HomeMy WebLinkAbout2012-085 DEAPR - Nello Italy LLC for Facility UsePiedmont Food & Agricultural Processing Center
USeP SeI'V1CeS COI1tPaCt This person or organization joins this Agreement as User of the Piedmont Food &
A ricultural Processin Center commercial kitchen facil i .
Full Legal Name of User Nello's Italy LLC Legal Status of User (Check One):
^ Individual ^ Partnership
0 ~orporation
~Limited Liability Company
^ Other
Name Authorized Representative : G. Neal Title : Owner
McTi he
Mailing Address : PO Box 80441, Raleigh, NC Email : nelloQnellositaly.com
27623
Tele hone : 919-428-4338 Fax
This User Services Agreement made and entered into this the 22nd day of March 2012 ,
(`Bffective Date") between the User (identified above) and Piedmont Food & Agricultural
Processing Center (also referred to here as "PFAP"). User and PFAP agree to the following terms:
1. SERVICES. PFAP will provide User with nonexclusive access to and use of PFAP's
commercial food production facility ("Kitchen"), subject to the terms of this Agreement.
a. Facility. The Kitchen is a shared-use facility, equipped with commercial culinary equipment
and other food preparation equipment. PFAP shall maintain the facility in a sanitary and
orderly state and ensure that all equipment available to the User operates to all applicable
federal, state and local health and safety standards.
b. Business Services. PFAP Center may also provide the User with, but is not liable for
Business Services, including but not limited to: advice on business development, product
development, packaging and label design; business plan development, training in safety and
sanitation; marketing support activities, and/or assistance with food safety regulation
compliance and accessing small business financing.
c. User Prerequisites. All Users of PFAP will have completed the following activities and
provided appropriate documentation to the PFAP Manager before the User may enter and use
the Kitchen:
(1) Completed application form and paid all associated fees and deposits
(2) Completed Initial Consultation,
(3) Completed the PFAP Orientation;
(4) Provided Proof of Product Liability Insurance, as detailed in Section 4(c), below;
(5) Obtained and provided to the PFAP Manager any required oversight documentation.
d. Authorized Food Products. User must obtain specific authorization from PFAP prior to
producing each food product.
e. Scheduling of Use. PFAP shall control the times and manner of all Users' access to and use
of the Kitchen. User shall request use of the Kitchen in advance. PFAP will make its best
efforts to create a schedule for use of the Kitchen that accommodates all Users' reasonable
requests. Scheduling is available on a first come, first served basis, or as amended by the
Manager.
2. PAYMENT TERMS. User will pay PFAP rent for each hour (or part thereo~ the User occupies
the Kitchen and/or for the Business Services described in Section 1 of this Agreement according
to the following terms:
a. Fee Schedule. The fees for various uses of the Kitchen andlor equipment are set out in the
Fee Structure, attached to this Agreement and incorporated herein as APPENDIX E. The
Fee Schedule is subject to change at any time, and PFAP will make reasonable efforts to
notify Users in advance of the changes.
b. Payment Terms - New User. Each User will pay for use of the Kitchen on a"pay-as-you-
go" basis for the initial three (3) months of using the facility. PFAP will provide User with a
bill after each use. Payment is due upon receipt. Storage fees are to be paid up-front by all
Users each month. User may not use the Kitchen or Business Services until all outstanding
bills are paid.
c. Payment Terms - Good Payment History. After three (3) months of on-time payments,
PFAP will bill User for facility and storage use at the end of each calendar month. Payment is
due within seven (7) business days of receipt. If User pays any bill late, PFAP may require
User to pay under New User payment Terms. A Late Payment Fee may be charged for
payments made more than 7 days after receipt of invoice.
3. USER DUTIES. User agrees to assume the following duties in its use of the Kitchen under this
Agreement:
a. Rental and Use Policies. User acknowledges that User has received and read the Standard
Operating Procedures ("SOPs"), a copy of which is attached to this Agreement and
incorporated herein as APPENDIX C. PFAP reserves the right to amend the SOPs at any time
upon written notice to User to be posted at the entrance of the building. If User violates the
SOPs, PFAP may impose a fine upon User and upon repeated violation PFAP may in its
discretion terminate Agreement. User agrees to comply with all of the rules and obligations
set forth in the Standard Operating Procedures as currently stated and as modified at any time
in the future.
b. Contact Information. User promises that the identification, address and contact information
stated at the beginning of this document is current and correct. User agrees to keep PFAP
informed of any changes in User's legal identity, address or other contact information.
c. Security. PFAP is equipped with both open use and individual locked storage areas. User
agrees that PFAP assumes no responsibility for the security of any equipment or supplies the
User brings for their use in the facility. Copies or combinations for all locks must be provided
to the Manager before their use. If any additional locked storage is brought into the facility
by the User, User shall supply a duplicate key to the Manager. The Manager may access any
space at any time for regulatory, safety, or maintenance reasons. User may not duplicate the
keys provided for any storage areas.
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d. Food and Equipment Safety and Sanitation. All Users and their employees are required to
successfully complete the PFAP Orientation before they may use the Kitchen. At least one
~1) User with current Serve Safe certification must be present at all times a~ licable based on
the product being produced, as directed by the Manager. Use of all equipment requires
special training and authorization from the Manager. Each person using the facility must
receive specific authorization before using the Facility and certain equipment. Use of
equipment can be revoked, or denied by the Manager at any time.
e. Housekeeping Policies. User policies include but are not limited to the following:
(1) Users will provide their own oven mitts, cooking items, ingredients, utensils, small
wares and other special items necessary to their specific production needs.
(2) No equipment or items owned by PFAP shall ever leave the premises.
(3) Users will strictly follow the Cleaning Guidelines in the SOPs provided by PFAP
before, during and after each use of the facility.
(4) Users must perform and fill in the "Shift Log" before, during, and after each kitchen
use, and leave them in the designated area.
(5) All production and packaging of food products must take place within designated
approved food production locations within the facility .
(6) If User fails to leave the facility in the proper condition, User will receive a
warning and be responsible to pay the actual cost of cleaning the facility as
determined by PFAP. Upon a second such failure, User shall pay a fine (set out in
the Standard Operating Procedures) and actual cleaning costs. Upon a third such
failure, this Agreement shall be terminated. ,
f. Assignment. Except for User's properly trained and authorized employees, User may not
transfer or assign User's privileges under this Agreement to any third party. This includes the
disclosure of the User's security codes or keys. The User shall not grant access or allow a
third party to operate in or enter the kitchen any time. Violation of this duty is grounds for
immediate termination of this Agreement and the immediate discharge of that User from the
kitchen.
g. Signs and Advertising. No signs or advertising matter shall be painted or attached in any
way on the PFAP premises.
4. HEALTH AND SAFETY RESPONSIBILITIES. To ensure the safety of all persons associated
with the PFAP facility, User shall also comply with the following duties:
a. Worker Safety. User is exclusively responsible for ensuring that User and its employees
observe proper safety procedures while using the Kitchen. All User employees must have
registered with the Manager and provided contact information in case of emergencies before
being authorized to work at PFAP. No children under 16 are allowed in the kitchens when
anv food processing is takin~place, or without the express permission of the Mana~er.
b. Right of Inspection. PFAP staff retain the right to enter and inspect operations at any time
during use. The Department of Environmental Health of Orange County as well as the Food
& Drug Administration or their designees shall have the right to inspect without prior notice
at any time deemed necessary by their
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c. Product Liabiity Insurance. Each User will maintain a minimum coverage of $2,000,000 of
general liability and product liability insurance, with Piedmont Food & Agricultural
Processing Center named as "added named insured" on each policy. Users must provide
proof of insurance to the PFAP Manager before User may enter and use the facility.
5. LIMITATION OF LIABILITY. No section of the Agreement is intended to create a waiver of
Orange County's rights or privileges as a sovereign entity. User agrees that any and all claims
involving PFAP are strictly subject to the following limitations:
a. Business Services. All Business Services provided by PFAP and/or any officers, staff, or
other agents of PFAP and/or Orange County are provided solely for the purpose of assisting
User in the operation of its business. Orange County makes no representations, warranties or
guarantees that the business services provided will result in the success of the User. User
understands and acknowledges that User is solely and completely at freedom to accept or
reject any business services, and that the principal(s) or owner(s) alone are in control of the
User and its success or failure. User acknowledges and agrees that Orange County and any
officers, staff, trustees or other agents of Orange County are not liable to the User, or its
principal(s) or owners(s) for any damages resulting from the use of or reliance upon the
business services provided by PFAP.
b. Liability. PFAP and/or Orange County shall not be liable for any damage to either person or
property sustained by the tenant or by any third party arising in any way out of the User's
use, operation, occupancy of PFAP premises, or sale or distributing of any product
manufactured on the premises. The Users covenant and agree to indemnify, defend, and hold
harmless PFAP and Orange County, and its employees from all claims, costs, and liability
arising from or in connection with damages, injuries to persons (including death), or
property in, upon, or about the PFAP premises, or any portions thereof, or resulting from the
sale, distribution, and use of any product manufactured by the User on the PFAP premises.
c. Indemnity. User agrees to defend, indemnify and hold harmless PFAP and Orange
County from all loss, liability, claims or expense, including attorney's fees, arising out of
or related to claims, costs, and liability arising from or in connection with damages, injuries
to persons (including death), or property in, upon, or about the PFAP premises, or any
portions thereof, or resulting from the sale, distribution, and use of any product
manufactured by the User on the PFAP premises, except to the extent same are caused by
the negligence or willful misconduct of PFAP and/or Orange County. It is the intent of
this provision to require User to indemnify Orange County and PFAP to the fullest
extent permitted under North Carolina law.
6. CONFIDENTIALITY. User and PFAP agree and acknowledge as follows:
a. Confidential Information. The Kitchen is a shared-use facility, and may be occupied and
used simultaneously by similarly situated third-party Users ("Others"). The Parties further
acknowledge and agree that the conduct of User's business and the production of User's
food products may involve the use of recipes, techniques, sources of ingredients, financial
and business records and other information that is owned and used exclusively by the User
that constitute trade secrets or proprietary knowledge that must remain confidential for the
protection of User's business ("Confidential Information"). User acknowledges and agrees
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that Others may also have Confidential Information that applies to the conduct of their own
business. User and PFAP acknowledge and agree that User's Confidential Information may
be disclosed to PFAP for the purpose of providing product authorization, training, or
Business Services to User. Provided however, Confidential Information does not include
information that is already known to PFAP, to the public or any third party beyond User's
control, or obtained by User from an independent source or otherwise developed
independently from the User. This agreement does not cover any disclosure required by
applicable law or regulation.
b. Permitted Disclosure.
(1) PFAP is required to report to its grantors and sponsors on the economic impact of the
services it provides. Users agree to provide an estimated sales value (wholesale and/or
retail) all of the goods they produce each time they use the Facility. PFAP will treat this
as Confidential Information and will provide only aggregate information in its reports.
(2) In the course of dealing with PFAP and its officers and employees under this
Agreement, User shall take care to inform PFAP whenever User is disclosing
Confidential Information to PFAP. PFAP shall make all reasonable efforts to prevent
disclosure of User's Confidential Information to any third party.
c. Protecting Con~dential Information. In the course of using the Facility, User shall make
reasonable efforts to not give User's Confidential Information to Others or any third party.
User shall also respect that Others using the Facility may be applying their Confidential
Information and shall take care not to discover Other's Confidential Information. Any
spying or deliberate intrusion into Others' Confidential Information is grounds for
terminating this Agreement. PFAP is not responsible for the misuse of Confidential
Information by Others.
d. Public Records. Notwithstanding the foregoing, User acknowledges that the Agreement
and any information obtained pursuant to the Agreement or use of the Kitchen or
Business Services may be deemed public records and subject to disclosure in whole or in
part under the North Carolina Public Records Law. PFAP andlor Orange County will
provide User with prompt notice of any intended public records disclosures, and an
appropriate opportunity to seek protection for User's confidential and proprietary
information consistent with all applicable laws and regulations.
7. TERMINATION. This Agreement shall continue indefinitely unless terminated as provided in
this Section. User's obligations pursuant to Section 6(Confidentiality) of this Agreement and any
financial obligation to PFAP shall survive the termination of this Agreement.
a. Voluntary Termination. This Agreement may be terminated at any time upon mutual
agreement of PFAP and the User. User may terminate this Agreement at any time upon
written notice to PFAP.
b. Breach or Default. User must correct any violation, breach, or failure to keep or perform any
conditions of this Agreement or the SOPs within three (3) days after receiving written notice
of such from the Manager of PFAP. If more than three (3) days pass without any corrective
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action taken by the User, PFAP may, in its sole discretion, terminate this Agreement. This
Agreement may also be terminated as provided in Section 3 of this Agreement.
c. User Property. Upon termination, User shall remove all of User's property from the Facility.
If User's property is not promptly removed, PFAP may enter, take possession of and remove
User's property. User shall be liable to PFAP for a reasonable storage cost for any property
removed in this way.
8. MISCELLANEOUS PROVISIONS.
a. Jurisdiction and Venue. Any disputes regarding this Agreement shall be resolved in the
courts of Orange County, North Carolina, and according to the laws of North Carolina.
b. Relationship of Parties. This Agreement shall not be construed to form a partnership or any
other business association between the Parties other than independent parties to contract.
User, its officers, agents and employees are not ernployees or agents of PFAP.
c. Entire Agreement. This Agreement with the Appendices represents the entire and
integrated agreement between the County and the Userr and supersedes all priar
negotiations, representations or agreements, either written or oral. This Agreement may
be amended only by written instrument signed by both parties. Modifications may be
evidenced by facsimile signatures.
d. Waiver. Failure of PFAP and/or Orange County to require compliance by User with any
provisions of this Agreement or the waiver by the PFAP and/or Orange County of any
breach of this Agreement or PFAP policies shall not constitute a waiver of any claim for
damages by PFAP and/or the County for any breach of this Agreement or a waiver of any
other required compliance with this Agreement.
e. Severability. If any provision of this Agreement is held as a matter of law to be
unenforceable, the remainder of this Agreement shall be valid and binding upon the
Parties.
9. ENJOYMENT. This shared-use commercial kitchen is a unique facility meant to be useful to
and enjoyed by its Users. The kitchen has been furnished to accommodate a wide variety of start-
up food businesses. It is necessary that all Users work collectively to make this shared-use space
work for all. Cooperation will benefit everyone and will allow harmony in the entire space. It is
the desire of PFAP to aid the many persons that may desire to start their business and provide a
clean and workable space for all parties. We wish each User's business the greatest success with
their product and with their business. May each grow and prosper and become a part of our
community.
SIGNATURES ON FOLLOWING PAGE
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This Agreement is executed all as of the day and year first above written, by the duly authorized
representative of each party.
ORANGE COUNTY: USER:
~
By: By. , •
County Man ger ~
G. I~l e a l l~ ~~; ~ e o n
Printed Name and Ti
PIEDMONT FOOD & AGRICULTURAL PROCESSING CENTER
B ~ -
Ma w Roybal, Manager
This in e t has be approv d as to technical content.
3'30 -! z
Steve Brantley, Department Directo
This instrument has been pre-audited in the manner required by the Local Government Budget
and Fi cal Control Act.
~1~.~. ~~
Office of the Finance Director
This i trument has been approved as to form and legal sufficiency.
Office of the unty Attorney
~"~
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'`~~!rO~ CERTIFICATE OF LIABILITY INSURANCE ROOZ 02TE27/D2O1'2
THIS CERTIFICATEIS 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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONALINSURED,the policylies) must be endorsed. If SUBROGATIONIS 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 endorsementls).
PRODUCER
THOMAS RUTHERFO CONTACT
NAME:
ORD INC/PHS
731978 P: (866) 467-8730 F
(877
53 Iq/CNNo eXC: (866) 467-8730 in"ic,rvo~: (877) 538-8526
:
)
8-8526
P~ B~X 29611 E-MAIL
ADDRESS:
CHARLOTTE NC 2 8 2 2 9 PRODUCER
C STOMER ID #:
INSURERIS) AFFORDING COVERAGE NAIC N
/NSURED INSURER A: S2I1t1I121 I11S CO LTD
NELLO' S ITALY
LLC INSURER B:
,
P~ B~X 80441 INSURERC:
RALEIGH NC 27623 INSURERD:
INSURER E :
INSURER F :
cuvtrs,q~ts CERTIFICATE NUMBER: RFVisinni n~i innRFa•
THIS IS TO CERTIFY THAT THE POIICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIICY 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 HEREfN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
/NSR
LTR TYPE OF /NSURANCE
/NSR
WVD
POL/CY NUMBfR POL/CY EFF
/MM/DD/YYYY1 POL/CY EXP
(MM/DD/YYYY/
L/M/TS
GENER.4L L/ABlL?Y EACH OCCURRENCE S 2~ O O O O O O
COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence) S 1 i O O O~ O O O
A CLAIMS-MADE ~ OCCUR MED EXP (Any one person) 6 1 O~ O O O
X General Liab X 14 SBM ZF3455 02~18~2012 02~18/2013 PERSONAL&ADVINJURY S 2~ ~~~~ ~0~
GENERAL AGGREGATE S 4~ O O O~ O O O
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 4~ O O O~ O O O
POLICV ~ PR~ ~ LOC S
AUT OMOB/LE L/AB/L/TY COMBINED SINGLE LIMIT
S
ANY AUTO (Ea accident) 2~ ~ ~ ~~ ~ ~ ~
ALL OWNED AUTOS BODILV INJURV ~Per person) S
SCHEDULED AUTOS BODILV INJURY (Per accident) S
A
14 SBM ZF3455
oa/ia/zoiz
oa/is/zoia PROPEflTY DAMAGE
S
X HIREDAUTOS (Peraccident)
X NON-OWNED AUTOS S
S
UMBRELLA UAB OCCUR
EACH OCCURRENCE
S
EXCESSL/AB CLAIMS-MADE
AGGREGATE
S
DEDUCTIBLE g
RETENTION S 5
WORKERS COMPENSAT/ON WC STATU- OTH-
AND EMPLOYERS' L/AB/L?Y TORY LIMITS ER
Y! N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDEDt ^
N~A
E.L. EACH ACCIDENT
S
lMandatory m NHJ
E.L. DISEASE - EA EMPLOYE
S
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCR/PT/ON OF OP£R4T/ONS / LOCAT/ONS / VEH/CLES /Attach ACORD 107, Addi[rone! RemaAcs Schedu/e, i/ more space is requbedl
Those usual to the Insured's Operations. Orange County, NC and Piedmont Food
and Agricultural Processing Center are listed as additional insured on the
business liability per business liability form 550008.
CERTIFICATE HOLDER CANCELLATION
Orange County, NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
and Piedmont FOOC~ BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
and Agricultural Processing Center DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
5 0 0 VALLEY FORGE RD AUTHOR/ZED REPRESENTAT/VE 4
HILLSBOROUGH, NC 27278 ~~_ ~q~(.~,~,.~-
° 1988-2009 ACORD CORPORATION. A~I rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
THOMAS RUTHERFOORD INC/PHS
PO BOX 2961 1
CHARLOTTE NC, 28229
Orange County, NC
and Piedmont Food
and Agricultural Processing Center
500 VALLEY FORGE RD
HILLSBOROUGH, NC 27278
ACORD 25 (2009/09)
.
PRODUCER'S FACT SHEET
NAMED INSURED: NELLO'S ITALY, LLC
POL #: 14 SBM ZF3455 DV
PRODUCER'S NAME: PRODUCER'S CODE: 731978
THOMAS RUTHERFOORD INC/PHS
POL EFF DATE: 02/18/12 POL EXP DATE: 02/18/13
DIRECT ACCOUNT BILL NLTMBER - 13252955
TRANSACTION TYPE: ENDORSEMENT
ENDORSEMENT PREMIUM: $0.00
COMPANY/AGENT SALES
TRANS EFF DATE: 02/24/12
CHANGE NO.: 001
ENDORSEMENT PREMIUM BREAKDOWN
PREMIUM COMMISSION PERCENTAGE
TOTAL $0.00
FORM TITLE
SS 12 11 04 05 POLICY CHANGE
SS 00 38 04 04 SPECTRUM SUPPLEMENTAL SCHEDULE OF AUDITABLE COVERAGES
IH 12 00 11 85 ADDITIONAL INSURED - PERSON-ORGANIZATION
PRODUCER'S FACT SHEET PAGE 1
02/27/12 14 SBM ZF3455 DV (02/18/13)
. ,
COMMERCIAL LINES AUTOMATION - SPECTRUM SUMMARY PAGE 3
POLICY INFORMATION
NAMED INSURED: NELLO'S ITALY, LLC
AGENT CODE AND NAME: 731978 THOMAS RUTHERFOORD INC/PHS
COMPANY CODE AND NAME: A SENTINEL INSURANCE COMPANY, LIMITED
POLICY EFFECTIVE DATE: 02/18/12 POLICY EXPIRATION DATE: 02/18/13
TRANS EFFECTIVE DATE: 02/24/12 AUDIT PERIOD: ANNUALLY
TRANSACTION TYPE: ENDORSEMENT CHANGE NiJMBER: 001
~ POLICY AUTOMATICALLY BOOKED
~
o COVERAGES LIMI TS OF LIABILITY PREMIUMS
POLICY BASE PREMIUM $0.00
BUSINESS LIABILITY
ri PREMISES/OPERATIONS $2,000,000 $0.00
,-'~,~ PRODUCTS/COMPLETED OPERATIONS $2,000,000 $2.00 AP
° DAMAGES TO PREMISES RENTED TO YOU
u`ni ANY ONE PREMISES $1,000,000 INCLUDED
~ WAIVER OF SUBROGATION $0.00
N EMPLOYMENT PRACTICES LIABILITY $10 ,000/ $10,000 INCLUDED
~ NON-OWNED AUTOMOBILE/HIRED CAR $2,000,000 $16.00 AP
o TERRORISM COVERAGE $0.00
o MINIMUM PREMILTM DIFFERENCE $18.00 RP
0
~
° TOTAL DIFFERENCE $0.00
POLICY # 14SBMZF3455 DV CONTROL # 003 TERM ID ROOIV2MA
PROCESS DATE 02/27/12 OPER INITIALS ECW AAR PREV POL # 14SBMZF3455
POLICY NUMBER: 14 SBM ZF3455
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - PERSON-ORGANIZATION
EARTH FARE
145 CANE CREEK INDUSTRIAL PARK DRIVE, SUITE 150
FLETCHER, NC 28732
WHOLE FOODS MARKET INC.
550 BOWIE ST
AUSTIN, TX 78703
ORANGE COUNTY, NC
AND PIEDMONT FOOD AND AGRICULTURAL PROCESSING CENTER
500 VALLEY FORGE ROAD
HILLSBOROUGH, NC 27278
Form IH 12 00 71 85 T SEQ. NO. o 0 2 Printed in U.S.A. Page o 01
Process Date: 0 2/ 2 7/ 12 Expiration Date: 0 2/ 18 / 13
UW COPY
Spectrum Supplemental Schedule of Auditable Coverages
REVISED
~
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This schedule reflects only those locations that have classes and/or coverages that are subject to audit.
Policy Number: 14 SBM ZF3455
Entries herein, except as specifically provided elsewhere in this policy, do not modify any of the other
provisions of this policy.
LOC/BLDG NO:
LOCATION:
001/001 TERR: 111
4021 BELLA PARK TRAIL
RALEIGH NC 27613
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CLASSIFICATION CODE NLJMBER 20351
DESCRIPTION:
Fruits & Vegetables - Pickled, Sauces, Seasonings Manufacturing
COVERAGE DESCRIPTION: PREMISES/OPERATIONS COVERAGE
REFER TO: BUSINESS LIABILITY COVERAGE PART FORM SS 00 OS
RATING BASIS: SALES PER 1000
EXPOSURE:
FINAL RATE:
NO CHANGE IN PREMIUM
COVERAGE DESCRIPTION:
REFER TO:
RATING BASIS:
EXPOSURE:
FINAL RATE:
ADDITIONAL PREMIUM:
7,725
0.129
$0.00
PRODUCTS/COMPLETED OPERATIONS COVERAGE
BUSINESS LIABILITY COVERAGE PART FORM SS 00 08
SALES PER 1000
7,725
2.201
$2.00
TOTAL ADDITIONAL PREMIUM $2.00 DOES NOT INCLUDE TERRORISM OR
FOR AUDITABLE COVERAGES ANY APPLICABLE STATE SURCHARGES OR FEES OR
MINIMUM PREMIUMS
Form SS 00 38 04 04T
Process Date: 02/2~/i2
Page ool
Policy Expiration Date: 02/18/13
POLICY CHANGE (Continued)
Policy Number: 14 sBM ZF3455
Policy Change Number: ooi
AGGREGATE LIMITS:
PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT IS CHANGED FROM
$2,000,000 TO $4,000,000
GENERAL AGGREGATE LIMIT IS CHANGED FROM
Sa,ooo,ooo To $4,000,000
BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED
HIRED/NON-OWNED AUTO LIABILITY
LIMIT OF INSURANCE IS CHANGED FROM $1,000,000 EACH OCCURRENCE
TO $2,000,000 EACH OCCURRENCE
FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE:
SS 00 38 04 04
IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION
Form SS 12 11 04 05 T Page o 02
Process Date: 0 2/ 2 ~/ l2 Policy Effective Date: 0 2/ 1 s/ i 2
Policy Expiration Date: 0 2/ i s/ 13
. ,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGE
This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated
below:
~ POIICy NUIYIbe~: 14 SBM ZF3455 DV COPY
~
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Named Insured and Mailing Address; NELLO~ s ITALY, LLC
M
r'~i PO BOX 80441
N RALEIGH NC 27623
~
w Policy Change Effective Date: 02/24/12 Effective hour is the same as stated in the
N Declarations Page of the Policy.
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~
o Policy Change Number: ool
0
° Agent Name: Txor~s RUTHERFOORD INC/PHS
~
Code: 731978
~
= POLICY CHANGES:
- SENTINEL INSUR.ANCE COMPANY, LIMITED
ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING
~ STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK
ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS.
= THIS IS NOT A BILL.
NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE
LIABILITY AND MEDICAL EXPENSES ARE REVISED
~ LIABILITY AND MEDICAL EXPENSES LIMIT IS CHANGED FROM
~ $1,000,000 EACH OCCURRENCE TO $2,000,000 EACH OCCURRENCE
° PERSONAL AND ADVERTISING INJURY LIMIT IS CHANGED FROM
~ $1,000,000 TO $2,000,000
PRO RATA FACTOR: 0.986
~ THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN.
Form SS 12 11 04 05 T
Process Date: 0 2/ 2 ~/ i 2
Page 001 (CONTINUED ON NEXT PAGE)
Policy Effective Date: 0 2/ i 8/ 12
Policy Expiration Date: 0 2/ 1 s/ 13
UW COPY
THE
HARTFORD
Select Customer Insurance Center
8711 UNIVERSITY EAST DRIVE
CHARLOTTE NC 28213
Policyholder, please call us at: (866) 467-8730
~
~ Agent, please call us at: (877) 853-2582
~
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~ ATTACHED
~
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~+ *** PLEASE REVIEW THE CHANGE ***
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~ Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have
~ questions or need to make further changes:
= Policyholder, please call us at: (866) 467-8730
- Agent, please call us at: (877) 853-2582 between 8 A.M. and 6 P.M. EASTERN TIME.
= The premium billing will be mailed to you separately. You can expect to receive it soon.
- Thank you for allowing us to service your business needs.
~ THOMAS RUTHFsRFOORD INC/PHS
= THE HARTFORD SELECT CUSTOMER INSURANCE CENTER
The Hartford Insurance Group
Hartford Fire Insurance Company and its Affiliates
Hartford Plaza, Hartford, Connecticut 06115
POLICY FACE SHEET
55
34 INSURED:
ZF SENTINEL INSURANCE COMPANY, LIMITED
SBM
CHANGE NO.: 001
CHANGE EFF DATE: 02/24/12
POLICY NO. 14 SBM ZF3455 DV
d~
~ DECLARATIONS
o ITEMS
l. NAMED INSURED AND
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MAILING ADDRESS:
2. POLICY PERIOD:
RECORDS RETENTION - PERMANENT
NELLO'S ITALY, LLC
PO BOX 80441
RALEIGH, WAKE
NC. 27623
oa/ie/ia oa/is/i3 i
INCEPTION EXPIRATION YEAR
AGENT'S CODE: 731978
AGENT'S NAME: THOMAS RUTHERFOORD INC/PHS
PREVIOUS POLICY NO. 14 SBM ZF3455
3. THE NAMED INSURED IS: LIMITED LIAB CORP
POLICY STATUS: ACTIVE
LOB LEVEL OF SUPPORT: SP-S
MARKET SEGMENTATION: 200
AUDIT PERIOD: ANNUAL
SELECT CUSTOMER
COMPANY/AGENT SALES AGREEMENT (COMMISSION STATUS )
DIRECT ACCOUNT BILL NUMBER - 13252955
DEDUCTIBLE
ADDITIONAL INSURED(S)
CODING ENTRY NOT REQUIRED
TRANS TYPE: ENDT CNTL#: 003
POLICY FACE SHEET TERMINAL ID: ROOlV2MA PAGE 2
02/27/12 14 SBM ZF3455 DV (02/18/13)
s
REGIONAL OFFICE INSTRUCTION SHEET
POLICY NUMBER: 14 SBM ZF3455 DV
CHANGE NiJMBER : 0 O l
CHANGE EFF DATE: 02/24/12
ROUTING INSTRUCTIONS
_SEND TO RECORDS. TRANSFER CORR IF APPLICABLE.
TERMINAL ID: ROOlV2MA OPER IN2T: ECW
02/27/12 14 SBM ZF3455 DV (02/18/13) PAGE 1
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