HomeMy WebLinkAbout2014-182 ES - White Cross Fire Volunteer for Fire Protection Agreement $0 STATE OF NORTH CAROLINA
ORANGE COUNTY
FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT
THIS AGREEMENT (this "Agreement"), made and entered into this Td day of April , 2013 by
and between Orange County, hereinafter referred to as the "County" and White Cross Volunteer 1
Fire Department Inc., hereinafter referred to as the "Fire Department", referred to herein as
"Party" and/or collectively as the "Parties".
WITNESSETH:
1. County created the White Cross Fire Protection District (the "District") as a special
tax district pursuant to Chapter 69 of the North Carolina General Statutes and
desires to contract with Fire Department for fire protection and other services as set
out herein. I
2. Pursuant to §NCGS 69-25.4 the County agrees that it will cause to be assessed or
levied a special tax of not more than fifteen cents ($.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 7, 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 1,
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.
10. 1'F Notwithstanding Section 6 above Fire Department may provide fire protection
se rvi es outside the District subject to the following terms and conditions [This
section plicable only to departments authorized to provide fire protection services
outside th ' districts. Remove or strike where not applicable]:
A. That Fire artment is authorized to provide primary fire protection services
in the area of White Cross Fire Tax District shown in Exhibit 1.
B. Fire Department shal t expend any funds or resources appropriated for the
use of persons and indi als in the District for the primary fire
protection services outside a area of the District shown in
Exhibit 1. In the event any such enditure occurs for primary fire protection
outside the area shown in Exhibit 1 ' e Department shall immediately notify
the County and Fire Department shall to corrective measures to rectify the
expenditure and to ensure such expenditure II not be repeated.
C. That Fire Department shall enter into an agreement ' the
Department in which Fire Department shall pr i e compensation
to Fire Department for Fire Department's availability and se in providing
primary fire protection services in the area of the 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
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
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suppression equipment, no later than July 31s' 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.
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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 I
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,
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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.
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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 I
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.
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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.
A. To the extent authorized by North Carolina law and subject to Article V
Section 4 of the North Carolina Constitution, County agrees to hold
harmless and indemnify Fire Department from and against liability and
expenses, including reasonable attorneys' fees, court costs, and other
reasonable costs incurred by Fire Department, only where such liability and
expenses are directly attributable to acts or failures to act by the County in
County's performance of individual County responsibilities pursuant to the
terms of this Agreement. This indemnification provision shall not extend to 1
or create any third party beneficiaries. This indemnification provision shall
not impair County's rights under the doctrine of sovereign immunity.
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
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($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
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 1
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.
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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.
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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.
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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 1
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.
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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.
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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
A. Section 5; ninety (90) days.
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
BY: BY:
g14P esi dent
Address: �d1 Address: ( ( (zW I FIU iZZ*
Contact Person: Contact Person: QT-SAIJ &A-ky No.:�1 q— a 5�- -13 a Telephone No.: Q( � Q a- 14i�
ATTEST AT TUT:
T:
Clerk Board of Commissioners Secretary
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(C n (Corporate Seal)
iz 52
8
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Dollar Thresholds in North Carolina LJNQ
Public Contracting Statutes
Dollar limits and statutDry authority current as afsepternber 1,2013
FoFfnal bidding fetimaredcast ofcw=cO
Construction or repair contraIcts $5K000 GrIdabove G.&143-129
Purchase of apparatus,supplies,materials,and eqidpment $90.-00 G and a6m G_5.143-11_Q
Infombal bidding facrIm"Cost ahmn trz.,T)
Construction or repair contracts $30,00 tGfDmkal limit G_&143-131
Purchase of apparatus,supplies,materials,and eqLripment $30,000 t0fiamol limit G_S_143-131
Construcibort methods authorized for build Ing projects Over 5300,000 G-S.143-1211fal I
Separate Prime test=arad cw ofp4ect
Single Prime
Dual Bidding
Construction Mazmgernent at Risk�3.143428:1)
Design-Build uId I)Esign-Bidld Bridging OG.l 74342R.M-G.1 743-128.1`8}
Public Private Partnership CF3;ES.J43-r2l,?Q
Historically Undmuttlized Business{HUB)requimnents
Building construction or repair projects
-Prop=with state funding K-Aahie 10%gad requfmc) $100i000ormore G-S.143-1282(al,
-Locally funded pq*cts domrai KUH requirements) $300,000 orawre [_5.143-128.2(})
-Projects in informal bidding range 4n6xm1Kffl requiraments) $30,000 M$500,000' Ga i43-i3i(b,1
Ikfa:f;2�, WSTqWemerz shmild be asedhyin formagy b(dAvPcfs amp-q bmwe%$",WDOAd S00,17M
Urnft an use of own fortin ftice,account work) tnor ro exceed, G.3.143-135
Construction or repair projects $125,000(toralproject casOZ
Bid bond as deposk
Construction or repair contracts(atfeast5%ofbidamounfl' Formal bids i$5WMand oboywJ a5.1-13429?;b)
Purchase contacts not required'
PerformanceiPayment bonds
Construction or repair contracts f 0-36 ofcantmc,amounO Each contract over$50;1}00 of G-5.143-129X1;
project costing over S300,01DID G.5.44A-26
%rchasecontracts Kit required
General conUactors license"uIred $30,000 andabow GS.97-1
Evemption force accountwork aeeabmt,
owner-builder aff idavit required Force account work(see abovej G_S_87-14(a lfl i
Use of licensed architect or enighwer required
Munstructural work $3K040 ondabow G.S.B3-1.1(ay
Smictural repair addifionsoT new cGristructicm $135,000andabove
Repairwwkaffect:ing life safety systems S100,DDO and abave
Selection of architect,engineer,surveyor,construction manager at risk or design-build contractor
*Qnlfficatictn-Eased Selection'procedure OQRS) All contracts unless exempted G-S-143-64.31
Exemption authorized Only projects where estimated GS_143-64.32
fee is less than$S0,W0
Fr::fm A Lea9f Gifid,?to Aj,,chcsino and J&-,rtr CGr,rS,z Loc,sl QvErnmear ts.2nd i2d,by Fraycta S.Bluestein,
o 2am by the 55r_h0ol d Government,The Universi-w of North Carckra at Chapel Hill.All rights resev,--d.
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American Alternative insurance Corporation
(a stock insurance company)
;Admtnistradve:Office:555 College Road East•Princeton;N7.08543-524,1•(300)305-4954
Statu(ory Office:271 It Centerville Road,Suitt 40.0 Wilmington.DE 19805 .�F IS
Admincsternd bv:.VF1S•183 Leader Heights Road•York PA 17402
(80).233-1957!-w aa�dp ptaNNe�e.uw.erce Droop
Named Insured and Mailing Address: Policy Number:VFTS—TR-2053750-06/000. .
WHITE `CROSS VOLUNTEER FIRE Renewal:of::.:,. VFIS—.TR-2053750-05
DEPARTMENT
5722 'OLD GREENSBORO ROAD Policy Period: from 0.6=08-201
3
CHAPEL HILL 'NC 27516 - To : ';06-:0.8-2014
at 12:01 AM Standard Trme at your mailing address
shown above
Type of Entity:CORPORATION.
Business Description:.EMERGENCY ;SERVICE ORGANLZATLON
! This policy consists of.the following.coverage parts: . Premium
Property $.: :2, 264_`00
Crime $ 2 2 0.0 0
Portable Equipment $ . .: : 1, 68 3 .0 0
Auto $ NOT COVERED
General Liability $ : 643.00
Management Liabllity $ 647.00
Excess Liabik $. . 750 .00
Taxes.! Fees / Surcharges: $
Estimated Total Premium: $
6. 207.'00
The policy premium is payable on the dates and in the amounts shown below:
See installment Schedule
TR1000(11/08)`
04-17-2013
2013
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Policy Number
VFIS-TR-2053750-06/000
". ,SCHEDULE OF FORMS.AND ENDORSEMENTS
Named Insured WHITE CROSS VOLUNTEER ;EIRE Effective Date: 06=08-13
DEPARTMENT , 12.01 A.M.,Standard Time
Agency Name ..VFIS . i
COMMON :POLICY FORMS AND ENDORSEMENTS
VC0300 03-03 COMMON POLICY CONDITIONS
CG 21 70 01- 08 CAPON LOSSES :FROM CERT ACTS OF -TERR
IL .09 52 03-08 CAP:ON .LOSSES FROM CERT.,ACTS/TERRORISM
VCONCI 09-04 NC CHANGES CANCELLATION .AND NONRENEWAL
VCONC2 08-04 TIME OF.:.POLICY .:INCEPTION
PROPERTY FORMS 'AND ENDORSEMENTS
VPR101 08-03 ES0 PROPERTX COVERAGE FORM
VPRNCI 10=06. NORTH :CAROLINA .CHANGES
EXCESS POLICY ,FORMS AND ENDORSEMENTS
CX0001 09-08 COMMERCIAL EXCESS LIABILITY COVRG FORM
CX0105 09-08 NC UNDERLYING CLAIMS-MADE COVERAGE
CX0219 09-08 NC CHANGES -- CANCELLATION AND NONRENEWAL
CX2101 09-08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDO
CX2130 09-08 CAP ON LOSSES FROM CERTFD ACTS OF TERROR .
CX2401 09-08 PRODUCTS—COMPL OPS AGGREGATE LMT OF INS
CXEC112 02-10 PER LOCATION AGGREGATE LIMIT OF INSURANC
f' CXE017:2 02-10 FIREWORKS OR PYROTECHNICS EXCLUSION
\ i CXE0173: 02-10 FUNGI. OR:.:BACTERIA .:EXCLUSION
CXE0279 . 02-10 .SUBLIMITED COVERAGES ENDORSEMENT,.
CXEC286 02-10 E.R.I .S.A. EXCLUSION
" CXEG0287 02 710 EMERG SERVICE :ORG .AMENDATORY :ENDORSEMENT
CRIME FORMS AND ENDORSEMENTS
VCR105 03-04 EMPLOYEE DISHONESTY — .BLANKET
VCR300 03-03 CRIME GENERAL PROVISIONS
VCRNCI 08--04 NORTH CAROLINA CHANGES
VCR109 01-12 COMPUTER FRAUD .COVERAGE FORM
VCR110 01-12 IDENTITY ,FRAUD EXPENSE. COVERAGE 'FORM
PORTABLE EQUIPMENT FORMS AND .-ENDORSEMENTS
CP'`'.00: 90 07-88 COMMERCIAL PROPERTY :CONDITIONS
PE1001 03-00 ESO •PORTABLE.EQUIPMENT .COVERAGE .FORM .
PE1003 01-96 WATERCRAFT EXTENSION
CM 01 03 10-06 NORTH CAROLINA CHANGES
GENERAL LIABILITY FORMS AND ENDORSEMENTS
VGLNCl 02-13 ESO GL COVERAGE FORM —. NORTH CAROLINA
GGL300 01-05 MOBILE EQUIPMENT .SUBJECT ,TO MV, INS LAWS
MANAGEMENT LIABILITY FORMS AND ENDORSEMENTS
VML101 03 703 ESO — '.MANAGEMENT LIAB .- `CLAIMS MADE
VML306 11-12 CYBER LIAB & PRIVACY CRISIS MGMT EXPENSE
VMLNCI 02-13 NORTH CAROLINA CHANGES
WORKERS' COMPENSATION
CERTIFICATE OF COVERAGE
ISSUED BY OR ON BEHALF OF THE'VOLUNTEER SAFETY
WORKERS' COMPENSATION FUND.
NAME AND ADDRESS OF FUND PARTICIPANT
WHITE CROSS VOLUNTEER FIRE DEPARTMENT
ATTN: TONY BLAKE
5722 OLD GREENSBORO RD
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: 911-463-0
COVERAGE PERIOD FROM: 07/01/13 TO 07/01/14
RENEWAL PREMIUM: $ 5,355
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:
Business Insurers of the Carolinas, Inc., 213
P. O. Box 2536
Chapel Hill, NC 27515-0000
VOLUNTEER SAFETY
WORKERS'COMPENSATION FUND