HomeMy WebLinkAbout2013-516 EMS - Orange Rural Fire Department for Fire Protection Agreement STATE OF NORTH CAROLINA
ORANGE COUNTY
FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENI
THIS AGREEMENT (this "Agreement"), made and entered into this 1 9 day of Deeembcr,
2013 by and between Orange County, hereinafter referred to as the "County" and Orange Rural
Fire Department, hereinafter referred to as the "Fire Department", referred to herein as "Party"
and/or collectively as the "Parties".
WITNESSETH:
1. County created the Central Orange Fire Protection District (the "District') as a special
tax district pursuant to Chapter 69 of the North Carolina General Statutes and
desires to contract with Fire Department for fire protection and other services as set
out herein.
2. Pursuant to §NCGS 69-25.4 the County agrees that it will cause to be assessed or
levied a special tax of not more than fifteen cents ($.15) per one-hundred dollar
($100) valuation of all real and personal property in the District unless otherwise
limited or prohibited by law or a vote of the people, and will collect said tax as a part
of the ad valorem taxes of Orange County; provided however, the amount levied
annually shall be based on the needs projected in the budget estimate submitted by
the Fire Department to the County as approved by the County.
3. That a special or separate fund shall be maintained by the County for funds collected
as a result of said special tax.
4. That from said special tax district the Board of County Commissioners will approve a
Fire Protection District tax rate and Annual Budget for the Fire Department. The
County agrees to remit quarterly payments, by the 15th day of the first month of each
quarter. The total quarterly payments to the fire department will equal the annual
budget.
5. The Fire Department shall provide and furnish adequate fire protection services and
shall provide the necessary equipment, personnel, and other resources as
determined by the North Carolina Department of Insurance, Fire and Rescue Service
Division, and the Insurance Service Office for all persons and property located within
the District. Fire Department currently has an insurance rating of Class 6, and during
the term of this Agreement will maintain at least a 9E insurance rating. Fire
Department will furnish fire and rescue services free of charge to all persons and
individuals within the District (excluding non-public commercial transportation). Fire
Department shall strive to achieve an insurance rating of 8 (or better) by July 2014
and 6 (or better) by July 2016. This section does not preclude the Fire Department
from charging a pre-arranged nominal fee when standing by for special events.
6. That all funds paid to the Fire Department by the County shall be used exclusively by
the Fire Department to provide fire protection services within the District (See Exhibit
1), and the Fire Department may also use said funds to provide Medical Responder
and rescue services within the District, and to pay other legitimate fire, rescue, and
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Medical Responder expenses attributable to the services rendered within the District.
This does not preclude mutual aid agreements.
7. The Fire Department shall provide Medical Responder Services within the District.
Medical Responder Services are defined as the provision of Basic Life Support
treatment as needed until such time as more highly trained personnel arrive on
scene. Such Medical Responder Services may be provided through mutual aid
agreements or through third party contracts
8. The Fire Department shall provide Hazardous Materials Response Services at the
North Carolina Department of Insurance "Operations" Level within the District.
Hazardous Materials Response Services are defined as defensive actions necessary
to protect life, property and the environment from the effects of the release.
9. The Fire Department shall provide Rescue Services to all persons and individuals
within the District. Rescue Services are defined as the removal, extrication, or freeing
of individuals from vehicle confinement or danger, rope rescue, vehicle and
machinery rescue, farm machinery rescue, and confined space rescue. Furthermore,
the Fire Department shall provide structural collapse rescue services by January 1,
2014, and water rescue by July 1, 2014. Such Rescue Services may be provided
through mutual aid agreements or through third party contracts.
10. Notwithstanding Section 6 above Fire Department may provide fire protection
services outside the District subject to the following terms and conditions [This
section applicable only to departments authorized to provide fire protection services
outside their districts. Remove or strike where not applicable]:
A. That Fire Department is authorized to provide primary fire protection services
in the area of the Cedar Grove Fire District shown in Exhibit 1.
B. Fire Department shall not expend any funds or resources appropriated for the
use of persons and individuals in the Central Orange Fire District for the
primary fire protection services outside the area of the Cedar Grove Fire
District shown in Exhibit 1. In the event any such expenditure occurs for
primary fire protection outside the area shown in Exhibit 1 Fire Department
shall immediately notify the County and Fire Department shall take corrective
measures to rectify the expenditure and to ensure such expenditure shall not
be repeated.
C. That Fire Department shall enter into an agreement with the Cedar Grove Fire
Department in which Cedar Grove Fire Department shall provide
compensation to Fire Department for Fire Department's availability and
service in providing primary fire protection services in the area of the Cedar
Grove Fire District shown in Exhibit 1.
11. In providing the services contemplated herein the Fire Department shall operate in
compliance with all applicable State and local laws and regulations including, but not
limited to the North Carolina Fire Incident Reporting System (G.S. 58-79-45, NC
Administrative Code, §.0402). The Fire Department shall submit electronic incident
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reports on a quarterly basis to the Orange County Fire Marshal. The Fire
Department further agrees to file with the Fire Marshal Office a current list of its
Board of Directors, and a roster of its fire department personnel, an annual training
report, and a list of apparatus including pump and tank size, and specialized fire
suppression equipment, no later than July 31St of each year. The County shall have
the right to inspect all books and accounts for the Fire Department at any time. Said
inspection shall be conducted by the Orange County Fire Marshal and/or Orange
County Finance Office and/or their designee. The following minimal performance
standards are agreed upon by the County and the Fire Department and are a part of
this contract:
A. Response Time. Fire Department should have the goal of having an
average response time (time of dispatch until time of arrival) of_16_
minutes or less for structural fire calls within the recognized Insurance
District. Fire Department should have the goal of having an average
response time of _16_ minutes or less for Medical Responder and
Rescue Services.
B. Personnel on Scene. Fire Department should have adopted standard
operating guidelines that address the appropriate number of firefighters
needed on all type fire calls. The National Incident Management System
shall be used at all incidents to manage personnel.
C. Training. Fire Department shall have the minimum standard training
requirements set forth by the State of North Carolina and NC
Department of Labor for providing fire and emergency services provided
by the Fire Department. For purposes of this agreement emergency
services includes both Medical Responder services, hazardous materials
services, and rescue services.
D. Fire Investigations. The Fire Department officer in charge at all fire
scenes shall attempt to determine the cause and origin of every fire.
When the officer in charge cannot determine the cause and origin of the
fire, or if the cause is suspected to be of an incendiary nature, the officer
in charge may request assistance from the Orange County Fire Marshal.
E. Reports. Fire Department shall keep all records for a minimum period of
seven (7) years. All State and county required reports and rosters shall
be submitted by the applicable deadlines.
F. Fire Hydrants. The Fire Department should coordinate with the owners
of the water distribution system so that every hydrant in the District is
flushed and checked for accessibility, functionality, visibility, and
operation at least annually. If the hydrant is owned by a municipality or
special water district, testing and maintenance should be handled as
agreed upon by the County and the system operator. The Fire
Department should report any malfunctions or damage to hydrants to the
owner of the water distribution system.
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G. Emergency/Disaster Response. Fire Department shall follow the Orange
County Emergency Operation Framework (EOF) Policy when responding
to an emergency or disaster.
H. State of Emergency. County requests that Fire Department, when
available, assist with the following services, but not limited to, before,
during, and following times of emergency/disaster: 1) Debris Clearance;
2) Traffic Control; 3) Alert and Warning; 4) Search and Rescue; 5)
Evacuation Notification and Coordination; and 6) other life-saving and
property protection measures as necessary. All operations shall be in
accordance with the Orange County Orange County Emergency
Operation Framework (EOF) Policy.
I. Medical Responder Services. When Fire Department provides Medical
Responder Services assistance, it shall be done in accordance with the
rules set forth by the Orange County Medical Director.
12. The Fire Department shall submit to an audit by a Certified Public Accountant, which
will be paid for by the County, and shall be in conformity with General Accepted
Accounting Principles. If an audit has already been performed by a certified entity,
the Fire Department shall present the County with a copy of that audit. Such audit to
be provided on or before December 31" of each year beginning in 2014, and to be in
conformity with the most recent audit policies of the County and the North Carolina
Local Government Commission. Further, the Fire Department agrees to comply with
County budgeting procedures including a mid-year financial statement and other
procedures provided for by State Law and agree to submit budget estimates to the
Board of Commissioners on the standard forms used by County departments. The
Fire Department also agrees to use standard line items for accounting as requested
by the County Finance Department.
13. The Fire Department shall comply with the County budgeting procedures, and shall
submit annual budget estimates in accordance with established County budget
timetables. A supporting letter of request for the proposed tax rate shall be signed
by the Fire Department's president upon approval of its Board of Directors. The
County will provide the Fire Department with standard forms for budget submission
and the Fire Department shall use such standard forms.
14. The Fire Department shall comply with the State of North Carolina purchasing
procedures for local governments as identified in Attachment #1, as well as other
procedures provided for by state law.
15. The Fire Department shall file with the County Fire Marshal a true copy of its Articles
of Incorporation, Bylaws, and shall furnish any changes made thereto not less than
thirty (30) days prior to their effective dates. Further, the Fire Department agrees to
amend its Articles of Incorporation and Bylaws as necessary to meet all minimum
legal requirements for a North Carolina nonprofit corporation, as required by the
provisions of Chapter 55A of the General Statutes of North Carolina. Should Fire
Department be notified that it has failed to meet all minimum legal requirements for a
North Carolina nonprofit corporation and/or failed to maintain its federal, state, or
local tax-exempt status the Fire Department shall, within thirty (30) days of such
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notification, begin taking appropriate steps to remedy said failure. Should said failure
not be appropriately remedied within ninety (90) days after such notification the
County may withhold special district tax revenues until such time as the Fire
Department meets all minimum legal requirements of Chapter 55A of the General
Statutes of North Carolina and/or until such time as the Fire Department's tax-
exempt status is restored.
16. In the event the Fire Department dissolves then the Fire Department shall deliver,
release, and convey to the County all of its equipment, cash, or other assets to be
used by the County exclusively for the provision of fire protection services, rescue
services, or Medical Responder services within the District. Any such dissolution
shall comply with applicable laws of North Carolina. If Fire Department ceases to
provide either fire protection services, rescue services, or Medical Responder
services within the District Fire Department shall deliver, release, and convey to
County all of its equipment, cash, or other assets used for those specific services the
Fire Department has ceased to provide, to be used by the County exclusively for the
provision of fire protection services, rescues services, or Medical Responder
services within the District. Should the terms of this paragraph conflict with Fire
Department's Articles of Incorporation the Articles of Incorporation shall control.
17. The Fire Department agrees to hold harmless and indemnify the County from and
against any and all liability and expenses including attorney fees, court costs and
other costs incurred by the County caused by any act or omission of the Fire
Department, its agents and employees. The Department shall purchase and
maintain, during the term of this Agreement, and any extension hereof, at least the
following insurance coverage:
A. Comprehensive Automobile Liability Insurance with combined single limits
of at least one million dollars ($1,000,000) per occurrence. Coverage shall
be provided under a symbol 1". Coverage shall apply, on an excess basis
for hired, borrowed and non-owned vehicles. Coverage shall apply, on a
primary basis, for commandeered vehicles. Volunteers or employees shall
be considered insureds and volunteers and employees shall have
coverage in excess of their personal auto liability limits when they are
using their vehicles on behalf of the Fire Department. Fellow member
liability shall be provided. Auto pollution liability shall be included in the
coverage.
B. Auto physical damage shall be provided on an agreed value basis.
Coverage shall be included for hire, borrowed or commandeered vehicles
without a limit of liability. Coverage shall be provided to bring replacement
vehicle up to the most current national standards, such as NFPA or DOT.
C. Comprehensive General Liability Insurance with limits of at least one
million dollars ($1,000,000) per occurrence and two million dollars
($2,000,000) aggregate. The aggregate shall apply per named insured
and per insured location. The policy shall include the following coverage:
Volunteers or employees as insureds, Medical Malpractice, Good
Samaritan Liability Coverage, Intentional Acts Coverage for both bodily
injury and or property damage, Fellow Member Liability, Non-owned
Watercraft, Fire Damage Legal Liability with limits of one million dollars
5
($1,000,000), Pollution Liability arising out of emergency operations,
training activities or equipment wash downs.
D. Directors and Officers Liability Insurance with limits of at least one million
dollars ($1,000,000) per occurrence with two million dollars ($2,000,000)
aggregate. This policy shall include coverage for prior acts. The insureds
shall include current volunteers and employees, former volunteers and
employees, and any persons or organizations providing service to the
Department under a mutual aid or similar agreement. Coverage shall
include civil rights type suits such as discrimination and sexual
harassment; liability arising out of the administration of benefit plans for
employees or volunteers and employment related practice suites.
Coverage shall include claims made for future compensation and benefits
lost from wrongful termination of an employee.
E. Umbrella Liability Insurance with limits of at least one million dollars
($1,000,000) per occurrence and one million dollars ($1,000,000)
aggregate. The umbrella policy shall provide excess coverage over the
Auto Liability Policy, General Liability Policy, and the Employer's Liability
Section of the Workers' Compensation Policy. Volunteers and employees
shall be included as insureds.
F. The Department shall maintain Property Insurance protecting against the
risk of direct physical loss or damage. The policy covering the building
shall be written on a Guaranteed Replacement Cost Basis, with coverage
included for Building Ordinance, Flood, and Earthquake. Coverage shall
include Commandeered Property in the amount of two-hundred fifty
thousand dollars ($250,000). Contents coverage shall be provided on a
replacement cost basis. Coinsurance penalties shall not apply.
G. Portable Equipment Coverage shall be provided protecting against the risk
of direct physical loss or damage, including electrical surges. Coverage
shall be provided on a Guaranteed Replacement Cost Basis.
H. The Automobile Liability Policy, General Liability Policy, Umbrella Liability
Policy and Management Liability Policy shall name the County as an
additional insured. The Department shall furnish the County with
Certificates of Insurance showing the type of policy, limits of liability, name
of insurance companies, policy numbers, effective dates and expiration
dates of policies.
I. Workers' Compensation Insurance covering all volunteers and salaries
firefighters meeting statutory limits in compliance with applicable State and
Federal Laws.
J. Each policy shall also contain a ten (10) day notice to the County in the
event of cancellation or modification of any stipulated insurance coverage.
18. In connection with the performance of this Agreement, the Fire Department agrees
not to discriminate against any employee, member, or applicant for employment or
membership because of race, color, national origin, religion, creed, ethnicity, sex,
6
sexual orientation, age, disability, political affiliation, and Vietnam-Era or disabled
veteran status. Employees, members and applicants must be competent and
capable to perform the requirements of the job. The Fire Department agrees to take
all reasonable measures to insure that applicants are employed, and that employees
are treated appropriately, during their employment, without regard to their race, color,
national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability,
political affiliation, and Vietnam-Era or disabled veteran status.
19. This Agreement shall continue for a term of five (5) years unless terminated as
hereinafter provided. This Agreement may be renewed for two additional five-year
terms upon mutual agreement of the Parties. Either Party may terminate this
Agreement effective at the end of any fiscal year by giving the other Party notice at
least one (1) year in advance of the end of the fiscal year that the Agreement is to
terminate.
20. This Agreement sets forth the entire understanding of the parties and supersedes
any and all prior agreements, arrangements, and understandings related to the
subject matter hereto. This Agreement may not be changed or terminated except in
writing and as provided herein, and no notice shall be effective unless evidenced by
a written instrument duly executed by the Party or Parties, hereto.
21. Any notice required under this Agreement will be in writing, addressed to the
appropriate party at its address identified on the signature page of this Agreement
and delivered either in person, by email, by facsimile, by registered or certified mail,
or by commercial courier service. All notices shall be effective upon the date of
receipt.
22. Any provision or part of this Agreement held to be void or unenforceable under any
Laws or Regulations shall be deemed stricken and all remaining provisions shall
continue to be valid and binding upon the Parties. The Parties agree that the
Agreement shall be reformed to replace such stricken provision or part thereof with a
valid and enforceable provision that comes as close as possible to expressing the
intention of the stricken provision.
23. That this Agreement shall be binding upon and inure to the benefit of the parties and
their respective successors, legal representatives and assigns, but this Agreement
may not be assigned by either party without prior written consent of the other party,
which may be withheld in the sole discretion of a party.
24. No act or failure to act by the County or the Fire Department shall constitute a waiver
of any right or duty granted to the Parties by the terms of this Agreement. Nor shall
any act or failure to act constitute any approval except as specifically agreed to in
writing.
25. In order to fully comply with the terms of this Agreement Fire Department shall have
a grace period commencing on the date of signature, and for the duration as stated
below before full compliance with the certain sections is mandated.
A. Section 5; ninety (90) days.
7
B. Section 9; one hundred eighty (180) days.
C. Section 11; ninety (90) days.
D. Section 13; thirty (30) days.
26. This Agreement shall be governed by and construed in accordance with the Laws of
the State of North Carolina.
IN WITNESS WHEREOF, the County has caused this instrument to be executed by the
Chairperson of the Board of County Commissioners and attested by the Clerk to the Board of
County Commissioners, and the Fire Department has caused this instrument to be signed in its
corporate name by its President, attested by its Secretary, and its corporate seal hereto affixed,
all by order of its Board of Directors.
Acknowledged and agreed to the day and date first above recorded.
ORANGE COUNTY FIRE DEPARTMENT
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ORANG-3 OP ID:HL
A`coEZ°� CERTIFICATE OF LIABILITY INSURANCE
DATE 0310 812 0 1 3Y►
03/08!2013
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(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 Phone:919-755-1401-NAME:
VFIS of North Carolina
P.O.Box 12825 Fax:919-755-1125 PHONE x
Raleigh,NC 27605 ADDRESS:
ac No
W.Cloyce Anders
INSURER(S)AFFORDING COVERAGE NAIC p
INSURER A:American Alternative Ins.Co. 19720G
INSURED Orange Rural Fire Dept Not Inc INSURERB:
Jeff Cabe,Chief
P.O.Box 1511 INSURER C:
Hillsborough,NC 27278 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILT R TYPE OF INSURANCE POLICY NUMBER M DI IYYFYY POLICY EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY TR-2052575-06 04114/2013 04/1412014 PREMISES eoccurrence $ 1,000,00
CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000
POLICY PRO- X Lac $
AUTOMOBILE LIABILITY COMBINED SINGLE LI T
Ea accident 1,000,000
A X ANY AUTO CM-1051614-06 04/1412013 04/14/2014 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
X AUTOS X AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOS $
X NON AUTOS-0WNED PROPERTY D AGE
Per accdent
UMBRELLA LIAR )( OCCUR
EACH OCCURRENCE $ 5,000,00
A X EXCESS LIAB CLAIMS-MADE TR-2052575-06 0411412013 04/14/2014 AGGREGATE $ 10,000,000
DE-7 RETENTION$ $
WORKERS COMPENSATION WC STATU- T'-
AND EMPLOYERS'LIABILITY YIN R I R
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? D NIA E.L.EACH ACCIDENT $
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE S
Dyea,deacdbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
• Real Property TR-2052575-06 04/14/2013 04/14/2014 Building GRC
• Personal Property TR-2052575-06 04/14/2013 04/1412014 Contents Bikt RC
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required)
Commercial Blanket Bond with a $3001000 limit. Portable Equipment on
Guaranteed Replacement Cost with a 4500 deductible. Management Liability
$1,000,000 Each Wrongful Act, $3,000,000 Aggregate. Orange County is
Included as an Additional Insured per Form VGLNCl "Who Is An Insured Blanket
Additional Insureds".
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O.8181 ACCORDANCE WITH THE POLICY PROVISIONS.
Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
1988-2010 ACORD CORPORATION. All rights reserved. -
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
ORANG-3 PAGE 2
NOTEPAD
INSURED'S NAME Orange Rural Fire Dept Not Inc OP ID:HL DATE 03/08113
Prem. 1-1/Fire Station located at 834 Phelps Rd., Hillsborough, NC 27278
Building Guaranteed Replacement Cost $286,000, $1,000 deductible
Contents Blanket Replacement Cost $208,732, $1,000 deductible
Prem. 2 71/Fire Station located at 206 S. Churchton St., Hillsborough, NC
27278
Building Not Covered
Contents Blanket Replacement Cost $208,732
Prem. 2-2/Storage located at 206 S Churchton St., Hillsborough, NC 27278
Building Guaranteed Replacement Cost $38,162, $1,000 deductible
Contents Blanket Replacement Cost $208,732
Prem. 3-1/Fire Station located at 2510 Walker Rd., Hillsborough, NC 27278
Building Guaranteed Replacement Cost $286,000, $1,000 deductible
Contents Blanket Replacement Cost $208,732, $1,000 deductible
' 6_ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1/2/2014
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 NAME: J. DAVID BALLARD
BALLARD AGENCY INC NAME: (919) 732-2158 ac No):(919)732-9636
PO Box roug AooREss:ballard @ballardagencyinc.com
Hillsborough, NC 27278
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A:VOLUNTEER SAFETY WORKERS COMPENSATION FUND
INSURED ORANGE RURAL FIRE DEPARTMENT #1, INC. INSURER B:
PO BOX 1511 INSURER C:
HILLSBOROUGH, NC 27278 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE ANSD WVD POLICY NUMBER MM/DDS POLICY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR PREMISES Ea occurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
1 JECT POLICY PRO- LOC
PRO-
PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
$
Ea accident
ANYAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS ( )
HIRED AUTOS NON-OWNED PROPER D AGE $
AUTOS per accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY X STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 911-710-0 7/1/13 7/1/14 E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEI $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
HILLSBOROUGH, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
AUT IZED REPRESENTATIVE
0198&2013 ACORD CORPORATION. All rights reserved.
ACORD25(2013/04) The ACORD name and logo are r gistered marks of ACORD