HomeMy WebLinkAbout13- Contract between James T. Newell and the City of Bozeman for deck and ADA Ramp at Lindley Center CON"t'R-A-C I'AGREI-MU"NT
TI US C(')N'I'RA.C'T.ACiREEMF,,N'f' ],,dated as of the &Y of in the)fear 201,3 by
andbetween CITY OF BC)Zl,-MANtici-eitiaflercillecI OWNER and
hereinafter called CONTRACTOR.
OWNER AND CONTRACTOR,in consideration of the mutual covenants hereinafter set,forth, agree as follows:
Article 1. WORK
CONTRACTOR shall complete all Work as specified or indicated in the Contract, The Pr 0*ect Work- is gonerallv
1
dcscribed as follows- (provide a description of the work under this contract)
LI() -TfL. C'�, A PUtv-,",P
Article 2. CONTRACETIME-
2.1 The Work will be completed within calendar(lays after the date the written Notice to Proceed is
issued. Final payment will be withheld until final completion and acceptance of`the work as Stipulated in this,
Agreement.
Article 3. CONTRACT PRICEI-
3A OW(tin��l?ge ER shall paY CONTRAC.FOR for performance oftbe Work in.accprdinec with the Contract Docui-nents
the surn c(toaqjustment as provided In the Contract Documents)(if
3S Dollar,,
Article 4. PAYMENTPROCEDUIZES
CONTRACTOR shall subi-nit applications for payinent in accordance with the Montana Public Works Standard
Specification, Third Edition General Conditions. Applications for payment,,vill. be processed as provided in the
General Conditions,
4.1 Payment. Upon satisfactory final completion and acceptance of the Work, in accordance with the General
Conditions, OWNER shall pay the full contract price,
4A 1 Measurein.ent and Payment. Payment for the work satisfactorily completed in accordance wiffi this contract
shall be made Pursuant to the applicable measurement and payment sections of the most euri-ent edition ofilic
Montana Public Works Specification based on.the unit prices established mExhibit A.
No item that is required by Contract for the proper and successful completion of the Work will be paid for outside of
or in addition to the prices submitted in the contract, All work-riot specifically set forth as a pay item lierein shall be
considered a subsidiary obligation of the CONTRACTOR and all costs in connection therewith shall be included in
the contract price.
^
Article 5. CONTRACTOR..'S REPRESE'NTATIONS
fn order to induce OWNER to enter into this Agreement, CONTRACTOR niakes the following ruprunmnmd000]
5.1 C[)07lR&C7OR has booihm6zeJ himself with the nature and extentufthe Contract Documents.Wozk.loca]b�`
and with all local conditions and federal, state and local laws,ordinances,rules.and regulations that ill any manner
may affect cost,nrogrenxorD*d000uucew[the Work.
52 CONTRACTOR has studied carefully all reports of iuvcaiiga1�*ox and tests Of oubsocf8vO and latent physical
condil ions at the site or otherwise affecting cost,progress or pQrfonnance of the Work.
.53 CONTRACTOR has made or caused to be rilade e.Naminations, and investigal.ions,as he deems necessali,forLbo
performance*f the Work.ut the contract price,within the contract time and in accordance with the other terms and
uonditimoxofthe Coutruct[1ouomeotm.and no additional esmcouuiiooy,investigations, tcsLm,reports orwirnilurdutu
arc or will 6e required by CONTRACTOR for such purposes,
54 C0h!I/I/\CTDRhas uooulxiudthe'osuh,ofull such o6s*rvu6umy,cxunuiou6ony. �ov��i�uhouo,���o.z��ads
and data with tire terms and conditions mf the Contract Documents.
The Contract Documents which uomphac the entire agreement between OWNER and CONTRACTOR xaattached
to or referenced in this Agreement,are made a part hereof and consist of the following in order ofprccedenuc�
61 This Agreement,
62 Cei1douzu**[Insurance and yei-fuzriiauccand Payment Bonds.
63 Montana.Public YVork.,;S/ondanlSncciDvmdoirs(MPW6S),Third Edition,dated October, |Q8%ua amended by
the August l. l9g|,MPTV Addendum No. l, and oo further amended 6ythe City o[Bozcmun Modifications tm
MPWSS (by ru§ereocc)
6.4 Notice 1oProceed.
There are no Contract Docurneirls other than those listed above in this Article 6.
'[be Contract Documents mayonly be altered, arriended or repealed by a modification (as defined in the Montana
Public Works 81uodmrd.5Deufiun¢ious. Third Edition, October 1988, General Cmodl Lions).
Tl Contractor Use o[Premises. The CONTRACTOR shall confine his operations at site of the proposed work to
within the ngb/'wf-`vuyur construction easements,provided.
It shall be understood that the responsibility for protection and safekeeping of equipment and materials on or near
the site will be entirely that of the CONTRACTOR and [fiat no claim shall be made against the OWNER by reason
of uoy uuT oymii eo-iplmveeor Uespaymo, It oboU be&o1ber understood that.should any occasion arise necessitating
access by the[>VVNBRmthe sites occupied 6ythese stored materials and equipment, the CONTRACTOR owning
urz�opuu��l*tbz{boytmr*�o.�mr��lmorugo��u��z6�}�ll/necGutuly remove same. No materials orequipment
may be placed upon any private propur�, until the property OWNER has agreed im writing to the l0001lao
contemplated 6y the CONTRACTOR 1abe used. for storage.
7.2 Protection uJ Existing Structures. The CONTRACTOR shall.he solely responsible for locating all existing
underground izstuIlgimux` including service cmaoeCli»os,in udruooe mfescuru6ng or trenching,by uuoiuc|isg the
OWNERS Ubcroofaudnrospeotiog. The CON'mACT0R shall use his own iof000u6mo and shall nutmely solely
2
upon.inforinationshowD on the drawings COJIM-ning existing LIMICI-gl-011nd installations. The CONTRACTOR shall
repair all damage to existing utilities or propen.v It his own cNponsc. The CONTRACTOR shall, at a murinium,call
(lie "One-Call" utility locate systcin (Phone: 1-800-.424-5555)at least 72 hours in advance of starting construction.
Where excavation will bc required adjacent to existing structures,the CONTRACTOR shall be solely responsible to
maintain the structural integrity of the existing structures, The CONTRACTOR shall take a,hatcver means
neec,ssar'v to insure that the existing structure is not damaged and ifilecessary shall install sheet piling, The
CONTRACTOR shall repair all damage to the existing structures at his own expense. Any fences destroyed during
construction shall be repaired to the,satisfaction of the property owner, Any_ delay,additional work, Or extra Cost to
the CONTRACTOR caused by existing underground installations shall not constitute a claim for extra work,
additional payment or damages.
7.3 Protection of Existing Mailboxes, Curbs and Gutters and Driveways, The CONTRACTOR shall take whatever
means necessary to insure tbat the existing,rnailboxes,curbs and glitters, and driveivays are not damaged during
construction. If it is necessary to retrieve or disturb mailbUNes during construction,the CONTRACTOR shall repair
and restore the mailboxes at his own expense to the satisfaction of the property owner. Any curb, gutter,or
driveways damaged during construction,not noted to be replaced on the drawings,shall lie replaced by the
CONTRACTOR at his own.expense.
7.4 Stu-face Drainage, Water frona such sources as surface runoff,dewateringand flushing of water lines during
project construction shall not be allowed to enter into drainage ways or open areas that will cause flooding of
existing structures, street intersections,or lawn areas.
7.5 Work Sequence. The CONTRACTOR shall schedule the work to minimize inconvenience to the OWNER and
to adjacent property owners and to minimize interruptions to utility service, This shall include minimizing
obstmetion to local traffic especially on dead end streets. Work shall bo scheduled so as to minimize disruption,,,to
local mail delivery. Close coordination will be required between the CONTRACTOR, OWN F'R, and COUNTY,
The utilitl,, service cornpanics such as power,gas,telephone,and cable shall be contacted at least 72 hours in
advance of when locating of services will be required
Article S. Warranty and Guarantee.
8,1 CONTRACTO R warrants and guarantees to OWN ER that all Work will be in accordance with,the Contract
Documents and will neat be defective. Pron-.ipt notice of all defects shall be given to CONTRACTOR. All defective
Work,whether or not in place,Wray be rejected, corrected or accepted as provided in Article 13 of the Montana
Public, Works Standard Specification,Third Edition (MPWSS),published October, 1988,as amended August 1,
1991 and as further amended by the City of Bozeman Modifications to MPWSS,
Article 9. Site Safety and Traffic Control
9.1 ]'lie CONTRACTOR shall conduct his work so as to interfere as little as possible with public travel,whether
vehicular or pedestrian. Whenever it is necessary to cross, obstruct,or close roads and walks,the CONTRACTOR
shall obtain approval of such actions from the County or Montana Department of Transportation and shall provide
and maintain suitable and safe lighted detours or other temporary expedients for the accommodation or public and
private travel in accordance with the CUITent edition of the Manual on Uniforni Control Devices for Streets and
Highways(MUTCD). The CONTRACTOR shall not occupy the work- site or initiate construction until all traffic
control provisions are in place and the OWNER has been so notified.
9,2 Safety Provisions. Safety provisions must be entirely adequate and meet Avith City.,County, State and Federal
regulations to protect the public on these streets and roads.
9.3 Barricades and Lights. Prior to the start of construction across roads or walks, all construction.pernill's,shall be
obtained,utility companies notified,and traffic patterns,signing,location of flagmen,barricades and other safety,
nicas-ares arranged. Providing and maintaining safety barricades,and other work site safety measures shall be the
responsibility ofilic CONTRACTOR and shall be included in the contract price. The CONTRACTOR shall
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m0perale1911d coordina�c his inethodm��the OWN]�.'R'3traffic conLrolplmmpi-iOr LO the dimfUPLIO11 Of the normal
Dmvofm� lnfffio,
All open trenches and offier excavations shall be provided with suitable han-iers. signs, and lights to the extent that
adequate pro1ootioujm provided tmtfie public, Obstructions, such is rnaterial piles and equipment, sliall be provided
with similar warning signs and lights.
All barricades arid ob.structions shall be illuminated by mcans of warning lights from SLUISCt tosunrise. Materials
stored upon or alongside public streets and bighwayu shall.hu provided with uiroilurvvamimg signs and li86ty.
Al[barricades, aignx, lights and other protective devices mkn)l be installed and maintained inoouiomuity with
ipplicable statutory requirements and,where within railroad and highway right-of-way,as required by the authority
having jmipdicdmzthor over.
Work performed within property under the OX7NBR'S jurisdiction.shall have all barricades, signs,lights and
protective devices installed and maintained.
Article 10. STATE LAWS AND REGULATIONS
10.1 All applicable laws,ozdioaoocs and the rules and rogdudoomnfuO authorities hav�o�jurisdiction ovor
construction nfthcprqiud shall apply tu the contract throughout.
lO l l The CONTRACTOR'S attention io directed t*Tdle30. Chapter 3:Part 7,MCA, 198,1.which requires the
CONTRACTOR tu post u surety bond or other form ofseon6ty insuring worker's wages arid fringe boueOts with the
Commission af Labor and Industry, State nyMontana. 'Elie bmudor other security shall bc filed vvidbthe
Commissioner and evidence Of the bond shall.be provided tu the 0VY]4EI8p6ori000numoncumeotofwork.
10�l2 The C#yJTR/\CTOQ'S attention.in also directed io Title lS. Chapter 50.Pail 2.MCA, 1981� 'Under the
provisions olthis law,public contractors shall pay to the State, in addition to license application fees, x sum equal to
one percent(1%)ofthe gross receipts froin all public contracts in excess of five thousand dollars($5,000). Prime
CONTRAUORS shall be responsible for withholding one percent(1%)of all monies due to subcontractorsfor
work, performed under contracts for public work-,and shall transmitsuch monies to the State Department of
Revenue. Additional,ioIuronu600per[oiniog to license requirements and license fees ouuY bc obtained from the
Montana State Department of Revenue, State Capital Building,Helena, Montana.
10.1.3 IbuC0NIRACTOR'SuttenboniaoolIudtothuIudnntiiulAncideiitIumnmuuelmwoinCorooioMuotaoxmnd
10 the responsibility af the OWNER for the collection mf premiums thereunder. The CONTRACTOR'S compliance
with said laws io required andeh*ll relieve the OWNER of any responsibility for payment m[prumiumathereunder
arid shall furnish the OWNER with satisfactory evidence showing that all.pzouiumasnaing from this contract have
been paid before payment iornudoonthe final estimate.
|0.l.4 Yo accordance with Montana iem(Title l0, Chapter 2'Part 4,.MCA. ly8l)mo contracts for State, County,
school construction, buuvyhighway ororuoi��paIcm��nutiao.repu�oroumioteuouoe work under any my1&elxv,mot
the 81�e'the C0��7l�\C FOR shall give preference to the eougluyo:cuLo[bwou fide Montana residents im (he
performance of sat d contract,and obol)further pay tlieutuuduolprenail6ug rate mI wages including fringe buucfitm
and travel allowance in effect as paid in the county or localit y in which the Work- is being performed, The minimurn
wages,U,included ospmrlof the contract ducuoeuL , are riot controlling*xCupiumto the ooimiommou for tile purpose uf
&eQmvin-Bacon.Aot. Therefore,it is,incumbent upon each employer to pay the standard prevailing rate of wages
including fringe benefits.for health arid welfare and pension contributions, and travel allowance provisions in effect
and applicable tm the county oclocality o which 16m Work- iy being pec8nnud.
Article 11. PE;RFORMANCE AND PAYMENT BONDS, The C0l4TD/\CTOBubullfumisbv Performance B"nd
and m Payment Bonds in favor or[tie OWNER each ioaouzumont equal to one-hundred percent(100%)uJthe
/\greuozuni mmomu
4
Article 12. INSURANO', Without limiling any oJde other obligations,m liabilities m[UeCONTRACTOR,
CONTRACTOR shall SCULWv and maintain such insurance from an iiisurarice company (or companies)authorized to
write insurance io the State of Montana, with cuio�oom "AM, Best Rating" *yB+. \/I_ amnd8Dru\odbuzm:|[his
subcoturactors.,the ffiviier and their respective agents and employees from clainis for bodily iqjt)iy,death or
proDmii y dmooger/biobmo7 o�ue�oou wper�imnmand uommlei*d operations under this Agreement, Stich coverage
shall be for vlainis arising out ofall premises/operations,siil)-coliti-xcted,olici-,ttions,products/completed
operations, and all 6uH\dT aowonnedby the CONTRACTOR under any contract oragreement, CO&|TR&C^l'0B
shall not commence work under this Apreement un6l such certified copies ofthe insurance policy shall lia),c been
Cited with the 0VVNB@�
All insurance coverages shall remain in effect throughout the life of the Agreeinent,
Each insurance policy shall contain u clause pru*idingLbmti1 will not hc cancelled by the insurance company
Nvithout 30,days written notice to the OWNFR and I'Engineer of intention to cancel. The minimum amn"otmu{Stich
insurance coverages being uo&`l]owe
A. 81.000,000 $2,000,000
Coverage uninclude:
I Premises Operations,
l Products and Completed Operations _92,000,000
Procucnmd Comp]e4:JQperatl'ooe
3 [ontrao|nal
4. Operations of Independent Contractors
5, peroaoull4jul7
6, 9ropertY Damage applicable to Blasting, Collapse and Underground Hazards shall.be included io
coverage.
May lie satisfied by pfirnary insurance or a combinationol'primary and excess of umbrella insurance. Omvcver'gnmory
occurrence limit cannot bc less dboo$l^00O.000, I)oduu1iblo not touxoocd$5X0 per occurrence mo property dumaHo,
R
Bodily 11jury and Property Damage:
Coverage<oinclndc�
] All Owned
2 Bired
3, Nmi-Owned
Cmod6oed Single L in Lit_Sl.0«00/X0QLEnub/\ccidco|
C.
Occupational Disease 31uu4my
l,"mpluyor'o[iabi|itY _$500.00 Eucb.Acoideut
Sections guodC above may bu satisfied hypcimu/ iusucu rice oro corn bioatiooufprouar7 and excess or Umbrella buSUouuce
Bodily Injury and Property Duux&c esl.000,000 $1,080.000
Sgiut-'actury protection for Owner may bouccompGshed by6ther an en6mseoent.of Contractor's Comprehensive General
Liabdi|ypn!i*yorhy Contractor's carrier issuing useparate protective liability policy,
E. Additional Insureds
The Contractor's insurance coverage shall name the Omnur as ao Additional Innxr dvnderCmmmercid GeueralLlahilltv`
/\mornohil*Liability, £xccmnurUzubruDupolicies.
F� Builder's Risk
Contxn4or shall Purchase Builder's Risk ou tire "Bnnmdknzn" form mf coverage inclusive mf Fire,Bs1onduI Coverages, and
Vandalism. insurance shall include the in1erentmofthe Contractor, 12'ngirrcur. and subcontractors,ue their insurable ioicrem\
muymppeur
Article 13. MISCELLAN-F"OUS
13.1 I«rioo used io this Agreement which are defined 6u the General Conditions shall have tire meanings indicated
in the General Conditions of tire Monitana Public Works Standard Spec ifica ti ons, 3rd Edition, October 1988,
132 flils Agreement and all ofLbcooVOnm&o hereof shall inure tmthe benefit vJuodbe binding upou the OWNER
and the CONTRACTOR respectively and his partners, successors, assigns,and legal representatives. Neither the
OWNER nor the CONTRACTOR shaL[have the right to assign, transfer Or Sublet his interest or obligations
berunoder without written consent oC the other party. The Owner n:servrs the right tn withdraw at any 1iounfrom
any subcontractor whose work has proven unsatisfactory the tight t*he engaged inor employed upon any part of the
Work.
13.3 Io the event i(bmuomoanecessary for either party, io this Agreement to retain mmattorney t*enforce anT of the
tcronor conditions o[this/\grcerriuutorto give any notice required herein, then the prevailing pmiLyorthe parly
given notice shall b*entitled toreaomuubl ottmrnmy'y fees and cua1�including feeo. salary.and costs ufin-house
umuua*l
13.4 Any amendment oC modifications o[this Agreement uruo} provisions herein shall be made io writing and
executed iothe same manner my this original document and shall after uNeoni*oo become u part of the Agreement.
13,5 The CONTRACTOR bcro6y agrees toiodunon�yand hold�e0�9NBR han�lemu6mzo all ulu�z and liability
�r bodily i�o�' (ioclw�ngd�u�) and damage to property due tu the negligence ol CONTRACTOR,then-agents,
employees,or both,in performing the worl,required tinder this Agreement.
136 '[he C{}N'TQACT0Ilagzmemtofnl\mwfbuCuy`auoLidiumdnoiuuchoupoliuyuodeGu*JiuCoozouinnimn
Resolution No, 425O &full copy oftbe Resolution 4250ie available upon request. Failure 10 comply with the
discrimination provision is a breach of the material term in the contract the same as not perforining the other
requirements nf the contract.
City Commission.Resolution 425O establishes numerous new policies prohibiting discrimination mztbe basis of
tace,color,refigion,creed,sex,age,nuinital status,national origin,or because of actual or perceived sexLlat
orientation, gender identity or disability in the development,execution,and implementation of city contracts and
other agreements.
Io order tocomply wi 1h the requirements(if this Resolution,the contractor,Nvith their signature on this contract,
agrees to the adoption of the Addendum to [be contract for services should they be awarded the contract, With then'
xigoatuze. tboumntrvutora1xoagc**atnfollo`vUbeuond66maaspe*if'iQdinduioao6-c6moriuinatiuopnlioy. The
Contractoragrees this requirement shall apply to the hiring and treatment of the Contractor's employees and tuall
nubcuubuw(ua.
6
,get As()TIC who a]I,
will riot take title 10,Trorsign anv manifest or pmeut documenIS for,]To]
TRACTOR I of Ctisposal S �).COT UDY I jazardolis, Regulawd or
UN � ite(,,
a I se,I Oct ILI"
j,ol. mts and disposal of,not-make the,actu, natiori ol the pro A
for anv I-)j-e0xjtjTig cirvironmelital coillarill jec
Special Waste. CONTRACTOR Nvill riot he IiDble ti()n of the projectsite shall be limited to the eNtcrll
coNJ'R-ACTOR's habilitY forcmirOnnlerital cont,BT111tia
site contributed to 01.e\accrbated the contamination of the pro,pect site
CONfly ACTORs,negligelICC has causcd�. to
'I'lic CONTRACTOR.is said shall perfOral this`91-eelllent as all independent conttactor-, and as such,is responsi
only' as to the 1-csIlIts to I)e obtained in [Ile-,VOrL- Ircyclij.specified, and to tire eJent that the work,,,hall
LI-te OWNER o Irl e jerins,plani and specificiltiOn,,., 1'he CONTRACTOR shall have and maintain
1,done in accordance w 1 -1 th jig responsible ror any required
complete coil trol over all of its en ip]oyces,subcoritrac tor s',a gents and opei-ati(-.)ns bei
-%ork!118TI'S Compensation and
payroll deductions and providing r lquired ben "s.1jej_1��Sj but not limited to,
unenlploVrnert 111SLIVEITACC
have eNecuted this Agreement the day and Year fil'St ab()VC wrrttem
IN WITNESS WI IERI`017t the parties hereto
(Contractor)
'Title C0411iN
ACCEPTE'D:
cl'['Y OF BOZUMAN
BY its
ATTEST:
City clerk,
STAR" OF MONTANA
)ss.
Colultv Of Gallatin
2 before me, a Nutar-v public for the State of Montana,
On this day of ity Manager and City
aird�'TACY ULMEN,known to Trie to be the C .
personally appeared CHRIS KIJKULSKI es are subscribed to tj-jC within instrurnont, and
Clerk for.the City of Bozeman and tile per-sons-�vhose riarn
acknowledged to Me that they executed the same for and on behalf of the City of Bozeman.
jji�,hand and affi\ed MY Official seal the day and year first
1NWJTNFSS�Wl1ERE0I.`J h8vChere"'t' set -
above written.
(SEAL)
l�lotar-V 11tilie for State or Morit,ana
(Printed l atne)
lLesiding at Bozeman,Montana
My
7
NON-DISCRIMINATION AFFIRMATION FORM
L
[iiame cat etifily submittingi hereby affirms itwill not discriminate
on the bast s of race,, color,religion, creed, sex, age, marital status, national origin, or because
of actual or perceived sexual orientation, gender identity or disability in the performance of
work performed for the city of Bozeman,if a contract is awarded to it,and also recognizes the
eventual contract,if awarded,will contain a provision prohibiting di scrirni nation as described
above and that this prohibition shall apply to the hiring and treatment of the
tname ofen its' submittingi employees and to all subcontracts it
enters into in performance of the agreement with the city of Bozeman.
Signature of Bidder:
a hoii
Per son). zcd to sip on behal r of the bidder
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BPM06753 3/15/i3
y
INSURED Gcaav
WNW, Farm Hareau
Family of Insurance Services
WS1693 CERTIFICATE Of INSURANCE 3/19/13
THE MOUNTAIN WEST FARM BUREAU MUTUAL INSURANCE COMPANY 931 BOULDER
DRIVE _ LARAMIE WYOMING 82070 - ISSUES THIS CERTIFICATE AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THE INSURANCE
AFFORDED IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF THE POLICIES.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CERTIFICATE ISSUED TO INSURED NAME AND ADDRESS
I I ,,I,o,Illo,l,l„lo,®IL„1,1'1„1„11,1
LIBERTY FENCE & DECK
JAMES NEWELL
PO BOX 11530 128 GLACIER MOUNTAIN
BOZEMAN MT 59719-1530 BOZEMAN MT 59718-8324
POLICY NUMBER BPM06753 EFFECTIVE DATE 2/04/13 EXPIRATION DATE 2/04/14
AGENT 962 CARLA J SCHMIDT 406 388-8188
TYPE OF INSURANCE LIMITS OF LIABILITY
GENERAL IILILIABILITY& ICAL OCCURRENCE BASIS LIMIT $500,000
LIABILITY & MEDICAL EXPENSES GENERAL
AGGREGATE LIMIT 1 ,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT 1 ,000,000
FIRE LEGAL LIABILITY LIMIT $50,000 ANY ONE FIRE
UNLESS A HIGHER LIMIT IS SHOWN FOR A SPECIFIC LOCATION IN SECTION 1
MEDICAL EXPENSE LIMIT $5,000 ANY ONE PERSON
AUTOMOBILE LIABILITY
AUTOS - COVERAGE SYMBOL 7 $500,000 COMBINED SINGLE LIMIT
SPECIFICALLY DESCRIBED VEHICLES
HIRED AUTOS - COVERAGE SYMBOL 8
NON-OWNERSHIP - COVERAGE SYMBOL 9
EXCESS LIABILITY
UMBRELLA FORM $ COMBINED SINGLE LIMIT
POLICY NUMBER
GENERAL INFORMATION
HAS SUBROGATION BEEN WAIVED? YES NO X
ADDITIONAL NAMED INSURED -
NHB LLC
PO BOX 11530
BOZEMAN MT 59719
WE WILL GIVE THE CERTIFICATE HOLDER 30 DAYS NOTICE IF THE POLICY IS
CANCELED BY US OR IF WE MATERIALLY CHANGE COVERAGE DURING THE TERM OF THIS POLICY.
0 3/19/13
AUTHORIZED SIGNATURE DATE ISSUED
Wcrtc2
j MONTANA DEPARTMENT O r: LABOR
INDUSTRY
W
r
µ
f
IND! EPEN0ENT COaNTRACTOR PROGRA M
State of Montana
l epatlment of Labor and Industry
INDEPENDENT CONTRACTOR
EXEMPTION CERTIFICATE
'Ti+S CERJ FlCATE CERTIFIES THAT
r
JAMES T NEWELL
6485 BOYD RD#2 1
BOZE AN,MT 59718
W
has sworn to the Departrnent of Labor and Industry that this person is: �
engage(] trt an indet ertderrtty c sitiatwtished tmde, occupation pr°ofessi u oa-b isi ae"ss, u1.1d
is free frcaart Control or direction by fit¢inn ag ems a"veic the pei4br imnee of the person's services,
both under cotltraet and in fact, when acting as an rtadependent contractor,
t �
The certificate holder has provided the Department of Labor and lndtistry sn fficient d'ocu mentation to concitade
the certificate holder has an established business. In reliance on that evidence, the Department
of Labor and industry has granted this independent Contractor IE ernpfion Certificate to the person named above
The certificate holder has waived all rights and benefits cruder the Workers' Compensation Act of Montana and is not
required to be personally covered by workers' compensation insurance. The certificate holder has acknowledged i
I
the certnficate holder is responsiNe for ail taxes related to work performed tender the Certificate,
Any certificate holder, hiring agent, employer, or any other person who violates the independent contractor
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provisions of Title wig chapter y l y MBA may be subject to a. 1,000 fine and other penalties provided by law,
This Certificate is effective for the following occupation(s),
CONSTRUCTION ]Effective: 04129/2011 through 04/2812013
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Effective Dates: 04129/2011 through 04/2012013
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