder is also an Additional Insured including its officers, agents and employees per CGL 2010 06 11. CERTIFICATE HOLOFR CANCFI 1 ATtnN City of Bozeman 121 North Rouse Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bozeman, MT 59715 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR D REPRESE v \ (01988 -2010 ACORD 60RPORATION. All rights reserved. ACORD25(2010105) The ACORD name and logo are registered marks of ACORD Jamie Saitta From: bigskyarchery@aol.com Sent: Monday, October 01, 2012 3:52 PM To: Jamie Saitta Subject: employees back ground checks Jaimie, All employees and instructors of Big Sky Archery have had a background check and also a drug test prior to hiring. All employees get a mandatory background check every Six months after that. These include, Gabe Roffe,Terry Maninger, Scott Grimm, Joey Grimes - Nelson, Josh Moore, Bryce Pick, Justin Berg, And Myself William Farris. This is done for multiple programs that we administer for different entities. Thank you William Farris Co Owner Big Sky Archery T