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Home My WebLink About2014-252 DEAPR - JB Tree Service for FEMA storm debris removal $5,100 [Departmental Use Only] TITLE FEMA Tree/Debris work FY 2014 ORANGE COUNTY CONTRACT UNDER$15,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 22 day of May, 2014, ("Effective Date") by and between Orange County,North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the "County"), party of the first part; and JB Tree Service (the "Provider"), party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement,time being of the essence: The services and/or materials (hereinafter referred to collectively as "Services") to be furnished under this Agreement are as follows: Contractor shall remove all fallen trees and tree parts from Park areas. Where feasible, contractor will chip debris and apply chips top wooded areas. Where not feasible, contractor will be responsible for removing all debris from site. Contractor will flush all removed trees to as close to the ground as possible. Contractor,when pruning trees,will adhere to ISA Tree pruning Standards. The term of this agreement rendered shall be from June 9 to June 30,2014. 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 to the satisfaction of the County. 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. Provider agrees that Provider shall not sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement,without the prior written approval of the County. SPECIFIC TERMS 1. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed $5100, ($5100). Payment shall be made within thirty (30) days of an invoice properly submitted to County. 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. 2. Non—waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent Provider, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may Revised 9/13 1 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 http://orangecouniync.gov/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. 5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. 7. Entire Agreement: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 8. Priori 1y: In determining the basic services to be provided, should any documents be referenced in this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. 9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Should either party initiate litigation to settle any dispute involving the terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. 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. 10. Non Appropriation: 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. [SIGNATURE PAGE TO FOLLOW] Revised 9/13 2 IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement,effective as of the day first written above. ORANGE Y PROVIDER 1)� By: By: 2�� JJ f-q f ke un Manager Title: D L,!AIF—it 200 S. Cameron St. P.O. BOX 8181 Hillsborough,NC 27278 This instrumWha een approved as to technical content. Department Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. Office of the Chief Financial Officer This instru nt ha a approved as to form and legal sufficiency. Ople of the County Attorney Revised 9/13 3 q CERTIFICATE OF LIABILITY INSURANCE 122/2 M/DQAYYYI 05/22/2014 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 POilcyOes)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 ONTACT Knight Insurance PHONE FAX 919-245-1020 (A/C No);919-245-1010 110 Boone Square Street,Suite 18 EDORAI� Hillsborough,INC 27278 gs. kni htinsurance ralei hawcbc.com INSURERS AFFORDING COVERAGE NAIC INSURER A: Int@ on National Insurance Com an INSURED Bracken,Jeffrey DBA INSURER B: Northfield Insurance Company JB Tree Service INSURER C INSURER D: 741 NC HWy(8E N INSURER E: Hillsborough,NC 2728 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 I TYPE OF INSURANCE I DL S yl) POLICY NUMBER MMIDCDIYYYY MWDD/YY LIMITS LTR GENERAL LIABILITY WS103388 07126/13 07126/14 EACH OCCURRENCE $1000000 B X COMMERCIAL GENERAL LIABILITY PRE GE.TO RENTED. s-50,000 CLAIMS-MADE a OCCUR MED EXP(Anyone person) S5 000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OP AGG 52,000,000 GEM_AGGa,iE(-ATE lMf ARIES PER: S X POLICY PER,(,- LOC COMBINED SINGL uMi7 AUTOMOBILE LIABILITY 720022i32193 03/23/14 09/23/14 Ea accident 750.000 BODILY INJURY(per person) 5 A ANY AUTO ALL OWNEI SCHEDU ED BODILY INJURY(Per accident) S. AUTOS x AUTOS PROPERTY DAMAGE S. NON-01A 4ED Per acciden HIRED AUTOS H AUTOS S UMBRELLA LIAB OCC R EACH OCCURRENCE $ EXCESS LIAB CLAI S-MADE AGGREGATE S S DED RETENTION$ WCSTATU- OTH- WORKERS COMPENSATION I TORY UM11 AND EMPIAYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECU VE a E.L.EACH ACCIDENT $ _ OFFICERIMEMBER EXCLUDED? NIA. 'IE.L DISEASE-EA.EMPLOYE $ (Mandatory In NH) lfyyes,describe under E.L.DISEASE.-POLICY LIMIT $ DESCRIPTION OF OPERATIONS Gel DESCRIPTION OF OPERATIONS I LOCATIC NS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Governmen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS, Hillsborough,NC 27278 AUTHORIZED JRPF1 E TATIVE rk L fl 1-988-201 0 OR ORPO TI N. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of A ORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 06/03/2014 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 sights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Knightlnsurance "HONE 919-245-1020 Arc No:919-245-1010 110 Boone Square Street Suite 18 E-MAIL ADDRESS: knightinsurance@raleigh.twcbc.com Hillsborough,NC 27275 INSURERS AFFORDING COVERAGE NAIL# INSURER A: inte on National Insurance Company INSURED INSURER B: Northfield Insurance Company Bracken,Jeffrey DBA INSURER C: JB Tree Service INSURER D: 7410 NC Hwy 86 N INSURER E Hillsborough,NC 27278 1 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. ILTR TYPE OF INSURANCE. ADDL SUER POLICY EFF POLICY EXP POLICY NUMBER MMIDDIYY.-X) IMMIDONYM LIMITS GENERAL LIABILITY WS103388 07126113. 07/26/14 EACH OCCURRENCE $1000,000 DAMAGE B COMMERCIAL GENERAL LIABILITY .PREMISE Ea axurreneae 650 000 CLAIMS-MADE a OCCUR MEDEXP An one rson .5.5000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE s2,000,000 GEML.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPfOP AGG s2,000,000 X POLICY PRO LOG S JECX F] AUTOMOBILE LABILITY 2002232193 03123114 09123!14 ,,MINED�SINGLE LIMIT 750 000 A X ANY.AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY( } Per accident),. NON-OWNED PROPERTY DAMAGE HIRED.AUTOS- AUTOS Per accident s S UMBRELLA LIAS OCCUR EACH OCCURRENCE s EXCESS LIAB CLAIMS-MADE. AGGREGATE s DED I RETENTIONS $- WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS I I FR ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER'EXCLUDED? NIA E.L.EACH ACCIDENT 9 (Mandatory in NH) 1=.L.DISEASE-EA EMPLOYE S I1.yes,d@scnbe under DESCRIPTION OF OPERATIONS below _F I E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES(Attach ACORD 104..Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Orange County Government: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED EPR NTATIVE (0 1988-201 CO D C RA ON. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks oVX&OAD A ! T DATE(MMIDDIYYYY) t,``rr�/j � CERTIFICATE OF LIABILITY INSURANCE 06103/2014 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 CONTACT NAME: Knight Insurance PHONE e:919-245.1020 c No):919-245-1010 110 Boone Square Street,Suite 18 ADDRESS: kni htinsurance ralei h.twcbc.com Hillsborough,NC 27278 INSURERS AFFORDING COVERAGE NAIL If INSURER A: Hartford Underwriters Insurance Co INSURED INSURER B: Jeremy Michael Thompson INSURER G: 7917 Wolfe Ln,Lot i INSURER D! Snow Camp,NC 27349 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. I R TYPE OF INSURANCE ADOL POLICY NUMBER Pmmyrn'FF MWDICY EXP LT LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $. .COMMERCIAL GENERAL LIABILITY DAMAGE T RENTE�Dn CLAIMS-MADE 1-7 OCCUR MED EXP(Any one pers ) $ ! PERVWAL B.ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $'.. POLICY 7 PRO- LOC AUTOMOBILE LIABILITY CdMBINED SINGLE LIMIT aced t ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident). .S. AUTOS NON-OWNED PROPERTY ade OEl DAMAGE S HIRED AUTOS AUTOS 5 UMBRELLA 4A$. OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION WCSTATU- OTH- YIN T77 AND EMPLOYERS'LIABILITY RV LIMIT- A ANY PROPRIETORIPARTNER]EXECUTIVE. 6S60UB-8087707-A-13 12121113 12121114 E.L.EACH ACCIDENT $100,000 OFFICF EWMEMBER EXCLUDED? N i A (Mandatory in NH). E.L.DISEASE-EA EMPLOYEE $100,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 961,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE' THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED R RESF,fTATIVE C 1988-2010 -OR ORP TI . All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of OR DATE(MWDDIYYYY) AC RO CERTIFICATE OF LIABILITY INSURANCE 06/0312014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Knight Insurance PHONE 919-245-1020 u'No;919-245-1010 110 Boone Square Street,Suite 1$ EA-DMDAREss, kni htinsurance ralei h.twcbc.com Hillsborough,NC 27278 INSURERS AFFORDING COVERAGE NAIL r1 INSURER A;Travelers Property Casualty Co of America INSURED INSURER 5; Gerald Waldon Morris INSURER C: 7410 NC Hwy 86 N INSURER D: Hillsborough,NC 2727$, INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED?BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED$Y 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 .R POLICYNUMBER MMIDDIYYYY MMIDD EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGE TO ENTED $. COMMERCIAL GENERAL LIABIUTY PREMISES I amirenom CLAIMS-MADE r-1 OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. S POLICY PRO- LOG S AUTOMOBILE LIABILITY Ea accident) GLE LIMIT rJ ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS HIRED ALYTOS NON-OWNED S PROPERTY DAMAGE. $ Par accident S UMBRELLA.LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION WCSTAT I- OTH•. AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECLMVE NIA ID 25013790 12121/13 12/21/14 E.L.EACH ACCIDENT $100,000 OFFICERJMEMBER EXCLUDED? (Mandatory 1.NH) E.L.DISEASE-EA EMPLOYEE S100,000 if yyees.describe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POI ICY LIMIT 5500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES.(Attach ACORD 101,Additlonal.Remarks Schedule,it more space Is required) CERTIFICATE HOLDER CANCELLATION Orange County Government PO BOX$1$1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 2727$ ACCORDANCE WITH THE POLICY PROVISIONS. f AUTHORIZED 'PRE NTATIVE 1988- 8 CORD O P TI N. Ali rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks>o OR ACC)RDi CERTIFICATE OF LIABILITY INSURANCE DATH(MwOD/YYYY) `� 06/03/2014 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 WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME_ Knight Insurance =,' 919-245-1020 Fax No:919-245-1010 110 Boone,Square Street,Suite 18 EMAIL ADDRESS: kni htinsurance ralei h.twcbc.com Hillsborough,NC 27278 INSURERS AFFORDING COVERAGE I NAIC9 INSURER A:Travelers Pro a Casualty Co of America INSURED INSURER B: Michael Ryan Askins INSURER C: 5914 Chnstys Ln,Lot 6 INSURER D Mebane,NC 27302 .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 7 ADDL SUER' POLIGY.EFF POLICY EXP LTR'! TYPE OF INSURANCE. POLICY NUMBER. MMIDDIYYW MMIDDfYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TORE ED COMMERCIAL.GENERAL LIABILITY ISES Ea occurrence CLAIMS-MADE r OCCUR MED EXP(Any one person $ PERSONAL 6 ADV INJURY 5 GENERAL AGGREGATE.. S GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPlOP'AGG $ POLICY PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acci ent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB. OCCUR j EACH OCCURRENCE `$ EXCESS LIAB. CLAIMS-MADE AGGREGATE $. DED I I RETENTION$ $. WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETORfPARTNERIFXECUTIVE YIN ID 25013990 12/21/13 12/21/14 E.L.EACH ACCIDENT 5100,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE -5.100,000 D s,describe under. . E.L.DISEASE.-.POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS below. DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach.ACORD 101 Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County Government PO BOX 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hillsborough,NC 27278 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR REPRESENTATIVE t q) - l i 1888 40 ft ACORD C R ORA ION. All rights reserved. ACORD25(2010/05) The,ACORD name and logo are registered marks AG RD` A Ro°0 CERTIFICATE OF LIABILITY INSURANCE 06/03/2014 THIS rzo�a m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO LIGHTS 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 NAME: Knight Insurance PHONE xt:919-245-1020 FA^XrcN 919-245-1010 110 Boone Square Street,Suite 18 ADDRESS:W. kni htinsurance ralei h.twcbc.cotn Hillsborough,NC 27278 INSURERS AFFORDING COVERAGE NAICS INSURERA: Hartford Underwriters Insurance Co INSURED INSURER 8: Felipe De Jesus Flores Gutierrez INSURER C: 5914 Christys Ln,Lot 6 INSURER O; Mebane,NC 27302 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 INSR BR POLICY NUMBER MM/LDDY/YYYY1' POLICY LIMITS. LT. GENERALUABILITY EACH OCCURRENCE S COMMERCIAL.GENERAL LIABILITY- DA M PREMISES EaE wrrenee $. CLAIMS-MADE LI OCCUR MEO.EXP(Any one person).. S- PERSONAL&ADV INJURY. $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG 5 POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident) ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED. SCHEOULED BODILY INJURY(Per accident) S AlfT05 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS. -AUTOS iPer acciden S UMBRELLA:LIAS OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED ..RETENTIONS S WORKERS COMPENSATION TWOCRY STATIT ER AND EMPLOYERS'LIABILITY O.N4 A ANY PROPRIETORIPARTNERIEXECUTIVE NIA BD877081 (12121/13 12121114 E.L.EACH ACCIDENT $100,000 OFFICERNEMBER EXCLUDED? El(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 11 yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-M ICY I IMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County Government PO BOX$1$1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE RE"ESENTATNE C)1988- CORD C TION. All rights reserved. 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