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HomeMy WebLinkAbout2012-266 AMS - Cameron & Cameron Painting Inc Link GSC Exterior Cleaning $18,200 olG/2- .Z6d NORTH CAROLINA CONSTRUCTION SERVICES AGREEMENT UNDER$25,000 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter "Agreement"), is made and entered into this 20th day of July, 2012 by and between Orange County, North Carolina (hereinafter the "Owner") party of the first part; and Cameron & Cameron Painting, 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: July 20, 2012 through August 31, 2012. The Project Commencement Date shall be July 20, 2012. 2. MAXIMUM AMOUNT PAYABLE Dollar Amount Not to Exceed: Eighteen Thousand Two Hundred Dollars($18,200.00) 3. SERVICES Contractor agrees to provide the following construction services (the "Work"): Cleaning of all exterior surfaces of the Link Government Services Center, 200 S. Cameron Drive, Hillsborough as well as interior window and screen cleaning per Attachment A. 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 (30) 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 F 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. Modific;tions 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 CO T CONT' • CTOR By LL' I By C--- Frank r lifton, ger — �� ' / 200 S. Cameron . s P.O. Box 8181 " ,, . - ' ` :, 4' Hillsborough,NC 27278 rs This instrument has been approved as to technical nt . / / c �� / 7 T' '?i Department Director This instrument has been pre-audited in the manner required by the Local Government Budget 4}U Fiscal Atxol ct. Office of the Finance Officer This ir.trument has been approved as to legal form and sufficiency. Office of hi ounty Attorney x $ 3 Revised November 2011 CAMERON CAMERON MOVING•ASSEMBLY•STORAGE June 28, 2012 Jeff Thompson Orange County Per the conversation and walk-thru Cameron&Cameron Painting can provide man power and equipment to pressure wash and clean windows inside and outside of the Link Complex on Cameron Street in Hillsborough, NC. (Scope of Work) Pressure wash the complete outside of the building with a Environment Safe Green Clean product that remove Mold&Mildew Stains. Remove the screens from (83)windows and clean them inside & outside replace screens. Clean the glass at the front and back main entry's. Clean the signs in the front and back of bldg. Sand and paint the rust spots on the back stairway. Clean concrete side walk in some areas (Front entry, Back entry, Common area, Steps) Trim/cut back about three feet of under growth/small trees from the back (West Side) of building and haul away. * The County will provide water for this project * Not to Exceed$18,200.00 $et&I/L%t F. Cavutrow Sr. Bennie F. Cameron Sr. President 18 Avondale Drive- Suite 18• Durham,NC 27701 • Phone (919) 530-1202 • Fax (919) 530-1207 • Info @CamCamMoving_co } % A`R O® CERTIFICATE OF LIABILITY INSURANCE D��3/ol' ) 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 pollcy(les)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 CONTACT NAME: Pam Harrell Murray M. White Inc. Ai No.Exte (336)889-4747 I Mg.No):(336)889-7033 1911 N Main Street EMAIL amemurra ,ADDRESS:P ymwhiteinc.COm P 0 Box 2196 INSURER(S)AFFORDING COVERAGE NA1C/ , High Point NC 27261 INSuRERA:Omega US Ins INSURED INSURERB:Progressive Southeastern Ins C 38784 B. Cameron & Cameron, Inc. MsuIERc:Torus Specialty Ins Co 1418 Avondale Drive INsuRER D Markel American Ins Co Suite 3 INSURERE; Durham NC 27701 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1271901019 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 WI-BCH 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. INSR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMM/DY/YYYY) (MM/ODII YYPY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED © COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 A ■■ CLAIMS-MADE t 3 l OCCUR 2219919 7/19/2012 7/19/2013 MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY n jFC 1 1 LOC $ AUTOMOBILE LIABILITY COMBINEEMSINGLE LIMIT $ 1,000,000 IN ANY AUTO BODILY INJURY(Pa person) S B = ALLOV IED ■ SCHEDULED 01745331-0 7/19/2012 7/19/2013 BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE S © HIRED AUTOS ■ AUTOS a (Per eccidern 11 Unnsured motorist combined S 85,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 C ■ EXCESS UAB ■ CLANS-MADE AGGREGATE $ 1,000,000 OED RETENTIONS 220069 7/19/2012 7/19/2013 S WORKERS COMPENSATION I VVC STATU-I IOTH- AND EMPLOYERS'LIABIUTY Y/N TORY LIMITS FR ANY PROPRETOR/PARTNERIEXECUTIVE I 1 N/A E.L.EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE S II es,deaeION under DESCRIPTION OF OPERATIONS be:ow EL DISEASE-POLICY LIMIT_5 D Motor Truck Cargo 1M523501 7/17/2012 7/17/2013 $I.00Dded Broad Form DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) The certificate holder is added as additional insured. Cancellation notice per policy conditions attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN County of Orange ACCORDANCE WITH THE POLICY PROVISIONS. Financial Services PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 Murray White, Jr./PAM ..Y„ .•-S.--:\. „_e=.,.„., ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD • IL 02 69 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA CHANGES -- CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART A. Paragraph 2. of the Cancellation Common Policy (b) An act or omission by the insured or Condition is replaced by the following: his or her representative that consti- 2. Cancellation Requirements lutes material misrepresentation or nondisclosure of a material fact In a. Policies In Effect Less Than 60 Days obtaining this policy, continuing this If this policy has been in effect for less than policy or presenting a claim under 60 days, we may cancel this policy by mail- this policy; ing or delivering to the first Named Insured (c) Increased hazard or material change written notice of cancellation at least: In the risk assumed that could not (1) 15 days before the effective date of have been reasonably contemplated cancellation if we cancel for nonpay- by the parties at the time of assump- ment of premium;or lion of the risk; (2) 30 days before the effective date of (d) Substantial breach of contractual cancellation if we cancel for any other duties, conditions or warranties that reason. materially affects the insurability of b. Policies In Effect More Than 60 Days the risk; If this policy has been in effect for 60 days (e) A fraudulent act against us by the or more, or is a renewal of a policy we is- Insured or his or her representative sued,we may cancel this policy prior to the: that materially affects the insurability (1) Expiration of the policy term;or of the risk; (f) Willful failure by the insured or his or (2) Anniversary date, her representative to institute rea- stated in the policy only for one or more of sonable loss control measures that the following reasons: materially affect the insurability of the (a) Nonpayment of premium; risk after written notice by us; IL 02 69 09 07 ©ISO Properties, Inc.,2006 Page 1 of 2 0 IL 00 1711 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation b. Give reports on the conditions we find; 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or doily- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or dolly- such actions we do undertake relate only to le- ering to the first Named Insured written notice surability and the premiums to be charged. We of cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of can- dertake to perform the duty of any person or cellation if we cancel for nonpayment of organization to provide for the health or safety premium;or of workers or the public.And we do not warrant b. 30 days before the effective date of can-that conditions: cellation if we cancel for any other reason. a. Are safe or healthful;or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1.and 2.of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation. The policy period will end service or similar organization which makes in- on that date. surance inspections, surveys, reports or rec- ommendations.If this policy ommendations. p y e any premium u refund send the first 4, Paragraph 2.of this condition does not apply to Named Insured any premium refund due. If we pp y cancel, the refund will be pro rata. If the first any inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be ef- tion, under state or municipal statutes, ordi- fective even if we have not made or offered a nances or regulations, of boilers, pressure yes- refund. sets or elevators. 6. If notice Is mailed,proof of mailing will be suffi- E. Premiums dent proof of notice. The first Named Insured shown in the Deciara- B. Changes tions: This policy contains all the agreements between 1. Is responsible for the payment of all premiums; you and us concerning the insurance afforded. and The first Named Insured shown in the Declarations 2. Will be the payee for any return premiums we is authorized to make changes in the terms of this pay. policy with our consent. This policy's terms can be F. Transfer Of Your Rights And Duties Under This amended or waived only by endorsement issued Policy by us and made a part of this policy. C. Examination Of Your Books And Records Your rights and duties under this policy may not be transferred without our written consent except in We may examine and audit your books and roc- the case of death of an individual named insured. ords as they relate to this policy at any time during If you die, your rights and duties will be transferred the policy period and up to three years afterward. to your legal representative but only while acting D. Inspections And Surveys within the scope of duties as your legal represen- 1. We have the right to: tative. Until your legal representative is appointed, a. Make inspections and surveys at any time; anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 1711 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 - . (g) Loss of facultative reinsurance, or B. The following provisions are added and supersede loss of or substantial changes in ap- any other provisions to the contrary: plicable reinsurance as provided in 1. Nonrenewal G.S.58-41-30; (h) Conviction of the insured of a crime a. If we elect not to renew this policy, we will mall or deliver to the first Named Insured arising out of acts that materially af- feet the insurability of the risk; shown in the Declarations written notice of nonrenewal at least 45 days prior to the: (I) A determination by the Commis- (1) Expiration of the policy if this policy sioner of Insurance that the con- 1 p is has tinuation of the policy would place us been written for one year or less;or in violation of the laws of North Caro- (2) Anniversary date of the policy if this ling;or policy has been written for more than (J) You fail to meet the requirements one year or for an indefinite term. contained in our corporate charter, b. We need not mail or deliver the notice of articles of incorporation or by-laws nonrenewal if you have: when we are a company organized (1) Insured property covered under this for the sole purpose of providing policy,under any other insurance policy; members of an organization with in- surance coverage in North Carolina. (2) Accepted replacement coverage;or We will mail or deliver written notice of can- (3) Requested or agreed to nonrenewal of collation to the first Named Insured at least: this policy. (I) 15 days before the effective date c. If notice is mailed, proof of mailing will be of cancellation if we cancel for sufficient proof of notice. nonpayment of premium;or 2. The written notice of cancellation or nonre- (ii) 30 days before the effective date newel will: of cancellation if we cancel for a. Be mailed or delivered to the first Named any other reason. Insured and any designated mortgagee or a. Cancellation for nonpayment of premium loss payee at their addresses shown In the will not become effective if you pay the policy, or if not indicated in the policy, at premium amount due before the effective their last known addresses;and date of cancellation. b. State the reason or reasons for cancellation d. We may also cancel this policy for any or nonrenewal. reason not stated above provided we obtain your prior written consent. Page 2 of 2 ©ISO Properties, Inc., 2006 IL 02 69 09 07 0 POLICY NUMBER: ouS010003.120 COMMERCIAL GENERAL LIABILITY • CO 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional insured Person(s) Or Organization(s): Location(s) Of Covered Operations Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II — Who Is An insured Is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown In the Schedule, but only sions apply: with respect to liability for "bodily Injury", "property This insurance does not apply to "bodily Injury" or damage or "personal and advertising Injury" "property damage"occurring after: caused, In whole or In part,by: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- ment furnished In connection with such work, 2, The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its In- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 O ISO Properties, Inc.,2004 Page 1 of 1 0 ACORD® CERTIFICATE OF LIABILITY INSURANCE aiz5i2oln2) 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 pollcy(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 CONTACT C stal Ireland NAME: Business Insurers of the Carolinas PHONE (919)968-4611 FAX Not (919)968-5991 800 Eastowne Drive, Suite 208 ApDireland @business-insurers.com PO Box 2536 PRODUCER 00020026 CUSTOMER ID N. Chapel Hill NC 27515-2536 INSURER(S)AFFORDING COVERAGE NAICN _ INSURED INsuRERANational Union Fire Ins. Co. INSURER B: Cameron & Cameron Logistics Inc. INSURERC: 1418 Avondale Drive INSURER D: Suite 18 INSURER E: — _ Durham NC 27701 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11102604997 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 POLI CIES.LIMITS SHOWN MAY HAVE BEEN REDU CED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR ,INSR WVD POLICY NUMBER (MM/00/YYYY) (MM/DD/YYYY) GENERAL UABIUTY EACH OCCURRENCE $ _ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE –1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE 5 GENL AGGREGATE LiMit APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE 5 HIRED AUTOS (Per accident) NON-OWNED AUTOS S UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ A WORKERS COMPENSATION X TORY I AMITS X OFR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT 5 1,000,000 OFFICER/MEMBER EXCLUDED? N NC007441941 10/26/201110/26/2012 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEES 1,000,000 V yyes tles1ON under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE C Ireland/IRELOI ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD } NORTH CAROLINA AMENDED COVERAGE ENDORSEMENT This endorsement changes the policy to which it Is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 10/26/201 1 forms a part of Policy No. WC 007-44-1941 Issued to CAMERON -& CAMERON LOGISTICS, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. This endorsement applies only to the insurance provided by the policy because North Carolina is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is replaced by this Condition: D. Cancellation 1. You may cancel this policy. If you cancel this policy, you must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. (a) If this policy has been in effect for fewer than 60 days and is not a renewal policy, we may cancel this policy for any reason by giving you at least 30 days prior written notice of cancellation and the reasons for cancellation by registered or certified mail, return receipt requested. (b) If this policy has been in effect at least 60 days or is a renewal policy, we may not cancel this policy without your prior written consent, except for any one of the following reasons: (1) Nonpayment of premium in accordance with the policy terms. (2) An act or omission by you or your representative that constitutes material misrepresentation or nondisclosure of a material fact in obtaining the policy, continuing the policy, or presenting a claim under the policy. (3) Increased hazard or material change in the risk assumed that could not have been reasonably contemplated by you and us at the time of assumption of the risk. (4) Substantial breach of contractual duties, conditions, or warranties that materially affects the insurability of the risk. (5) A fraudulent act against us by you or your representative that materially affects the insurability of the risk. (6) Willful failure by you or your representative to institute reasonable loss control measures that materially affect the insurability of the risk after written notice by us. (7) Loss of facultative reinsurance or loss of or substantial changes in applicable reinsurance as provided in G.S. 58-41-30. (8) Your conviction of a crime arising out of acts that materially affect the insurability of the,risk. (9) A determination by the Commissioner that the continuation of this policy would,place us in violation of the laws of North Carolina. (10) You fail to meet the requirement contained in our corporate charter, articles of incorporation, or bylaws, when we are a company organized for the sole purpose of providing members of an organization with insurance coverage in North Carolina. (c) If we cancel for any of the reasons listed in paragraph (b), we must provide you with at least 15 days prior written notice of cancellation stating the precise reason for cancellation. We must provide this notice by registered or certified mail, return receipt requested, to you and any other person designated in the WC 32 03 01B (Ed. 10/01) 02001 National Council on Compensation Insurance,Inc. 1 of 2 policy to receive notice of cancellation at the addresses shown in the policy or, if not indicated in the policy, at the last known addresses. Whenever notice of cancellation is required to be given by registered or certified mail, cancellation will not be effective unless and until that method is employed and completed. Failure to send notice as provided in this paragraph to any other person designated in the policy to receive notice of cancellation invalidates the cancellation only as to that other person's interest. (d) Cancellation for nonpayment of premium is not effective if the amount due is paid before the effective date stated in the notice of cancellation. 3. We may refuse to renew this policy: (a) If this policy is for a term of one year or less, we must provide you with notice of nonrenewal at least 45 days prior to the expiration date of the policy. (b) If this policy is for a term of more than one year or for an indefinite term, we must provide you with notice of nonrenewal at least 45 days prior to the anniversary date of the policy. (c) The notice of nonrenewal must state the precise reason for nonrenewal. Failure to send this notice, as provided in paragraphs 3 and 5, to any other person designated in the policy to receive this notice invalidates the nonrenewal only as to that other person's interest. (d) Any nonrenewal attempted or made that is not in compliance with paragraphs (a), (b) and (c) is not effective. Paragraphs (a), (b) and (c) do not apply if you have obtained insurance elsewhere, have accepted replacement coverage,or have requested or agreed to nonrenewal. 4. Whenever we lower coverage limits, raise deductibles, or raise premium rates for reasons within our exclusive control and other than at your request, we will mail you written notice of the change at least 30 days in advance of the effective date of the change. As used in this paragraph, the phrase, "reasons within our exclusive control" does not mean experience modification changes, exposure changes, or loss cost rate changes. 5. We must provide the notice required by paragraphs 3 and 4 by mail to you and any other person designated in the policy to receive this notice at the addresses shown in the policy or, if not indicated in the policy, at the last known addresses. Mailing copies of the notice by regular first-class mail satisfies the notice requirements of paragraphs 3, 4 and 5. 6. We will also send copies of the notice required by this endorsement to the agent or broker of record, though failure to send copies of the notice to the agent or broker of record will not invalidate a cancellation or nonrenewal. Mailing copies of the notice by regular first-class mail to the agent or broker of record satisfies the requirements of this paragraph. WC 32 03 01B Countersigned by (Ed. 10/01) 02001 National Council on Compensation Insurance.Inc. 2 of 2 Authorized Representative