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HomeMy WebLinkAbout2013-518 EMS - New Hope Fire Department for Fire Protection Agreement ems G h STATE OF NORTH CAROLINA ORANGE COUNTY FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT THIS AGREEMENT (this "Agreement"), made and entered into this / 9 day of Na 0 e fA Y1e y , 2013 by and between Orange County, hereinafter referred to as the "County" and New Hope Volunteer Fire Department of Orange County, Inc. hereinafter referred to as the "Fire Department", referred to herein as "Party" and/or collectively as the "Parties". WITNESSETH: 1. County created the Orange New Hope 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 6/9E, 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 1 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. Such Rescue Services may be provided through mutual aid agreements or through third party contracts. A. That Fire Depar-tFnent is autheFized to provide pFin;aFy fire PFGteGtwon SeWiGes t f e ctrio♦sheuin in hih't ') 9. Fore Depar-knent shall Rot expend aRY funds OF FeSGUFGes apprepFiated fGF the in�he-area e,-t#� Di E-�c,,,�;z-T use of persons and individuals in the DiStFin4 for the nrimaFy firs preteGtien veWiGes outside the aree-a of the DiStFin+ shown in au tsode the area shown in Exhibit 1 Fire Department shall immediately notify the County and Fire Department shall take nerrentive meas gyres to rentifv the G. That Fire epartm eRt shall-enter into an am e emeR t with the PF*FAaFy fiFe-pr^t the—aFea of the Dist 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 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 2 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. 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, 3 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 31St 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 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. 4 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 ($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 5 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, 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, 6 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. B. Section 9; one hundred eighty (180) days. C. Section 11; ninety (90) days. 7 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 BY: BY: GD "d President Address. Address: P� Contact Person: ]�L/U/a Contact Person: IVl ikE�A"�� C��CIS Telephone No.: G_ _ 3 U Telephone No.: /C(—�,lC/' 810 0� ATTEST: ATT Clerk Voard of Commissioners Secreta (County Seal) ® (Corporate Seal) 17 52 • SEAL '• .co t 1973 :=o �a:•Zorth tO�.O�`�JC``� y .,.•Ce:.. ti �� MaN 111j11111100 8 Attachment 1 9 Dollar Thresholds in North Carolina LINC Public Contracting Statutes Dobr Im is and statutory mWw tty clrmm as of September 1,2013 FWFAd M"" fetireedaastafaorrtocq Canstrucfen or repair axwj3 a 5500,000 arrf aLrre GS 143-129 daPP .-ppsm ,m d eww—t S90,000ardabore CS.143-129 bIosmolWOMB O=WCwrofamnaW CnnsMx6onarvepairmtraci 530,000to formaiin* &1143-131 Pudr afvparaua,suppt---'grids,arrd egripmet $30,000 mfannd trim GS_143-131 CC MS611m saaUlotbdfM•fb01111dift'H}[b1 &ws300,000 G-5L 143-128(a1) Separate P* feriimmdmsrdp.ajeW Singe Prime Dud Bidfim Cmmucvon IMmagermet at lick 1GS-143-11&0 t9 143-UMLZA;GS.143-12&1 M&Pdww Partnership 013)(GS.143-EXIO IrlisrhraOF tbl&MMhnd I(mil -a>•oots BA&M awmarmcuon or repair projects -Projects with stage f m&q Q mifwb g 10%gndm**ed) S100,000 arnme GS 143-128.1(-) -lnc*fudedpntj,0-odlAN-q*-- l S300,0000rmae GS.143-12&2(11 -Pmjem it idormah hKMmg range frdorouf NWn quigrnertO $30,000 m 5500,000' GS 143 t31(bl •MotFarrdHlMt reperem sbaril6g usedtarrr(orrr�6rdpralecis�9 berreen Sliogaasa.d fseooso tlrt o•w11!�Oaa fMOf�Q a0mral<t�h (rtocroe>e®dJ GS 143-135 Construction or mgmir projects S12S,000 Ibr+dpvpKt cmo a SSOAoode8rra COW M bmd or dopsr Cant:ueaonarmpirmrmaetsWiw s%cfbWauxW Far. bi&dWQ0000andabad "143-12KW H.du9e�rxts not ret#:ed hoods Ca sawtion or rejri►mroacu(MM ofew manmouO Each c mttaa om SSQ000 of a&"3-lmq pro. oostitg ag 5300,000 G.S.44A-26 Pudme mrmam Not mp:rd G2m=N000locfor"shlmrnota4 1 S30,000andabore G&87-1 Exemptirr Force acmra wak(seefibmAl Or mw4 uldw aFdwit required Force acamm wak 0eea6o W GS_87-14W)p) Uoo d Ium=d a dditd w mm*w r@gmW*i Nor umrcudwork S3M.Marda6ae C%-S-1334-1(a) Strwasrah repw adMons,or newmrgxcuctiorr S135,000 aodabow 9 safetr m S100,000aoda w SdKd=ofassilOocR,mgbmmK sal aM c mdmcSm m000w at risk s dm ftn4 dM embad w IQuaMkabon-BasedSdEctim'pwoWkwgM M contracts u lessaranp4gc' GS_143-6431 Fmmmnpdontmthariaed Orlyprojectswhereestimated "143-64M fee is les dm 550,000 Frert Alapf GuiMr b Ardrosiagard Corsiocnirglo►hlbrrh('aoirglaad Goraranerts,and ed.bX Ftayda i o]004 bar gw Sdwd of Gom m mile The Uriwmigr d Nadi Carom'at Arapd Hi M doe wswvmi 10 i 'a1 NEWHO-1 OP ID:AJ A�RO� DATE Y)CERTIFICATE OF LIABILITY INSURANCE 1 01/07/201 4 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 CONTACT W (.`IO ce Anders VFIS of North Carolina NAME: P.O.Box 12825 AHCNNo El::919-755-1401 A/c No):919-755-1125 Raleigh,NC 27605 E-MAIL W.Cloyce Anders ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURER A:American Alternative Ins.Co. 19720G INSURED New Hope VFD of Orange Co,Inc INSURER B: Mike Tapp,Chief PO Box 16484 INSURER C: Chapel Hill,NC 27516 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. INSR TYPE OF INSURANCE RUUL U POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DDIWW GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 • X COMMERCIAL GENERAL LIABILITY VFIS-TR-2053688 06/11/2013 06/11/2014 PREMISES(Ea Ea occurrence) $_ 1+000+00 CLAIMS-MADE 1 OCCUR MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00 POLICY PRO- X LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000,000 Ea accident $ _+ • JX ANY AU TO VFIS-CM-1052253 06/11/2013 0611112014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS 1XCOII:AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT OTC: $250 $50 $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ 2,000,00 • X EXCESS LIAB HCLAIMS-MADE VFIS-TR-2053688 06/11/2013 06111/2014 AGGREGATE $ 4,000,00 DIED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN T R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Management VFIS-TR-2053688 0611112013 0611112014 Aggregate 3,000,00 Wrongful 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Commercial Blanket Bond, $100,000 limit; Blanket Portable Equipment is on Guaranteed Replacement Cost with $100 Deductible; Orange County is included as an Additional Insured per Form VGLNCI, "Who is An Insured, Blanket Additional Insureds". See NotePad for Property Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ty ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NEWHO-1 PAGE 2 NOTEPAD INSURED'S NAME New Hope VFD of Orange Co,Inc OP ID:AJ Date 01/0712014 Prom. 1-1, Fire Station @ 4700 Hwy 86 Building: $287,061 (Guaranteed Replacement Cost) *Contents: $65,797 (Blanket, Replacement Cost) Deductible: $250 Earthquake Deductible: $17,643 Flood Deductible: $1,000 Prom. 1-2, Storage @ 4700 Hwy 86 Building: $13,160 (Guaranteed Replacement Cost) *Contents: $6,083 (Blanket, Replacement Cost) Deductible: ,$250 Earthquake Deductible: $962 Flood Deductible: $1,000 Prom. 2-1, Fire Station @ 4012 Whitefield Rd. Building: $600,476 (Guaranteed Replacement Cost) *Contents: $49,785 (Blanket, Replacement Cost) Deductible: $250 Earthquake Deductible: $32,513, Flood Deductible: $1,000 *Included in Total Blanket Contents Limit of $121,665 WORKERS' COMPENSATION CERTIFICATE OF COVERAGE ISSUED BY OR ON BEHALF OF THE VOLUNTEER SAFETY WORKERS' COMPENSATION FUND NAME AND ADDRESS OF FUND PARTICIPANT NEW HOPE VFD OF ORANGE COUNTY, INC. ATTN: MIKE TAPP PO BOX 16484 CHAPEL HILL, NC 27516-0000 This company is a qualified self-insured in the state of North Carolina for its Workers'Compensation liabilities pursuant to all statutory requirements under section 97-93 of the North Carolina Workers'Compensation Act, CLIENT NUMBER, 911-705-0 COVERAGE PERIOD FROM: 07/01/13 TO 07/01114 RENEWAL PREMIUM: $ 5,690 EMPLOYERS LIABILITY LIMITS: $100,000 Each Accident $500,000 Disease-Policy Limit $100,000 Disease-Each Employee AUTHORIZED AGENT: DATE: 08/0112013 KEY RISK MANAGEMENT SERVICES, INC. P.O. BOX 49129 GREENSBORO, NC 27419 AGENCY: Code 3 Insurance, 16089 P. O. Box 296 Pikeville, NC 27863-0000 VOLUNTEER SAFETY 04ORKER&CO,APFNSATION FUND