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HomeMy WebLinkAbout2014-161 Health - Accounting Principles Inc for Temporary Staffing Services $22,000 //ti [Departmental Use Only] TITLE Accounting Principles NORTH CAROLINA FY 2013-2014 ORANGE COUNTY SERVICES AGREEMENT UNDER$90,000.00 This Services Agreement (herinafter "Agreement"), made and entered into this first day of February, 2014, ("Effective Date") by and between Orange County, North Carolina a body politic and corporate of the State of North Carolina (hereinafter, the "County") and Accounting Principles, Inc., also doing business as Ajilon Finance, Ajilon Office, Ajilon Professional Staffing and Parker+Lynch, (hereinafter, the "Provider"). WITNESSETH: 4 `Cle�ty and Provider, for the consideration herein named, do hereby agree as follows: 1. Contract Documents: a. This Contract consists of the following documents: 0 This contract; ii) Exhibit A, Proposal for Hire iii) Exhibit B. Accounting Tech I Work Plan&Responsibilities These documents constitute the entire agreement between the Parties and supersede all prior oral or written statement or agreements. b. Precedence among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents, the terms in the Contract Document with the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in Paragraph l.a., above, with the first-listed document having the highest precedence and the last-listed document having the lowest precedence. If there are multiple Contract Amendments, the most recent amendment shall have the highest precedence and the older amendment shall have the lowest precedence. 2. Services a. Scope of Work. i) This Agreement is for services to be rendered by Provider to County with respect to (insert type ofproject): Temporary Staffing Services ii) By executing this Agreement, the 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. iii) Time is of the essence with respect to this Agreement. Revised 9/13 1 iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 3. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. Provider is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work related to the Basic Services. ii) 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. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) Provider agrees that Provider, its employees, agents and its subcontractors, if any, shall be required to comply with all federal, state and local antidiscrimination laws, regulations and policies that relate to the performance of Provider's services under this Agreement. vi) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. vii) In determining the basic services to be provided, should any documents be referenced in this Agreement, the terms of this Agreement shall have priority in Revised 9/13 2 any conflict between the terms of referenced documents and the terms of this Agreement. Should a request for proposals and a proposal be referenced the terms of the request for proposals shall have priority over the terms of any proposal. 4. Basic Services a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): Temporary Staffing Services as described Exhibit A "Proposal to Hire Services" and Exhibit B "Account Tech I Work Plan & Responsibilities" of which is attached and hereby incorporated by reference. 5. Duration of Services a. Term. The term of this Agreement shall be from February 1, 2014 to August 30, 2014. b. Scheduling of Services. i) The Provider shall schedule and perform his activities in a timely manner. ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate his efforts, including providing additional resources and working overtime, as necessary, to perform his services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be February 1, 2014. 6. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services under this Agreement except for any authorized Reimbursable Expenses which are defined herein. The maximum amount payable for Basic Services shall not exceed Twenty-Two Thousand Dollars ($22,000). Payment for Basic Services shall become due and payable within thirty (30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). b. Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. 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. c. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. Revised 9/13 3 7. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Colleen Bridger) to act as the County's representative with respect to the Project and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 8. Insurance a. General Requirements. Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, Professional Liability Insurance, and any additional insurance as may be required by Owner's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at h ://oran ecountync goy/purchasing/contracts asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. 9. Indemnity a. Indemnity. The Parties agree to defend, indemnify and hold harmless each other from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from bodily injury including death or property damage to any person or persons caused in whole or in part by the negligence or misconduct of that Party, or their employee, except to the extent same are caused by the negligence or willful misconduct of the other Party. It is the intent of this provision to require the Parties to indemnify the other to the fullest extent permitted under North Carolina law. 10. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 11. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days' prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable Revised 9/13 4 actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. ii) Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. d. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 12. Additional Provisions a. Limitation and Assi ent. The County and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. c. Compliance with Laws. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all anti-discrimination laws. Pursuant to the terms of North Carolina General Statute 153A-449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Provider's breach of this Agreement. By executing this Agreement Provider affirms Provider is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County,North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. The Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. Revised 9/13 5 e. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h. Non-Appro nation. Provider acknowledges 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 under 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. It is expressly agreed that County 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. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail,return receipt requested to the following: Orange County Provider's Name Attention: Pascal Moore II Accounting Principles, Inc. P.O. Box 8181 5400 Trinity Road, Suite 204 Hillsborough,NC 27278 Raleigh,NC 27607 [SIGNATURE PAGE TO FOLLOW] Revised 9/13 6 IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVID By: By: County a g r Printed ame and Title This instrument has been approved as to technical content. 4L, ��� Colleen Bridger, NTPH, Ph.D, D>Wment Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Controly Ac0t. Office of the Chief Financial Officer This n tru has been approved as to form and legal sufficiency. Offi e of the County Attorney Revised 9/13 7 Exhibit A Ref:Proposal to Hire Services CONTRACT TO HIRE SERVICES As used in this document,the term"Company"refers to Accounting Principals, (a) COMPANY EXCLUDES AND DISCLAIMS ALL WARRANTIES Inc., also doing business as Ajilon Finance, Ajilon Office, Ajilon Professional WHATSOEVER,INCLUDING ANY WARRANTY OF NONINFRINGEMENT, Staffing and Parker+Lynch,and the term"Client"refers to the party for which MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE. Company provides services pursuant to the terms and conditions set forth herein (b) NEITHER PARTY SHALL BE LIABLE TO THE OTHER (the"Agreement"). WHATSOEVER FOR ANY SPECIAL,CONSEQUENTIAL,EXEMPLARY OR PUNITIVE DAMAGES, INCLUDING ANY DAMAGES ON ACCOUNT OF 1. Servi ces Company shall present to Client candidates for such LOST PROFITS OR LOST OPPORTUNITY,WHETHER OR NOT PLACED ON positions as Client may from time to time request. The details of such NOTICE OF ANY SUCH ALLEGED DAMAGES AND REGARDLESS OF THE assignments may be set forth in written or electronic communications between FORM OF ACTION IN WHICH SUCH DAMAGES MAY BE SOUGHT. the parties. Company shall verify employment references, education,and, (c) COMPANY DISCLAIMS RESPONSIBILITY OR LIABILITY FOR where applicable,professional licenses. Company shall,at Client's expense, BUD OR MISREPRESENTATION BY CANDIDATES NOT READILY perform such other resume verification as criminal background, credit ASCERTAINABLE BY REASONABLE DILIGENCE IN PERFORMING checking and skills testing as may be requested in writing by Client and COMPANY'S SERVICES. acknowledged by Company. Resumes and other materials concerning candidates presented by Company shall be forwarded to contact person(s) S:— -fir ij +ndaxm and iewrtless-the�thar designated by Client. Acceptance of candidate resumes constitutes acceptance �°�-�� f ern s�inM alt l-4-_Ae man.icr n,ifa an�� a�(�h,�t:�n..ems-ol.lo of these terms,with or without a signature from the Client as requested below. ftame�s.fees}�� � � 2. Fee Payment and Invoi ins Company o will �(�uAn° oralkgalact-0cemiaeieo-ot�kn°- y employee present a rndemn ifvi vin j!a*-or anv�of ife ympkn q and cnnhartree in the 'p..ns.....of timeshm to his/her immediate supervisor for verification and signature at the end of each week. Client will be billed on a weekly basis.Company will guarantee theasgligfmtoailiegaLacier amisfdew" mi'mty oritsemp Client's satisfaction with Company's employee by offering Client an eight(8)hour guarantee. If Client is dissatisfied with Company's employee,Client will not be 6. Confidentiality, Client will treat as confidential all information charged for that time,provided that Company is notified within eight(8)hours. received about a candidate, including the identity of a candidate, and will not Company will immediately replace its employee. If Client hires a candidate disclose such information without the prior consent of Company. presented by Company,upon evaluation of the employee's performance,Client shall pay to Company a standard conversion fee,as follows: 7, Client Obileadons Client will direct the performance of all services performed by Company's employees during the tenure of their assignment.Client • 0-173 hours worked -20'A of annual salary warrants that it will not entrust Company employees with cash,checks,negotiable,, • 174-346 hours worked -17%of annual salary stocks, bonds, instruments or any other valuables without the prior written • 347-520 boors worked -14%of annual salary permission of Company. Client shall not leave or entrust Company employees with • 521-693 hours worked -I I%of annual salary unattended premises and will not pay Company employees directly or advance any • 694-866 hours worked -8%of annual salary funds to then. Client shall not request or allow a Company employee to render any • 867-1040 hours worked -5%of annual salary opinion,sign or certify any paper,statement or return,pertaining to underwriting, • 1040 plus hours worked -No conversion fee tax,SEC or other related matters. Accordingly,Client waives(on behalf of itself and its insurance companies to the extent any such losses may be covered by insurance)any right of recovery against Company for any losses,costs,expenses or damages insured by Client arising out of the work product or services provided or Iaveiees era due even-roeapt -iedefauit-ehaty�{3p}ekys not provided, including any claims of negligence or malpractice,arising from fem bmanes of Gamp hich-time-a-defnilt charge will✓be services by Company's employees assigned to Client and,further,will indemnify, (1 1004) ' 4alffAm4santial, defend and hold Company harmless from any claims arising out of the foregoing p large raM of ry'gbJeen pencenf(1 R%) nr the— ....mil j ;880� rules. ...hirl.e...r �a3t �sa€araewnts .pasL due including-mss maple annneyal fee- and costs. Client Shall remain a iturriraL The parties' obligations under these Conditions of responsible for the payment of all applicable federal or state sales or use taxes,or Assignment,which by their nature continue beyond termination,cancellation or related levies,attributable to the services rendered hereunder. Client agrees not to expiration of these Conditions of Assignment, shall survive termination, solicit,hiraoraseq*sat ieea or werk,directly or indirectly,from any candidate cancellation or expiration of these Conditions of Assignment. whose resume was received hereunder for one(1)year after receipt of the resume without paying the fee stated in this paragraph. 9. thM out of by binding 3. Relationship of Parties. The parties agree that the relationship - between them is that of independent contractor and that neither party shall have any 2#dbiftaf4en Amociation in effect as-of-the-datc authority to represent or bind the other and that neither party shall hold itself out or initiated--A-sin&wbitrator w ff make a-de --nation mad m award within have any authority as an agent of the other for any purpose whatsoever. Nothing "f�}�lSbftl elesrof enee-in wick arbitration proceeding but w ill heroin shall be construed as creating a principal and agent,joint venture,or any havencanthatil9 toward casts other type of relationship besides independent contractor between Client and ' and -award Company. wig be final and bhWing mid ffid 1 Is ,will be entered thercon in any—m . jmiseliation-- ' gam--Y-fapy--Y 9-k Company and Client shall each remain solely responsible for the payment of all iaamediets ad brvaetiento I.Mventftfty-"K�lw use of disciestme of the wages and benefits for each of their own respective employees,and neither party eptieloy-infeematien-ef-tlne (at dim to uhmn it e shall be responsible for the withholding or payment of any payroll deductions or active- taxes, or the provision of workers' compensation or unemployment insurance coverage,for or on behalf of employees of the other party or for any payment or -q%b - w"'l-esents the entire agreement expense in respect of claims arising under the other party's employee benefit plats The hire and decisions regarding the pay and employment of any candidate written nr near hehvenn 9w pAi-flee MeSpa.� subject presented by Company are entirely within the sole discretion of Client who shall -baerled in-e remain specifically responsible for any applicable federal, state or local pmid21m and cz „leer bylmth parti—This Agreemrat withholding or income taxes, paying Social Security taxes, and providing and-a e-binding ud unemployment compensation and workers'compensation insurance or coverage i—FOSSAIMIkISS,5119900SON"Micas,snbjeeEte�ho-lbeitedeno eeatsiieed 6aeia. and any other employee benefits for candidates selected or hired by it lie t brillegal w3d-shaH-bv.- 4. No Warranties:Limits of liaWiitv. —nbjeet 40-refota atixw belt wepeess&a eviginal intent of the parties. Client understands and agrees that these terms and conditions shall gover h pro ' io f ices by Company to Client. Orange County Government ACC O G ,INC. By By: Title: Title' f� Date: Date: ZZ Rev.07.26.11 , be' CERTIFICATE OF LIABILITY INSURANCE DATE/2014 /YYYY) 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 Marsh USA,Inc. NAME: 1166 Avenue of the Americas PHONE FAX A/C No New York,NY 10036 E-MAIL Attn:Adecco.certs @Marsh.com Fax:212-948.0018 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 370044-ALL-GAUWC-14-15 INSURER A:AXA Insurance Company 33022 INSURED INSURER B:National Union Fire Insurance CD Of Pittsburgh 19445 ACCOUNTING PRINCIPALS /PARKER&LYNCH/AJILON INSURER C Insurance Company Of The State Of PA 19429 5400 Trinity Rd.,Suite 204 N/A N/A Raleigh,NC 27607 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-006797321-01 REVISION NUMBER:1 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY PCS002071(14) 01/01/2014 0,/0112015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMA T RENTED 2,000,000 PREMISES Ea occurrence $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ NA PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY X PRO- X LOC 1 1 $ B AUTOMOBILE LIABILITY CA 7062785(AOS) 01/01/2014 01/0112015 COMa aBcciINdent S ED INGLE LIMIT 2,000,000 E B X ANY AUTO CA 7062787(MA) 01/01/2014 01/01/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC043408999(ACS) 01/0112014 01/0112015 X WC STATU-' OTH- AND EMPLOYERS LIABILITY C Y/N WC043409002(AK,AZ,GA,VA) 01/01/2014 01/01/2015 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ O OFFICER/MEMBER(Mandatory NH)EXCLUDED? N/A WC043409007 MA,ND,WA,WI,WY 01/0112014 01/01/2015 2,000,000 (Mandatory in NH) ( ) E.L.DISEASE-EA EMPLOYE $ C DESCRIPTION OF OPERATIONS below WC043409003(CA) 01101/2014 01/01/2015 E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Orange County Health Care Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 South Cameron St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC#: New York A`COREP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA,Inc. ACCOUNTING PRINCIPALS /PARKER&LYNCH/AJILON POLICY NUMBER 5400 Trinity Rd.,Suite 204 Raleigh,NC 27607 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: INSURER:INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC043409004(FL) EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 INSURER:INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC043409000(IL,KY,NC,NH,UT,VT) EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 INSURER:INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC043409005(ME) EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 INSURER:INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC043409001(NJ,PA) EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 INSURER:INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC043409006(MN) EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 EXCESS WORKERS COMP-OHIO ONLY: INSURER:NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER:WC6636254 EFFECTIVE DATE:1/1/2014 EXPIRATION DATE:1/1/2015 LIMITS: SIR:$3,000,000 EL EACH ACCIDENT:$1,000,000 EL DISEASE:$1,000,000 EL DISEASE-EACH EMPLOYEE:$1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD