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HomeMy WebLinkAbout2011-355 SW - Patriot Building Company, Inc. for recycling concrete pad NORTH CAROLINA CONSTRUCTION SERVICES AGREEMENT UNDER$25,000 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter"Agreement"), is made and entered into this 10th day of November, 2011 by and between Orange County, North Carolina (hereinafter the "Owner") party of the first part; and Patriot Building Company, Inc. (hereinafter the "Contractor"),party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the Owner hereby contracts for the construction services of the Contractor, and the Contractor agrees to provide the construction services to the Owner in accordance with the terms of this Agreement. 1. TERM Beginning and ending dates of contract: November 28, 2011 through January 15, 2011. The Project Commencement Date shall be November 28, 2011. 2. MAXIMUM AMOUNT PAYABLE Dollar Amount Not to Exceed: fifteen thousands seven hundred forty seven dollars($15,747) 3. SERVICES Contractor agrees to provide the following construction services (the "Work"): Installation of a 30 x 70 foot concrete pad at the Orange County landfill in two separate phases. Scope of work, drawings and specifications are provided as attachment to this contract. Contractor shall not sub-contract all or any part of the construction services provided for in this Agreement without prior written approval of the Owner. Contractor shall be responsible for all errors or omissions, in the performance of the Agreement. Contractor shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to Owner. 4. PAYMENT Contractor shall submit an invoice for construction services provided. The invoice shall contain Contractor's name and federal tax identification number and shall be signed and dated by an officer of Contractor. It shall detail all construction services provided in.payment requests. The Owner will make payments to Contractor within thirty (30) days after receipt of and approval of the invoice by the contracting department. In the event the amount stated on an invoice is disputed by Owner, then Owner may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. In addition, should Contractor fail to perform its duties under the terms of this Agreement, Owner may, without fault or penalty, withhold any payment associated with the Work to be performed until such time as said work is completed. 5. RELATIONSHIP OF PARTIES Revised November 2011 1 Contractor is an independent Contractor of the Owner. Contractor represents that it has or will secure, at its own expense, all personnel required in performing the construction services under this Agreement. Such personnel shall not be employees of or have any contractual relationship with the Owner. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized or permitted under state and local law to perform such construction services. It is further agreed that Contractor will obey all,State and Federal statutes, rules and regulations which are applicable to provisions of the construction services called for herein. Neither Contractor nor any employee of the Contractor shall be deemed an officer, employee or agent of the Owner. 6. TERMINATION This Agreement may be terminated by Contractor upon thirty (3 0) days' written notice to the Owner, and the Owner may terminate this agreement upon thirty (30) days' written notice to Contractor. 7. INSURANCE REQUIREMENTS Contractor shall obtain, at its sole expense, all insurance as required in the Owner's risk management policy and shall not commence construction work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. Such insurance shall name the Owner as Additional Insured under both General Liability and Auto Liability policies. 8. INDEMNIFICATION Contractor agrees to defend, indemnify, save and protect Owner and Owner's lender, if any, harmless from and against any and all claims, liens, liabilities, losses, damages, causes of action, and expenses (including court costs and reasonable attorney's fees related thereto) arising out of, in connection with, or resulting from any negligence, act or failure to act by the Contractor, the Contractor's agents,assigns or employees related to the Work. It is the intent of this section to require Contractor to indemnify the Owner to the extent permitted under North Carolina law. 9. NON-ASSIGNMENT Contractor shall not assign all or any part of this Agreement, including rights to payments,to any other party without the prior written consent of the Owner. 10.NON—APPROPRIATION Contractor acknowledges that Owner is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of Owner's obligations under this Agreement, then this Agreement shall automatically expire without penalty to Owner immediately upon written notice to Contractor of the unavailability and non-appropriation of public funds. It is expressly agreed that Owner shall not activate this non- appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. Revised November 2011 2 In the event of a change in the Owner's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects Owner's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to Owner upon written notice to Contractor of such limitation or change in Owner's legal authority. 11. ENTIRE AGREEMENT The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified by a written amendment to this Agreement signed by the parties. Modifications may be evidenced by telefacsimile signatures. 12. GOVERNING LAW Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina and any action brought under this Agreement shall be brought in the General Court of Justice of the State of North Carolina in Orange County. IN WITNESS WHEREOF Orange County and the Contractor have signed this agreement, effective as of the day and date first above written. ORANGE COUNTY CONTRACTOR By BY hll,-1 -&/A�t Frank li anager 200 S. CaTZron St Ward L. Setzer, PE President Patriot Building Company, Inc. P.O. Box 8181 P.O. Bog 1419 Hillsborough,NC 27278 Hillsborough, N.C. 27278 This instrument has been approved as to technical content. con I W Gayle Wi on Solid Waste,Department Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. � X_ Office of the Finance Officer This instrument has been approved as to legal form and sufficiency. Office of the ounty Attorney Revised November 2011 3 10/13/2011 10:16 9197321517 PATRIOT BLDG CO PAGE 02 COUNTY OF ORANGE FINANCIAL SERVICES-PURCHASING PO BOX 8181 HILLSBOROUGH, NORTH CAROLINA 27278 ORANGE COUNTY BID NO. 1633 October 7, 2011 ATTENTION: INTERESTED VENDORS Orange County requests your competitive quotation to furnish the item(s) listed below for the Orange County Solid Waste, Hillsborough,NC. Please transmit this quotation vie facsimile or deliver by hand or U.S. Mail, to the Orange County Purchasing Agent-fax#(919)644-3324(NEW 11),200 South Cameron Street,Hillsborough,NG 27278 by October 12 at 11:00 AM ITEM QTY COMMODITIESIGOODS OR SERVICES TOTAL # COST LUMP SUM COST FOR RECYCLING CONCRETE PAD 1 1 EXPANSION AT THE LANDFILL IN CHAPEL HILL PER ATTACHED SCOPE OF WORK AND DRAWING $ 15J47.00 Will any people working on this job make less than $10:33 per hour YES NO a If es,the lowest hourly wage to be paid any employee Shall be.$ !HOUR CAN YOU START IMMEDIATELY?YES X NO �IF NO WHEN? PLEASE STATE THE NUMBER OF DAYS TO COMPLETE THE WORK DAYS 3 days per n PLEASE SEE ATTACHED INSTRUCTIONS TO BIDDERS PIRM NAME Patriot Building Convany. Inc. BY Ward L. Setzer PE, Preaideut (Proposal must be signed in writing) ADDRESS 400 NiI atone Drive FAX.4]9.-732-1517 Suits 100 Hillsborough, NC 77278 TELEPHONE, 919-732-8200 EMAIL: vaetzer @patriotbuil,dinS.cam Licence No_ NC29128 10/13/2011 10:16 9197321517 _ PATRIOT BLDG CO PAGE 03 L�attr x e 4�a 4*r • tt � Orange County Financial Services Department ADDENDUM#1 October i1,2011 Concrete Pad at Landfill bid 1633 To all Vendors: Modifications to laid documents for the above named Request for Proposal are made as follows and shall be included in the proposed amount. Please quote the following,option one contractor supplies and install trench drain, option 2 County supplies trench drain and contractor installs. 1. FURNISH AND INSTALL APPROXIMATELY 70 FEET OF 12"CORRUGATED TRENC14 DRAIN � OR EQUIVALENT WITH CAST IRON GRATES CAPABLE TO WITHSTAND H-20 VEHICLE WEIGHT. ADD- 12,394.00 2. INSTALL AFpROXIMATELy 70 FEET OF 12"CORRUGATED TRENCH DRAIN OR EQUIVALENT WITH CAST IRON GRATES CAPABLE TO WITHSTAND H-20 VEHICLE WEIGHT PROVIDED BY COUNTY. ADD.$ 700.00 All other terms and conditions shall remain the same By: David E. Cannell,Purchasing Agent; ck nnell co orange nc us (919)245-2651 A signed copy of this addendum shall be included with the bid submitted by your company Company Name: Patriot By: Date Received: October Ill, 90111 P.O. Box 8181 200 South Cameron Street Hillsborough, North Carolina 27278 Telephones:Area Code 919 245-2651 Fax:919 644-3324 Page 1 OF ORANGE COUNTY , FINANCIAL SERVICES- PURCHASING PO BOX 8181 HILLSBOROUGH, NORTH CAROLINA 27278 ORANGE COUNTY BID NO. 1633 October 7, 2011 ATTENTION: INTERESTED VENDORS Orange County requests your competitive quotation to furnish the item(s) listed below for the Orange County Solid Waste, Hillsborough, NC. Please transmit this quotation via facsimile or deliver by hand or U.S. Mail, to the Orange County Purchasing Agent-fax#(919) 644-3324(NEW!!) , 200 South Cameron Street, Hillsborough, NC 27278 by October 12 at 11:00 AM ITEM QTY COMMODITIES/GOODS OR SERVICES TOTAL # COST LUMP SUM COST FOR RECYCLING CONCRETE PAD 1 1 EXPANSION AT THE LANDFILL IN CHAPEL HILL PER ATTACHED SCOPE OF WORK AND DRAWING $ Will any people working on this job make less than $10.33 per hour YES NO If yes, the lowest hourly wage to be paid any employee shall be: $ / HOUR CAN YOU START IMMEDIATELY? YES NO IF NO WHEN? PLEASE STATE THE NUMBER OF DAYS TO COMPLETE THE WORK DAYS PLEASE SEE ATTACHED INSTRUCTIONS TO BIDDERS FIRM NAME BY (Proposal must be signed in writing) ADDRESS FAX: TELEPHONE: EMAIL: COUNTY OF ORANGE FINANCIAL SERVICES— PURCHASING PO BOX 8181 ❑ 200 South Cameron Street HILLSBOROUGH, NORTH CAROLINA 27278 1.All bids and proposals shall be for furnishing apparatus, supplies, materials, equipment and/or work and services in accordance with the applicable plans and specifications prescribed by Orange County. Plans and/or specifications may be obtained at the Orange County Financial Services-Purchasing Division,200 S Cameron Street, Hillsborough, North Carolina 27278. 2.Orange County reserves the right to award the bid that is in the best interest of Orange County or to reject any or all bids, and to waive minor irregularities. 3.The successful bidder shall comply fully with the requirements of General Statutes,Section 143-129 and 143- 131,as amended. This is an informal bid,therefore there will not be a formal opening. Results will be made available after award. 4.In the event of default by any contractor or vendor Orange County may procure from other sources whatever service or item is being bid and hold the contractor responsible for any excess cost occasioned thereby. 5.Payment by check is due thirty days after completion and inspection unless otherwise specifically provided; subject to any discounts allowed. 6.North Carolina sales and use tax shall not be included in the bid amount. 7.13ids submitted via facsimile shall be accepted. 8.Proposals received after opening date and time shall not be considered. 9.13ids must be signed and submitted on the attached form. 10. All bids must be returned in a sealed envelope with the bid number, opening date and license number prominently displayed. 11. The Contractor shall purchase from an insurance company authorized to write casualty insurance in the State of North Carolina the following limits of insurance: a. Worker's Compensation Insurance - Worker's Compensation insurance as required by law for all of the Contractor's employees. The Contractor shall also require his subcontractors to provide Worker's Compensation for all of the latter's employees, unless the Contractor affords protection to such employees. b. Comprehensive General Liability Insurance-Comprehensive General Liability Insurance shall be carried in the following amounts: One Million Dollars ($1,000,000) bodily injury each person, One Million Dollars ($1,000,000) property damage. Comprehensive General Liability Insurance shall include Premises and Operations Liability, Independent Contractors Liability, Contractual Liability and Completed Operations Liability, and will also contain a provision for"u" (underground) hazard liability. c. Automobile Liability Insurance-Automobile Liability Insurance shall be carried in the following limits: Five Hundred Thousand Dollars ($500,000) bodily injury each person, One Million Dollars ($1,000,000) bodily injury each accident,One Million Dollars($1,000,000) property liability. Automobile Liability Insurance shall cover liability arising out of the use of owned, non-owned and hired motor vehicles. The cost of all insurance shall be included in the price(s) bid. The Contractor shall not commence work until he has obtained all the insurance required herein. Insurance shall be maintained in full force and effect until the Contract has been fully and completely performed, as evidenced by final acceptance payment. Contractor shall provide Certificate of Insurance reflecting aforementioned coverages as proof of coverage. Certificate of Insurance shall provide for a thirty(30) day written notice to the Owner in the event of any modifications, cancellation, or expiration of said policies. Work shall not commence until the contractor has obtained all required insurance and the owner has approved verifying certificates of insurance in writing. 12. Orange County supports a living wage of $10.33 per hour. Please indicate on the bid form whether any workers on this job will make less than $10.33 per hour 13. All contractors are hereby notified that they must have proper license under the State laws governing their respective trades. Please display license number on your submittal. 14. Please supply a list of 3 commercial references with phone numbers and contact people. If you have not completed a similar job for Orange County 15. Please direct questions concerning this bid to David Cannell, Purchasing Agent Orange County Financial Services—Purchasing Division, (919) 245-2651 or via email at dcannelI co.orange.nc.us. 16. A non mandatory site visit is scheduled for October 10,2011 C@ 3:30 pm. We will meet at the small trailer as you enter the landfill on north side of 1514 Eubanks Road, Chapel Hill, NC. This is the only scheduled time for contractors to view the site. By submitting a bid the contractor acknowledges full comprehension of the scope of this project. SPECIFICATIONS PROJECT SPECIFICATIONS Project: Concrete slab Building/Facility: Landfill Location: 1514 Eubanks , Chapel Hill, NC All work shall comply with all applicable national,state and local building codes. Contractor shall be responsible for securing required permits. Successful Contractor Shall be responsible for the Following The County of Orange, North Carolina is soliciting proposals for the expansion of a recycling concrete slab at the Orange County Landfill located on 1514 Eubanks Road, in Chapel Hill, NC. The lump sum proposal shall include but not limited to furnishing all labor, materials, equipment, tools and services for the installation and construction of all items and the performance of all work necessary to complete the work shown on the drawings. The project shall consist of all work specified in the following table. The specifications below are intended to describe Orange County's needs. Slight deviations may be accepted with advance approval by Orange County Purchasing. Please use the space provided in the 'VARIANCE"column to identify any proposed variances to the specifications. This project will be managed by the Orange County Finance and DEAPR Departments. All work shall comply with all applicable national,state and local building codes. Contractor shall be responsible for securing required permits. Successful Contractor Shall be responsible for the Following The County of Orange, North Carolina is soliciting proposals for the expansion of a recycling concrete slab at the Orange County Landfill located on 1514 Eubanks Road, in Chapel Hill, NC. The lump sum proposal shall include but not limited to furnishing all labor, materials, equipment, tools and services for the installation and construction of all items and the performance of all work necessary to complete the work shown on the drawings. The Owner will be responsible for: • Rough excavation to ±2-inch of the proposed subgrade. • Placement and compaction of fill material to bring grades around the new slab to existing • grades at completion. • Providing a stockpile if stone near the working area for the slab foundation. The • contractor will be responsible for placement and compaction of the stone. The Contractor will be responsible for any other work including but not limited to: • Fine grading and compaction of the subgrade soil. • Supplying forms, material (concrete, reinforcing steel, filter fabric, and any other items • necessary to complete the construction) services and incidental for the installation of the • work as shown on the drawings and-specified herein. • Installation and compaction of the crushed stone base layer. • Installation of 70ft x 30ft concrete slabs (8-inch thick, 4,000 psi compressive strength). • The pad is to be constructed in two (2) separate phases as shown on the drawings. The • phases shall be at minimum 14 days apart to accommodate for operations at the recycling • facility. • Concrete testing procedure per ASTM C39/C39M. • Installation of joints as shown on the drawings. • Reinforcement shall be 6 6 10 10 wire mesh. • Removal of forms and debris from the jobsite at completion of the work. i Q w a CL pJ J a t7 Construction Joints w„ Z Z (Detail D-2/A) co W Control Joints } W (Detail D-2/13) H W Existing/New Slab Tie-in Joint v� X Q W (Detail D-1/13) X v W }'• '}l}r:f}.�•:•111\.t"1S~lRrti,:r:. r}l:l ril�f.•1~J r:}f:l}':l�l:r�:r�r}l R. �R•\•L.\•R•\ R•\•L.•,.R.\.R•L•L \.R•R••.•\•L•L•R••.L S ti ti R•L•.•\• : r•r•HH.• r•:•:•:.r•r.••: :i.HHH:•Hr•r., l::•:•r ' ::•YYyL. jjf!{.R•\.R.L.YR.Lr} r.ftir�ti;}J:ir�'�i:f�=r~':�::rR•i :itii i• r-r•J.J..•�•:•HHH:•d.f• YY\•\n L.R.-..L.L• L;} •R•R•'..R•\•R+LK•L•R•\•R•R•YLA -L.R.R. 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Y 1f_M 111.11 5 Existing Slab Proposed Slab D1 1B EXISTING/NEW SLAB TIE-IN JOINT(Not-to-scale) ORANGE COUNTY SOLID WASTE MANAGEMENT DEPARTMENT LDA4�� X044 O' r� 17 52 e or�� Cate 4" max •L:1�:'L.:`:�'`.'�5�:'S�:L:'1.'�1JLiti.{r ............•1r'•.:1 1i:'S:{t'.: .:'•:ti:}f:j�.•:J�'.•`:1':r�f•:1~J'}`l'%.J�,1`f:T'•"•.S':'t'•li.•�1"1:d' r rY•:•r•.••r•:•:•r•:•:•r•r r•.•r•r•:•rrr•••r•r•r•.': S tiy.•�L�L.L�•.L 1 ti•L'.•L 1 L•L.�•L 1•L•L:L. L.L•M1•,�.�L• •L t•L.L•YL•L.L•yyL•y'L'L'M1•YYyL•L•y.LL•L•L YL•L'L•L•L�. ` Mw Mr:•.w'•'`n•w•:.r'r:.••:.:.:•••^•''"'•: "'••"•• ti�L.•••L•L•ti•L•L S,L.L..•.L.L•L•.•••,.L.1•L,••••'• L•L.•••yyL.'L 4M�1,..�fLr'y:ti•ti'.l{t l:�y:L'L�yr •:,r••.:�1i'ti:.'•r�,rLr'Lf'M1%S S�S ti. '1M•r r:,J•:•:.f•r,r,r•r�r,r,r,r.r�:�l•r•r•:, J•r•r•:•rL:•:•. S. •{,ti•L•••.K•SK•.•ti•S•L•L•.•L•L•L•'M1•S•L•L•L• •L•L•'4 L''. ti•L•L�••1•L•L•••L�L•L•L•.•.•L• •S•.•L•,•yL•Y'•L•L r••• :•i•r•r•.•r•r•r•:,:•r`:•r•r•:•:•r• �:L�`.11:1:'t:ti.f1:5n'.r••.jL•1:ti?1;'n'.1ti:5�:'.�1, •r•::r•t�:�r•r•r•r.•••r.r•r•r•.•�r•r�r•r•r• Smooth Dowels at 24"O.C. (See Note 1) D2 1A CONSTRUCTION JOINT(Not-to-scale) 2-inch deep saw cut(See Note 2) •:`:::::::ti:'•:::Lr':S:•..f�.,.L.• ,f,,•,rti•,��r�r��1��.��� :L�L S L S.. L L S.. L .�S L.••y .y L• .. S�. •�•. .: ". •. • ..r.r•r.::.''.r.l.r::.:�.�r.r� •'1•r.r.r•::r•r•r:r•::r•r:r '::r.J•r. r�r�r:l�•'•:.l:t�•'•::•1•t�:�l�.;r�r•:• ••L•.•S.L S�.•.S L• L.{�ti�•.S•L•L•L•S•L"•S•L•L•L•••• .r't:.:.:.r.r.i.:..•.}.i.::r::.:.r.:.:.'•..•.r.:.r.:::•r•.••r•:•r _ Li• .l,L'• •.•-LiL..iL. ,�L�•iL:• •:L..'.-•.•'y:' •.'.'•:ti•+L.. •iS' ...L.L..\.YL.L.4Yy. .L.L .YY1.4.L•S.y.\. AKat•YS •S•' S•SK•S•S S•t••.+L�S•SK^.• S L ti•S•S•LK+r•.'•••��•r•r•.• •I r•l• .r• r r•1. •S•.•. 2 :.r.,••:•r•:•:•l. •l.f•:••••:•:.:•:•r.:...r•:•l,.• •l.j.l:r.r..••• tiyL. L..�.S•L..•.L;titi.L.•..L•1�ti.•.•V•ti.tirL..•,L�S�S.L �.• �y.y.S.S.S.yL..,.r•.••.L•:.•.�•.,,.L•L.•..5...L S.L..••�1r S S,••••..L•ti•S•'•,:yr•..S�L:y::,:L:tjti•.:L:ti:tr'.:•.�LJS:Li'.:L:::ti:{:L:ti•y�ti•S�ti•L•S�ti ''.flrLrti::'�1�.:';:ti:'L�S:titi�:'.�1f1�t:lfti•::L 1:1rti:'.jLj::`.:ti:t�•••ti� �•r•:�rY•�•:•:•:•r•l•:•:•r•:•:..�:•jY�r•r•:,:r•r•:•:�r�r•:•r•:• :r:r:• •r:r:r'r'1'• :r'r'r4:'r:f'r• •r'r f • •r.r,. . rti�ti. .�S tir,f`.�•�tirLfti;L�• .�tif.�t•,L.•:tij: '�:f•'::1::::•t1L,r.' P ON D2 18 CONTROL JOINT/SAW CUT JOINT(Not-to-scale) Notes: 1- Smooth Dowels shall be 3/4-inch diameter x 16-inch long with polyethylene sleeve on one side. Sleeve must have 1/2-inch long gap at the end of dowels to assure slippage in both directions. Locate Dowels at mid-height of slab. 2- Slab shall be saw cut after only after concrete is hard enough to avoid damage but in a timely manner to avoid random cracking(approximately 12 hours after concrete placement). ORANGE COUNTY SOLID WASTE MANAGEMENT DEPARTMENT u 52 4 cr�5 �aCetyL� - I r i u z. to eW'4 Orange County Financial Services Department ADDENDUM#1 October 11, 2011 Concrete Pad at Landfill bid 1633 To all Vendors: Modifications to bid documents for the above named Request for Proposal are made as follows and shall be included in the proposed amount. Please quote the following,option one contractor supplies and install trench drain, option 2 County supplies trench drain and contractor installs. 1. FURNISH AND INSTALL APPROXIMATELY 70 FEET OF 12" CORRUGATED TRENCH DRAIN OR EQUIVALENT WITH CAST IRON GRATES CAPABLE TO WITHSTAND H-20 VEHICLE WEIGHT. ADD - $ 2. INSTALL APPROXIMATELY 70 FEET OF 12" CORRUGATED TRENCH DRAIN OR EQUIVALENT WITH CAST IRON GRATES CAPABLE TO WITHSTAND H-20 VEHICLE WEIGHT PROVIDED BY COUNTY. ADD- $ All other terms and conditions shall remain the same By: David E. Cannell, Purchasing Agent; dcannell co.orancle.nc.us - (919) 245-2651 A signed copy of this addendum shall be included with the bid submitted by your company Company Name: By: Date Received: P.O. Box 8181 200 South Cameron Street Hillsborough, North Carolina 27278 Telephones: Area Code 919 245-2651 Fax: 919 644-3324 Page 1 CERTIFICATE OF LIABILITY INSURANCE 71/17/11(MMIDDIYYYY) OP ID MA 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 po icy(ies)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). UUNIAUI PRODUCER NAME: TriSure Corporation-HS PHONE 4325 Lake Boone Trail VC,No,Ext: (ac,No): Suite 200 ADDRESS: Raleigh NC 27607 CUSTOMERID#. PATRI-5 Phone:919-469-2473 Fax:919-467-4987 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Amerisure Mutual Ins. Co. Patriot Building Company, Inc INSURER B: Ward Setzer 400 Millstone Drive Ste 100 INSURER C: Hillsborough NC 27278 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 cu "WGETOEM A X COMMERCIAL GENERAL LIABILITY CPP2048089 09/01/11 09/01/12 PREMISES(Ea occurrence) $ 100000 CLAIMS-MADE FX]OCCUR MED EXP(Anyone person) $ 10000 X Blanket Addl Insd X PERSONAL&ADV INJURY $ 1000000 X Pollution COy GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3000000 POLICY X JECOT LOC Ben. $ 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident) A X ANY AUTO CA2048088 09/01/11 09/01/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X UMBRELLA LIAB X OCCUR CU2078090 09/01/11 09/01/12 EACH OCCURRENCE $ 5000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5000000 DEDUCTIBLE $ X RETENTION $ 0 $ OTH- A WORKERS COMPENSATION WC204$ 1 09/01/11 09/01/12 X TORY LIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEa E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBEREXCLUDED? /A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 A Leased/Rented CPP2048089 09/01/11 09/01/12 Limit $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Orange County is also listed as additional insured with respects to General liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORA131X THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Asset Management Services AUTHORIZED REPRESENTATIVE 131 West Margaret Lane Hillsborough NC 27278 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM All of the terms, provisions,exclusions, and limitations of the coverage form apply except as specifically stated below. Policy Number Agency Number Policy Effective Date CPP 2048089 81-6396-150 09/01/2011 Policy Expiration/Cancellation Date Date Account Number 09/01/2012 09/08/2011 10815503 Named Insured Agency Issuing Company PATRIOT BUILDING COMPANY INC TRISURE CORPORAITON AMERISURE INSURANCE CO 1. SECTION II-WHO IS AN INSURED is amended to add as an insured any person or organization: a. Whom you are required to add as an additional insured on this policy under a written contract or written agreement relating to your business; or b. Who is named as an additional insured under this policy on a certificate of insurance. However,the written contract,written agreement or certificate of insurance must require additional insured status for a time period during the term of this policy and be executed prior to the"bodily injury", "property damage", or"personal and advertising injury"giving rise to a claim under this policy. If, however, "your work"was commenced under a letter of intent or work order, subject to a subsequent reduction to writing within 30 days from such commencement and with customers whose customary contracts require they be named as additional insureds,we will provide additional insured status as specified in this endorsement. 2. SECTION II-WHO IS AN INSURED is amended to add the following: If the additional insured is: a. An individual, their spouse is also an additional insured. b. A partnership or joint venture, members, partners, and their spouses are also additional insureds. c. A limited liability company, members and managers are also additional insureds. d. An organization other than a partnership,joint venture or limited liability company, executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect to their liability as stockholders. e. A trust,trustees are also insureds, but only with respect to their duties as trustees. 3. The insurance provided to the additional insured under this endorsement is limited as follows: a. That person or organization is only an additional insured with respect to liability arising out of: (1) Premises you own, rent, lease,or occupy;or (2) Your ongoing operations, unless the written contract,written agreement or certificate of insurance also requires completed operations coverage (or wording to the same effect), in which case the coverage provided shall extend to your completed operations for that additional insured. Includes copyrighted material of Insurance Services Office, Inc. CG 70 48 1109 Page 1 of 3 Premises, as respects this provision,shall include common or public areas about such premises if so required in the written contract or written agreement. Ongoing operations, as respects this provision,does not apply to"bodily injury"or"property damage" occurring after: (a) All work including materials, parts or equipment furnished in connection with such work on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed;or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. b. The limits of insurance applicable to the additional insured are the least of those specified in the: (1) Written contract or written agreement; (2) Certificate of insurance;or (3) Declarations of this policy. The limits of insurance applicable to the additional insured are inclusive of and not in addition to the limits of insurance shown in the Declarations, c. The additional insured status provided by this endorsement does not extend beyond the expiration or termination of a premises lease or rental agreement nor beyond the term of this policy. d. If a written contract,written agreement or certificate of insurance as outlined above requires that additional insured status be provided by the use of CG 20 10 1185,then the terms of that endorsement,which are shown below,are incorporated into this endorsement as respects such additional insured,to the extent that such terms do not restrict coverage otherwise provided by this endorsement. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS(FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II)is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your work"for that insured by or for you. Copyright, Insurance Services Office, Inc., 1984 CG 20 10 11 85 e. The insurance provided to the additional insured does not apply to"bodily injury", "property damage", or "personal and advertising injury"arising out of an architect's, engineer's,or surveyor's rendering of or failure to render any professional services including but not limited to: (1) The preparing, approving, or failing to prepare or approve maps,drawings,opinions, reports, surveys, change orders, design specifications;and (2) Supervisory, inspection,or engineering services. Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 3 CG 70 48 11 09 f. SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4.Other Insurance is deleted and replaced with the following: 4. Other Insurance. Any coverage provided in this endorsement is excess over any other valid and collectible insurance available to the additional insured whether primary, excess,contingent,or on any other basis unless the written contract, written agreement,or certificate of insurance requires that this insurance be primary, in which case this insurance will be primary without contribution from such other insurance available to the additional insured. Includes copyrighted material of Insurance Services Office, Inc. CG 70 48 1109 Page 3 of 3