Loading...
HomeMy WebLinkAbout2012-095 AMS - Brown Brothers Plumbing & Heating Company $6.585[Departmental Use Only] TITLE Water Backflow Device FY 2012 ORANGE COUNTY CONTRACT UNDER $10,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 11th day of April, 2012, ( "Effective Date ") by and between Orange County, North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the "County "), party of the first part; and Brown Brothers Plumbing & Heating Company, Inc. (the "Provider "), party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement, time being of the essence: The services and/or materials (hereinafter referred to collectively as "Services ") to be furnished under this Agreement are as follows: Services identified in the attached proposal, dated March 21, 2012 The term of this agreement rendered shall be from May 1, to May 31, 2012. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub - contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement, without the prior written approval of the County. SPECIFIC TERMS 1. Pa, moment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed Six thousand, five hundred and eighty -five dollars, ($6,585). Payment shall be made within thirty (30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. 2. Non — waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non - Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent Provider, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4. Insurance: The Provider shall obtain, at its sole expense, all insurance needed to adequately insure itself during the performance of these services as required by the County's Risk Management Policy. Revised July 2010 5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury. including death; to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. 7. 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 in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 8. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Should either party initiate litigation to settle any dispute involving the terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. 9. Non AWro nation: Provider ac1mowledgcs that County 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 County's obligations lender this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non - appropriation of public funds. IN WITNESS WHEREOF, Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE COUNT By: lm� County Manage 200 S. Cameron St_ P.O. Box 8181 Hillsborough, NC 27278 PROVID R.ALV WAt �% °�f(1,�5 �4 By Title: 4 This instrument has been approved as to technical content. G�Yri E t4 Dep ent Director This instrument has been pre - audited in the manner required by the Local Government Budget and Fiscal Control Act. Ua,4. Ins �. Office of the Finance Director This in rument has been approved as to form and legal sufficiency. Office of the C my Attorney Revised July 2010 2 ROWN SINCE ROTHERS ,g33 PLUMBING & HEATING COMPANY, INC. FAX QUOTE FROM: BROWN BROTHERS PLUMBING & HEATING, CO. INC. PH. #919- 220 - 2554.. N.C. LIC. #282.. FAX #919- 220 -2531 DATE: March 21, 2012 JOB NAME: 300 West Tryon Street Attn: Wayne Fenton Email: wfenton @co.orange.nc.us Phone: (919) 245 -2628 JOB LOCATION: Hillsborough Ref: Domestic Water Backflow Device Scope of Work: Provide material and labor to install one two inch RPZ backflow device, above ground with insulated enclosure, at 300 W. Tryon Street. Proposal Includes: Device testing and certification. Aluminum insulated enclosure. Concrete pad and drain. /FOR THE PRICE OF: Sao °° Add heated enclosure. X FOR THE PRICE ADD OF:z5. °" Add pressure reducing valve a backflow. Remove existing PRV. /FOR THE PRICE ADD OF: gacl. Deduct for fiberglass enclosure without insulation. Heater would be required. X FOR THE PRICE DEDUCT OF: Labor rates are based on working hours of 7 :30 am to 4:00 pm weekdays. EXCLUSIONS: Bond Electrical Proposal may be withdrawn if not accepted within 30 days. PAYMENTS TO BE MADE AS FOLLOWS: AUTHORIZED SIGNATURE_ Project Manager PO Box 15668 - 2820 North Roxboro Road -Durham, NC 27704 -0668 Telephone (919) 220 -2554 Fax (919) 220 -2531 OP ID: DL 11CG "JVER, _- k• CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 04119/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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). PRODUCER 919. 471 -8222 Tyson Insurance Services, Inc. 3814 -A North Duke Street P. O. Box 16734 Durham, NC 27704- Diane S. Long CONTACT PHONE C NO Ext : a/c No); E-MAIL ADDRESS: CUSTOMER u _ ID a: BROWBRO INSURER(S) AFFORDING COVERAGE NAICS INSURED Brown Brothers Plumbing & Heating Company 2820 N. Roxboro Road Durham, NC 27704 INSURER A: Builders Mutual Insurance Co. INSURER B: EACH OCCURRENCE INSURER C: A INSURER D: INSURER E: PCP0000055 03 INSURER F 12/31/12 %IVr 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 RFFN RFnI if r-n RV PAln c1 nlaec INSR LTR TYPE OF INSURANCE AD 4= WVD POLICY NUMBER N - — - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PCP0000055 03 12/31/11 12/31/12 PREMISES EKtN occurrence) s 100,00 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,00 X contractual liab. PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY Fxj . x PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 X A ANY AUTO PCA0006942 01 12/31/11 12/31/12 (Ea dent) BODILY INJURY (Per person) is ALL OWNED AUTOS i BODILY INJURY (Per accident) s SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X $ NON -OWNED AUTOS r$ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 5,000,00 '4 EXCESS UAB CLAIMS -MADE UM$0010121 03 12/31/11 12131112 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 1,000,00 A ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED ❑N NIA CP0044355 03 12/31111 12131112 E.L DISEASE - EA EMPLOYEE $ 11000100 (Mandatory to un ) if describe under E.L. DISEASE - POLICY I IMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below A Equipment: Leased PCPQD00055 03 12/31/11 12131112 Equipment 250,00 or Rented 1 ded DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space b required) Job: Orange County - 300 W. Tryon Street ?range County, North Carolina (owner) is additional insured per the attached orms. ORANC07 Orange County Attn: County Manager 200 S. Cameron St. P.O. Box 8181 Hillsborough, NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Diane S. Long • d. 01983 -2009 ACORD ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD rights reserved. THiS ENDORSEMENT CHANGES THE POLICY, COMMERCIAL GENERAL LIABILITY PLEASE READ IT CAREFULLY. BUILDERS PREMi . ER [INSURANCE COMPANY ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the followin : COMMERCIAL GENERAL LIABILITY COVERAGE PART g Except as otherwise the t stated in this endorsement, erms and conditions of the policy apply to the insurance stated below, in that premises. A. The following is added to the Commercial b. Structural construction alterations, new General Liability Coverage Form, Section 11 °r' demolition WHO iS AN INSURED: operations performed by or on behalf of the person or organization �. The Person(s) or organizations(s) from from whom you lease property. Whom equipment has been leased; but $• The person ( only with respect to their liability arising s) or organizations) from out of the maintenance, operation or use wham, land is (eased but only with respect to liability arising Out of the by you of equipment leased to you by ownershi such persons) or organization (s), subject n maintenance or use of that to the fallowing additional exclusions: part io land leased to you. The following additional exclusions apply: This insurance does not apply: This insurance does not apply to: a To any "occurrence" which takes a• Any °occurrence" which takes Place after the equipment lease place after you cease to lease that expires; land; b. To "bodily injury" or "property b. Structural alterations, new damage" arising out of the sole construction or negligence of the person or demolition operations performed by or on organization. from whom equipment -behalf of the has been leased, from whom landrhas been leased. 6. The person(s) or organization(s) shown 9. Any state or political subdivision subject in the Declarations as mortgagee, to the following additional provisions: assignee, or receiver, but only with respect to their liability as mortgagee, This insurance applies only with respect assignee, or receiver and arising out of to the following hazards for which the the ownership, maintenance, or use of state or political subdivision has issued the premises by you, a permit in connection with premises You own, rent, or control and to which This insurance does not apply to this insurance applies: structurel alterations, new construction a. The existence and demolition performed by or for that maintenance, repair, person or organization. construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, . coat holes, driveways, manholes, 7• The person(s) or organization (s), from marquees, hoistaway openings, whom you lease property but only with sidewalk vaults, street banners, or respect to liability arising out of the decorations .and similar exposures; ownership, maintenance or use of that or Part of the premises leased to you and subject to the following additional b The construction, erection, or exclusions: removal of elevators; or This insurance does not apply to: c• The ownership, maintenance, or use of any elevators covered by this A.- Any "Occurrence" which takes insurance. place after you cease To be a tenant 10. Any architect, engineer or surveyor PCG 0013 02 05 includes copyrighted material of Insurance Services Office, Inc its permission. Copyright, Insurance services Office; inc., 1997 Page 1 of 2 engaged by you but only with respect to Parising out of your premises or "your work ". This insurance, with respect to such architects, engineers, or surveyors, does not apply to "bodil " property y injury", advertising injury"' injury" or rendering or failure arising to render any professional services by or for you including: a• The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field order; change orders, or drawings and specifications; and b. Supervisory, architectural or, inspection, activities. engineering 11. Any person or organization other than an architect, engineer or surveyor, which requires in a "work contract" that such person or organization be made an insured under this policy. However, such person or organization shall be an insured only with respect to covered "bodily injury ", "property damage", "personal injury" and "advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) only at the location designated by the "work, contract" The coverage afforded to such person or organization does not apply to "bodily injury", "property damage ", "personal injury" . and "advertising injury" occurring after the earliest of the following times: PCG 0013 02 05 a. When "Your work" under the contract" work maintenance' otrerepa repairs) has service, completed. b. When that portion of "your work" under the "work contract" out of which any 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. C. When • our coverage for you under this policy or a renewal of this policy terminates and is not continued by other insurance provided by us. "Worst contract" means a written agreement into which you enter for work performed by you or on your behalf. 12. Any person or organization to whom You are obligated by virtue of a written "insured contract" to provide insurance such as is afforded by this policy, but only with respect to liability arising • out of the ownership, maintenance, or use of that part of any premises or land leased to you. This does not apply to: a. Any "occurrence" that takes place after you cease to be a tenant on those premises, or cease to Lease the land; or b. Structural alterations, construction o new r demolition operations performed by or on behalf of such insured. Includes copyrighted material of Insurance services Office, Inc., with its permission, Copyright, Insurance Services Offic ®, Inc., 1997 Page 2 of 2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUILDERS PREMIER INSURANCE COMPANY ADDITIONAL INSURED PRIMARY AND NON - CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART T11e following additional provisions apply to Additional insured Endorsement BCG 0013 attached to your policy; B. if all additional insured's policy has ail Other insurance provision making the additional insured's Policy excess, and a Named insured has agreed in a written contract or written agreement to 1. perform work; and /or 2. have someone perform work on the Named Insured's behalf for the benefit of the additional insured and such written contract or written agreement contractually requires the Named Insured to provide the additional insured coverage on a primary and 11017- contributory basis, this insurance shall be primary and we will not seep contribution from the additional insured's policy for damages we are obligated to pay under this insurance arising out of the on -going operations of the work the Named Insured, or any person or organization performing work on the Named Insured's behalf, was required to perform for the additional irisured under such written contract. it is expressly understood that our agreement to: 1, have this insurance be primary; and 2. not seek contribution from the additional insured's policy as outlined above under this section 12. Addition To BCG 0013 Endorsement - Additional Insured Primary And Non - Contributory provision of this endorsement, does not apply to "bodily injury" or "property damage" included within the "products- completed operations hazard" unless there is another additional insured endorsement that applies to this insurance that agrees to; 1. provide coverage to the additional insured for liability for "bodily injury" or "property damage" included in the "products- completed operations hazard" for work performed by the Named Insured (or someone performing work on the Named Insured's behalf) and performed under a written contract for that additional insured. This insurance expressly doesn't provide the additional insured with "products completed operations hazard" coverage. Except as provided in Paragraph 4.a, of Section IV - Commercial General Liability Conditions, any coverage provided by this section 12 shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis. In the event an additional insured has other coverage available for an "occurrence" by virtue of also being at) additional insured on other policies, this insurance is excess over those other policies. PCG 0022 0108 Includes copyrighted material of Insurance Services Office, inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 PCP 0000655 02 THIS 'END{)IRSEMENT CHANGES THE POLICY. PLEASE READ COMMERCIAL GENERAL LIABILITY' Contractor 's Biaiike$ Additional Insured IT CAREFULLY. Products _ Completed Operations rseii ein$ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11— WHO IS AN INSURED is amended to include as an additional Insured an person organization when you and such person or organization have agreed in a written contract or wri agreement that such person or organization be added to our policy, but only with respect to liability for "bodily injury" or "property damage" caused b written included in the "products - completed operations "Your performed for that additional insured and When the named insured is required to add an additlon written agreement must be: 'insured nsured on this Policy, written ntten contract or 1. Currently in effect or becoming effective during the term of this policy; 2. Executed prior to a "bodily injury" "occurrence" or "property damage" "occurrence" to which this insurance would apply; and 3. Between a Named Insured and the additional insured B. The insurance provided to the additional insured is subject to the following provisions: 1. That person or organization is an additional insured only for liability caused by your negligence specifically resulting from "your work" for the additional insured as detailed in the written contract or written agreement. 2. The Limits of Insurance (Section 111) is amended to include; The limits applicable to the additional insured are the lesser of those specified in the written contract or agreement executed between you and the additional Insured or in the Declaration of this Coverage Part, whichever is less. These Limits of Insurance are inclusive of, and are not in addi #ion to, the Limits of Insurance shown in the Declarations and defined in Section III .— Limits of Insurance. 3. The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" arising out of the rendering of, or the failure to render any professional services by you or on your behalf, but only with respect to the following operations: a. Providing engineerin , architectural or surveying services to others in your capacity as an engineer, architect or surveyor; and b. Providing, or hiring independent professional firms to provide, engineering, architectural or surveying services in connection with construction work you perform. Professional services include: C. The preparing, approving,'failing . to prepare, approve, maps, shop drawings, opinlons, reports, surveys, field orders, change orders, or drawings and specifications; and d. Supervisor or inspection activities performed as part of any related architectural or engineering activities. e. However, professional services do not include services within construction means, methods, i techniques, tiisin your capacity as a construction f on c ntrractor, in connection CG 70 24 03 09 Includes copyrighted material of insurance Services Office, inc., with its permission. Copyright, Insurance Services Office, Inc., 1997 Page I of '2 4. The following replaces Exclusion I under 2. Exclusions of Section I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Damage to Your Work This insurance does not apply to "property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard ". 5. When a written contract or written agreement requires coverage to be provided for "bodily injury" or" propperrttyy damage" within the "products - completed operations hazard ", coverage will not apply fo "bodily injury' or "property damage" which occurs after: a. The period of time required by the written contractor written agreement; or b. Five years from the completion of "your work" on the project that is the subject of the written contract or written agreement. 6. Any coverage provided to the additional insured by this endorsement shall be excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis, unless the written contract or written agreement in effect during this Policy period and executed by you prior to an "occurrence" specificatly requires that the insurance be provided on either a primary or on a primary and noncontributory basis. 7. The insurance provided in this endorsement does not apply to "bodily injury", damage" arising out of "your work" for which a consolidated (wrap-up) y insurance ry °r "property been provided by the prime contractor, project manager or owner of construction rprroject has which you are involved. 8. The following is added to SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2., Duties.in The Event of Occurrence, Offense, Claim or Suit: e. An additional insured under this endorsement must comply with all provisions of this section. The company may audit or require a copy of the contract. CG 70 24 03 09 Includes copyrighted material of insurance Services Office, inc., with its permission. page 2 of 2 Copyright, insurance Services Office, Inc., 1997 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. �. s3 WAIVER OF TRANSFER OF RIGHTS AGAINST OTHERS TO U F RECOVERY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Brown Brothers Plumbing & Heating Co Inc (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 11 Da���i� area Name of Grnup• 11alue of Meiaber : Address - 12/22/2011'* x1Q: BUILDERS MUTUAL INSURANCE CO." BROWN BROTHERS PLUMBING & HEATING CO INC PO BOX 15668 DURHAM,'NC 27704 Policy. Number • WCF 0044355 03 po�� cy Period - I12131/201i to 12/31/2012 Effective Date. 12/31/2011 • 37354 INTENT OF EIJDORSEMENT (- ZTDICATE ONLY 01TE ACTION PER EIMORSEMENT) . ( X ) CI ANGES TO WAIVER OF SIISROGATION SCHEDULE- INSTRUCTIONS: For changes, indicate below the name or } Indicate below the new name or address address prior to endorsement. Each item } after change or the name and address of an On the left must correspond with an item } addition or deletion. For deletions give on the right. } disposition. } 00002 BLANI= NAIVSR Applies to all,jobs as required by } wrttten contract. I - 2820 N_ ' ox '6oro Ind. I 'Duxbam, NC 27704 I I I I Agent: 443 - TYSON INSURANCE SERVICES. Reguestor: DWRITAK STATE ?NGURED PIL9 AGENT LC POLICY NUMBER: COMMERCIAL AUTO CA 20 48 07 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following; BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless mod- ified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An insured provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 12/31/2011 Countersigned By; Named Insured: Brown Brothers Plumbing SCHEDULE Dame of Person(s) or Organization(s): Any or All Person(s) or Organization(s) as required by written /executed contract, for jobs in the state of. North Carolina. (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations or above Schedule as applicable to the endorsement.) Each person or organization indicated above is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured' under the Who Is An insured provision contained in SECTION ti of the Coverage Form. CA 20 48 07 97 Copyright, Insurance Services Office, Inc., 1996 . Page 1 of I ❑ WAIVE, R OF Quit ziz ri.rr xo ztz;COV ! . . Wa have tl'e if k 1''IZOU OTI1 elifoire "1,11 to a'ecovet oU• payuieuts fto ' r"NDo 1LS1a>r T ur right rfotm C the person or or a n>, auyoAe liable pol• as cx f.eut that you IJeMoruz w ork under a g wzatiou uatned ui. Uie S vujtuy covered by tGis polic , wxiCieu �uLcact e- dule.(111is a ee Y ,% will not xhis agreement sha that Xe Wres you to ot?la' zneut applies only lluoC o this agroeuleut f p Y to Lho peaate directly ox iudu'ectt t m us.) Y o beue$t any one 110 mined in flee Schedule. Sclzec�,ile Blanket Waiver 2820 X. Roxboro Rd_ Durham, NC 27704 Applies to all. jobs as required by written coutr3Ct. Th1s endorsement eltanges Ste policy to which it is allached and Is e{Teclit c on the data issued unless oche (The lnfonnation bdmv is squired only when this endorsemeul is issued subsequuttto re noise slated. lorsement Effecii"; T' P+slion ofUre policy) 12/31/2011 . PolicyTdo tred: VN BT(OTTTERS "L UvBING 33EgTTNG CO TNC IfCp 004355 03 > Tindorscrneni 7.To,; ) Carrier Noy 37354 haute Compalty: BUILDERg T'tcmiurn: ' T`'IUTUAL 1NSURANC73 CO. ' C 00 03.13 . A /oK) • Countersigned by tyright 1983 National Council on Campetttation Insurance, ~ !'!h ll�St:RAh't;L' SLRt'ICl•S- !lalAJ Prhls:d nre alae �� zVtp U IYKMAK ORANGE COUNTY - CONTRACT CONTROL SHEET Routing Order: (1) Department, (2) IT, (3) Risk Management, (4) Financial Services, (5) Attorney, (6) Manager, (7) Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through, and complete, the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Brown Brothers Plumb' g Party/Vendor Contact Person: Jeff Addison Contact Phone: 919 - 220 -2554 Party/Vendor Address: Roxboro Rd City Durham State: NC Zip: 27704 Department: Asset Management Services Amount: $6_,,585 Purpose: Sup 1 &installation of Backflow prevention valve, pressure reducing valve and enclosure, per attached uotation. Budget Code(s): 570000 Vendor # 35730 (N /A if new vendor vendor is a BOCC consu taut. es No Contract Type: (Check one) New ® Renewal ❑ Amendment F1 Effective Date Approved by Board Yes❑ No® Agenda Date: Title of Contract: If this is a Grant Agreement, pre - application has been approved by the Board of Commissioners Yes❑ No❑. If submitted for bid were bids/RFPs received Yes❑ No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: , Department Director's Signature: PM �' Date: _J� IT Director (Applicable only to hardware /software purchases or related services) This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: [�CGL; [Auto; C' ❑ Professional; E9 -Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved by the Risk Manager: Risk Manager's Signature: 4y F Date: e c `d 2 3I z Lt -3o 11 PAt 71v CVM-r Financial Services This Contract is condition d upon appropriation by the Board of Commissioners Yes ❑No�. A budget amendment is necessary before approval Yes❑ NoX. If budget amendment is necessary, please attach to this form. his instrument has been pre- audited in the manner required by the Local Government Budget and Fiscal Control Act: e Financial Services Director's Signature: C64vGa t.✓ A Date: 4 a% 2 County Attorney Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by Manager 0 (All other contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency. Attorney's Signature Date: 61111 .Z County Manager This contract has been reviewed and is approved by the County Manager Yesp�T`No❑. This contract has been reviewed and is for signature by the Chair Yes❑No2—. Manager's Signature: Date: Clerk to the Board Approved by BOCC on the _ day of 20 . Submitted for Chair signature on the _day of 20 Clerk's Signature: Revised November 2011 Date: