HomeMy WebLinkAbout2014-556 Finance - Orange County Literacy Council - Outside Agency Performance Agreement $12,000 2014-15 OUTSIDE AGENCY PERFORMANCE AGREEMENT
THIS AGREEMENT,made and entered into the first day of July 2014,("Effective Date")by and between
the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street,
Hillsborough, North Carolina, 27278, ("County") and Orange County Literacy Council, a not-for-profit
corporation,located at 200 N Greensboro Street, Suite C-2,Carrboro,NC 27510("Provider").
WITNESSETH:
WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby
enhance its availability to residents of the County, and said program addresses an important community
human services need,as identified by the Board of Commissioners;
NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set
forth,the County and Orange County Literacy Council agree as follows:
1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,
2014 to June 30,2015.
2. Scope of Services.
a. Provider will provide services, as outlined in the attached Outside Agency Funding
Application Scope of Services and any amendments or revision thereto which is attached as
Exhibit"A"and incorporated by reference,to the residents of Orange County. The Scope
of Services may be different from the original application based on County appropriation;
however, any revisions or amendments to this Agreement must be approved in writing by
the County and attached to this Agreement.
b. The Provider shall be solely responsible for the means, methods, techniques, sequence,
safety program and procedures necessary to properly and fully complete the work set forth
in the Scope of Services.
3. Funding.
a. The County agrees to appropriate for the provision of services described in Exhibit A,
Scope of Services and more particularly described in the Program Budget, the maximum
sum of$12,000.
b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not
used for the purposes stated shall be returned to the County. Any changes in the use of
funds must be authorized in writing by the County prior to any expenditure of the funds by
the Provider. If the funds are expended not in accordance with the Scope of Services,at the
discretion of the County the Provider may be required to repay the funds to the County.
c. The Provider shall be paid in four equal installments in the amount of$3,000. The first
payment is contingent upon receipt of the agency's performance agreement; the remaining
payments are contingent upon receipt of the request for reimbursement and related
supporting documentation.
(Orange County Literacy Council)
Orange County Outside Agency Performance Agreement Page 1 of 7
d. The County's obligation to make the three quarterly payments is contingent upon receipt of
Progress Reports, which show satisfactory progress toward completion of performance
measures and an accounting of expenditures as detailed in the attached Scope of Services.
e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21
days after receipt of the Progress Report and Request for Reimbursement or 21 days after
due date of Progress Report whichever is later.
f. The County is not obligated to provide any other support to Provider in this or in
succeeding fiscal years.
4. Agency Reporting.
a. Provider will provide Orange County a Progress Report that includes a fiscal report and
updates on 2014-15 performance measures as outlined in the Scope of Services. Progress
Report dates are: July 1 — December 31; January I — March 31 and April 1 - June
30. Reports are due on January 9,April 15,and July 10 of the program fiscal year.
b. Provider agrees to allow the County to inspect its financial books and records, which
document costs of those services,upon reasonable notice during normal working hours.
5. Termination.
a. In the event of any of the circumstances set forth below (hereinafter referred to as
"default"), the County may immediately terminate this Agreement, in whole or in part, and
from time to time. Notice of termination must be in writing, state the reason or reasons for
the termination,and specify the effective date of the termination:
i. In the event that Provider shall cease to exist as an organization or shall enter
bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all
of its assets, or significantly reduce its services or accessibility to Orange County
residents during the term of this Agreement; or
ii. In the event that Provider shall fail to render a satisfactory accounting as provided
section 4 above, the County may terminate this Agreement and Provider shall
return all payments already made to it by the County for services which have not
been provided or for which no satisfactory accounting has been rendered; or
iii. In the event of any fraudulent representation by the Provider in an invoice or other
verification required to obtain payment under this Agreement or other dishonesty
on a material matter relating to the performance of services under this Agreement.
iv. Nonperformance,incomplete service or performance,or failure to satisfactorily
perform any part of the work identified in the Scope of Services or to comply with
any provision of this Agreement,as determined by the County in its sole discretion.
v. Failure to adhere to the terms of applicable county, state or federal laws,
regulations,or stated public policy.
b. In the event of default by the Provider,the county may elect to terminate this Agreement,in
whole or in part and/or require the Provider to repay the funds within ten(10)business days
from written notice of default. The County may (but shall not be required to) grant the
Orange County Outside Agency Performance Agreement Page 2 of 7
Provider an opportunity to cure the default without termination of this Agreement. This
clause shall not be interpreted to limit the County's remedies in law or in equity.
c. Notwithstanding the foregoing, either party may terminate the agreement at any time
without penalty; provided that written notice of such termination is furnished to the other
party at least 30 days prior to termination. In the event of such termination, any payment
due shall be prorated to the date of termination and any unused funds shall be returned to
the County within 10 days of termination.
d. Any termination of this Agreement for default under this section that is later deemed to be
unjustified shall be deemed a termination for convenience.
6. Insurance.
a. General Requirements. The Provider shall purchase and maintain,during the period of
performance of this Agreement,insurance:
i. Worker's Compensation. For protection from claims under workers'or workmen's
compensation acts;
ii. Comprehensive General Liability Insurance covering claims arising out of or
relating to bodily injury,including bodily injury, sickness,disease or death of any
of the Consultant's employees or any other person and to real and personal property
including loss of use resulting thereof;
iii. Comprehensive Automobile Liability Insurance, including hired and non-owned
vehicles,if any,covering personal injury or death,and property damage; and
b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows:
INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE
• Worker's Compensation Limits for Coverage A-Statutory State
NC&Coverage B -Employers Liability
$100,000 each accident, $500,000 disease policy limit
and$100,000 disease each employee
• Commercial General $1,000,000 Each Occurrence
Liability $2,000,000 Aggregate
• Automobile Liability $500,000 Combined Single Limit
c. All insurance policies(with the exception of Worker's Compensation and Professional
Liability)required under this Agreement shall name the County as an additional insured
party and as a certificate holder. Evidence of such insurance and all correspondence shall
be sent to:
Orange County Risk Manager
Post Office Box 8181
Hillsborough,NC 27278
d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity
defenses.
Orange County Outside Agency Performance Agreement Page 3 of 7
7. Relationship of the Parties. Provider is an independent contractor of the County. Provider
represents that they have or will secure, at his own expense, all personnel required in performing
the services under this Agreement. Such personnel shall not be employees or have any
contractual relationship with the County. All personnel engaged in work under this Agreement
shall be fully qualified and shall be authorized and permitted under federal, state and local law to
perform such services.
8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws,
ordinances, orders and regulations of the federal, state or local governments, as well as their
respective departments, commissions, boards, and officers, which are in effect at the time of
execution of this Agreement or are adopted at any time following execution of this agreement.
9. Subcontract. The County and Provider deem the services provided under this Agreement to be
personal in nature and Provider may not subcontract any rights or duties under this Agreement to
any other party without prior written consent from the County.
10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to
any other party without the prior written consent of the County.
11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all
loss, liability, claims or expense(including reasonable attorney's fees) arising from bodily injury,
including death or property damage, to any person or persons caused in whole or in part by the
negligence or willful misconduct of the Provider, except to the extent same are caused by the
negligence or willful misconduct of the County. It is the intent of this section to require Provider
to indemnify the County to the extent permitted under North Carolina law. Nothing in this
section is intended to affect or abrogate the County's sovereign immunity defenses.
12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the
specified services and may be terminated at any time if such funds become unavailable.
13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange
County the parties hereto for themselves,their agents,officials, employees and servants agree not
to discriminate in any manner of these basis of race,color,gender,national origin, age,handicap,
religion, sexual orientation, familial status or veterans status with reference to any activities
carried out by the grantee, no matter how remote. The parties hereto further agree in all respects
to conform to the provision and intent of Orange County Civil Rights Ordinance, as
amended. This provision is enforced by action for specific performance, injunctive relief, or
other remedy as by law provided; this provision shall be binding on the grantees, the successors
and assigns of the parties hereto with reference to the above subject manner.
14. Living Wage. Orange County is committed to providing its employees with a living wage and
encourages agencies if funds to pursue the same goal. The County's living wage is $12.76 per
hour. To the extent possible, Orange County recommends that Orange County Literacy Council
provide a living wage to its employees.
15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the
last known address shall constitute sufficient notice to the County and the Provider. All notices
required and/or made pursuant to this Agreement to be given to the County and the Provides shall
be in writing and mailed to the party addressed as follows:
County: Finance&Administrative Services Provider: Orange County Literacy Council
Orange County 200 N Greensboro Street, Suite C-
Post Office Box 8181 2
Orange County Outside Agency Pei formance Agreement Page 4 of 7
Hillsborough,NC 27278 Carrboro,NC 27510
16. Entire Agreement. This Agreement,including any referenced attachments,constitutes the entire
Agreement between the parties and shall supersede, replace or nullify any and all prior
Agreements of understandings; written or oral, relating to the matters set forth herein, and any
such prior Agreements or understandings shall have no force or affect whatsoever on this
Agreement. The County and Provider have read this Agreement and agree to be bound by all of
its terms, and further agree that this Agreement constitutes the complete and exclusive statement
of the Agreement between the County and Provider.
17. Severability. All clauses found herein shall act independently of each other. If a clause is found
to be illegal or unenforceable,it shall have no effect on the other provisions of this Agreement. It
is understood by the parties hereto that if any part, term or provision of this Agreement is by the
Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United
States, the validity of the remaining portions or provisions shall not be affected, and the rights
and obligations of the parties shall be construed and enforced as if the Agreement did not contain
the particular part,term or provision held to be invalid.
18. Governing Law. The laws of the State of North Carolina shall govern all aspects of this
Agreement. In the event that it is necessary for either party to initiate legal action regarding this
Agreement, venue shall lie in Orange County, North Carolina. The parties hereby waive their
right to trial by jury in any action,proceeding or claim, arising out of this Agreement,which may
be brought by either of the parties.
[SIGNATURES ON FOLLOWING PAGE]
:MOB )
Orange County Outside Agencv Performance Agreement Page 5 of 7
IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement,effective on
the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures
below.
For and on behalf of the Provider
gnaturee r Date
rented Name
For and o bel f of Or nge County Government
Bonnie Hammersley,County&ager ate
Approv form and legal sufficiency
ct Ia
Office r f the County Attorney Dale
Approved as to technical content
This instrument has been pre-audited in the manner required by the Local Government Budget and
Fisc l Control Act
Clarence Grier,Assistant County Manager/ Date
Chief Financial Officer
Orange County Outside Agency Performance Agreement Page 6 of 7
ATTACHMENT "A"
Orange County Certifications—FY 2014-15
Outside Agency Performance Agreement
Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer
I certify that I have provided a list of the chief contact,administrators,chief executive officer and chief
financial officer for my agency with this Agreement and that I will keep it current to the County of Orange.
The list should be in writing with the name,title,residential address;phone and email address and if
possible,fax number.
Officers and Board of Directors
I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and
that we will continue to update the list as changes occur. The list should be in writing,with the name,
physical address,mailing address and if possible,phone, fax and email address.
Budget Submission
I certify that I have provided a budget for the period to be covered by funding Orange County,and that any
substantive changes made to this budget have been in advance authorized in writing by Orange County.
Annual Financial Review
I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget
adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a
separate sheet of paper.
Alignment with Organization's Mission
I certify that the programs and services for which this funding is requested align with the mission of the
organization.
Intended Purpose
I certify that the funds provided to the agency under the terms of this Agreement will be used for a public
purpose and shall only be used for the purposes intended and any money not used for those purposes will be
promptly returned to Orange County.
Certified b itle: �T--n "r,//" ate:
(Provider's ignature)
Orange County Outside Agency Performance Agreement Page 7 of 7
EXHIBIT"A"
Scope of Services—FY 2014- 15
Outside Agency Performance Agreement
Agency Name: Orange County Literacy Council
Program Name: Adult Literacy
Funding Award: $12,000
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Rent $12,000
Program Services
For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the
contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes
below,by June 30,2015.
• Adult Literacy Program - on-going individualized and small group instruction to adult learners
who want to improve their reading, writing, basic math, basic computer, English language and
GED preparation skills.
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange
County. only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants
within that measure's description or for an earlier performance measure.
Performance Measures Anticipated
Results
Enrollment in Adult Literacy Program 575
Number of enrolled students who become fulltime(12 hours or more) 345
Fulltime students who reach required minimum number of instructional hours are post- 248
tested on federally recognized, standardized test
Students who are post-tested will make measurable progress on a federally recognized 150
standardized test
Certified by Title: 4 _� l�G���`'' �� Date:
Provider's Signature)
Chubb Group of Insurance Companies ForeFront PortfolicP
15 Mountain View Road For Not-for-Profit Organizations
Warren, New Jersey 07059 General Terms and Conditions Section
CHUBS
DECLARATIONS FEDERAL. INSURANCE COMPANY
A stock insurance company, incorporated
under the laws of Indiana, herein called the Company
Capital Center, 251 North Illinois, Suite 1100
Indianapolis, IN 46204-1927
Policy Number: 8173-0102
THE DIRECTORS AND OFFICERS LIABILITY AND ENTITY LIABILITY, FIDUCIARY LIABILITY AND
EMPLOYMENT PRACTICES LIABILITY COVERAGE SECTIONS(WHICHEVER ARE PURCHASED) PROVIDE
CLAIMS MADE COVERAGE, WHICH APPLIES ONLY TO "CLAIMS" FIRST MADE DURING THE "POLICY
PERIOD", OR DURING AN APPLICABLE EXTENDED REPORTING PERIOD, THE LIMIT OF LIABILITY TO
PAY DAMAGES OR SETTLEMENTS WILL BE REDUCED AND MAY BE EXHAUSTED UNLESS OTHERWISE
PROVIDED HEREIN, BY "DEFENSE COSTS," AND "DEFENSE COSTS" WILL BE APPLIED AGAINST THE
RETENTION. IN NO EVENT WILL THE COMPANY BE LIABLE FOR "DEFENSE COSTS" OR THE AMOUNT
OF ANY JUDGMENT OR SETTLEMENT IN EXCESS OF THE APPLICABLE LIMIT OF LIABILITY. READ THE
ENTIRE POLICY CAREFULLY.
Item 1. Organization: ORANGE COUNTY LITERACY COUNCIL
Principal Address: 200 N Greensboro St.
Suite C-2
Carrboro, NC 27510
Item 2. Policy Period: (A) From: 12:01 A.M. on August 17, 2013
(B) To: 12:01 A.M. on August 17, 2016
Local time at the address shown in Item 1.
Item 3. A Combined Maximum Aggregate Limit of Liability is applicable:
❑
X Yes ❑ No The Combined Maximum Aggregate Limit of Liability for all Claims under
all Liability Coverage Sections each Policy Year shall be: $1,000,000.00
Item 4. Coverage is available for the following only:
❑ Yes ❑ No Directors& Officers Liability and Entity Liability Coverage Section
❑
X Yes ❑ No Employment Practices Liability Coverage Section
Yes ❑ No Fiduciary Liability Coverage Section
❑ Yes Q No Crime Non-Liability Coverage Section
❑ Yes ❑X No Kidnap/Ransom and Extortion Non-Liability Coverage Section
14-02-10190 (Ed. 11/2004) Page 1 of 12
ForeFront Portfolios"'
For Not-for-Profit Organizations
General Terms and Conditions Section
Item 5. Extended Reporting Period:
(A) Additional Period: (8) Additional Premium:
1 year 75%of Annual Premium
Item 6. Termination of prior policies: 8173-0102 (Aug 17, 2010 - Aug 17, 2013)
In witness whereof, the Company issuing this Policy has caused this Policy to be signed by its authorized
officers, but it shall not be valid unless also signed by a duly authorized representative of the Company.
FEDERAL INSURANCE COMPANY
Secretary President
07/25!2013
Date Authorized Representative
14-02-10190 (Ed. 11/2004) Panw 9 of 1 7
PAGE 1
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to- rs WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY 16144
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014
AGENCY HIGH & RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
ITEM 1 CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
COMPANY FROM 12:01 A.M. 06-17-2014
ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015
CARRBORO NC 27510-1849 AT THE INSURED'S
MAILING ADDRESS
INSURED IS - CORPORATION
OTHER WORK PLACES NOT SHOWN ABOVE:
TEM 3 A. WORKERS' COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO WORKERS'
COMPENSATION LAW OF THE STATES LISTED HERE: NC
B. EMPLOYERS LIABILITY INSURANCE: PART TWO OF THE POLICY APPLIES TO WORK IN EACH STATE
LISTED IN ITEM 3. THE LIMITS OF OUR LIABILITY UNDER PART TWO ARE:
BODILY INJURY BY ACCIDENT $100,000 EACH ACCIDENT
BODILY INJURY BY DISEASE $100,000 EACH EMPLOYEE
BODILY INJURY BY DISEASE $500,000 POLICY LIMIT
C. OTHER STATES INSURANCE: PART THREE OF THE POLICY APPLIES TO THE STATES, IF ANY,
LISTED HERE: AL, AR, AZ, CO, FL, GA, IA, ID, IL, IN, KS, KY, MI, MN, MO, NC, NE,
PA, SC, SD, TN, UT, VA & WI UNLESS ALREADY LISTED IN ITEM 3A.
TEM 4 THE PREMIUM FOR THIS POLICY WILL BE DETERMINED BY OUR MANUALS RULES, CLASSIFICATIONS,
RATES AND RATING PLANS. ALL INFORMATION REQUIRED BELOW IS SUBJECT TO VERIFICATION
AND CHANGE BY AUDIT.
CLASSIFICATIONS OF OPERATIONS PREMIUM BASIS RATES
ESTIMATED RATE ESTIMATED
CLASS TOTAL ANNUAL PER ANNUAL
CODE REMUNERATION $100 PREMIUM
STATE OF NORTH CAROLINA
ED# 0010 (SEE FED NUM 001) DESC 001
CLERICAL OFFICE EMPLOYEES NOC 8810 151,938 .30 456
TOTAL 456
1% MULTI-POLICY DISCOUNT 5- 451
EXPENSE CONSTANT 250 701
TERRORISM-SEE FORM 27317 15 716
CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) 15 731
SEE FORM 27322
TOTAL ESTIMATED ANNUAL PREMIUM 731
ISSUED 5-12-2014
27777 (10-88)(WC000001A) AGENCY COPY 1414
PAGE 2
auto-Owners WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY 16144
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014
AGENCY HIGH 8 RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
ITEM 1
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
COMPANY FROM 12:01 A.M. 06-17-2014
ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015
CARRBORO NC 27510-1849 AT THE INSURED'S
MAILING ADDRESS
EDERAL ID - 561433933
C EMPLOYER CODE - 08138060
OUNTY 068
1% CUMULATIVE MULTI-POLICY DISCOUNT APPLIES. SUPPORTING POLICIES ARE MARKED WITH AN (X) :
OMM UMB( ) COMM PROP/COMM LIAB(X) COMM AUTO( ) LIFE( ) PERSONAL( ) FARM( ) .
HE PAID IN FULL DISCOUNT DOES NOT APPLY TO FIXED EXPENSE FEES, STATUTORY CHARGES OR
INIMUM PREMIUMS.
HE PAID IN FULL DISCOUNT IS BASED ON FAVORABLE LOSS EXPERIENCE FOR THE COLLECTIVE GROUP
F POLICYHOLDERS WHO CHOOSE TO PAY THEIR PREMIUM IN FULL DIRECTLY TO THE COMPANY.
OUR POLICY QUALIFIES FOR THE PAID IN FULL DISCOUNT IF YOU CHOOSE TO PAY YOUR PREMIUM IN
ULL. YOUR PAID IN FULL DISCOUNT MAY CHANGE AS A RESULT OF POLICY CHANGES. THESE CHANGES
ILL BE REFLECTED IN A FUTURE INVJICE.
TOTAL ESTIMATED ANNUAL PREMIUM 731
PAID IN FULL DISCOUNT 34-
TOTAL POLICY PREMIUM IF PAID IN FULL 697
INIMUM PREMIUM $310 NORTH CAROLINA
UDIT IS - ANNUAL
NDORSEMENTS:
27011 CWC000308 ) 2703 (WCOOOOOOB) 27043 (WC320301C) 27279 (WC000419 ) 27317 (WC000422A)
27322 (WC000421C) 27417 27942 (WC000414 )
YOU MAY VIEW YOUR POLICY ONLINE AT WWW.AUTO-OWNERS.COM .
TO ENROLL, USE THE POLICY NUMBER 35022549 AND PERSONAL
ID CODE 78A 2N8 G3T.
BILLING TYPE: COMPANY BILL - FULL PAY ACCOUNT 009652074
ISSUED 5-12-2014
731 100
27177 (10-88)(WC000OO1A) AGENCY COPY 1415
at`Dd tt PAGE 1
-'V//��tU� ers WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY ATTACHED TO AND FORMING PART OF
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-201e
AGENCY HIGH & RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
ITEM 1
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
COMPANY FROM 12:01 A.M. 06-17-2014
ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015
CARRBORO NC 27510-1849 AT THE INSURED'S
MAILING ADDRESS
FED NUM 001 STATE NC
FED ID 561433933
ENTITY CORPORATION
NUMBER OF EMPLOYEES 1
ORANGE COUNTY LITERACY COUNCIL INC
200 N GREENSBORO ST STE C2
CARRBORO NC 27510-1833
ISSUED 5-12-2014
2762 (4-84) 1413
�J /� PAGE 2
t uto-VWners WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY 16144
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014
AGENCY HIGH & RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
ITEM 1 CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
COMPANY FROM 12:01 A.M. 06-17-2014
ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015
CARRBORO NC 27510-1849 AT THE INSURED'S
MAILING ADDRESS
FEDERAL ID - 561433933
NC EMPLOYER CODE - 08138060
COUNTY 068
A 1% CUMULATIVE MULTI-POLICY DISCOUNT APPLIES. SUPPORTING POLICIES ARE MARKED WITH AN (X);
COMM UMB( ) COMM PROP/COMM LIAB(X) COMM AUTO( ) LIFE( ) PERSONAL( ) FARM( ).
THE PAID IN FULL DISCOUNT DOES NOT APPLY TO FIXED EXPENSE FEES, STATUTORY CHARGES OR
MINIMUM PREMIUMS.
THE PAID IN FULL DISCOUNT IS BASED ON FAVORABLE LOSS EXPERIENCE FOR THE COLLECTIVE GROUP
OF POLICYHOLDERS WHO CHOOSE TO PAY THEIR PREMIUM IN FULL DIRECTLY TO THE COMPANY.
YOUR POLICY QUALIFIES FOR THE PAID IN FULL DISCOUNT IF YOU CHOOSE TO PAY YOUR PREMIUM IN
FULL. YOUR PAID IN FULL DISCOUNT MAY CHANGE AS A RESULT OF POLICY CHANGES. THESE CHANGES
WILL BE REFLECTED IN A FUTURE INVOICE.
TOTAL ESTIMATED ANNUAL PREMIUM 731
PAID IN FULL DISCOUNT 34-
TOTAL POLICY PREMIUM IF PAID IN FULL 697
MINIMUM PREMIUM $310 NORTH CAROLINA
AUDIT IS - ANNUAL
ENDORSEMENTS:
27011 (WC000308 ) 2703 (WC000000B) 27043 (WC320301C) 27279 (WC000419 ) 27317 (WC000422A)
27322 (WC000421C) 27417 27942 (WC000414 )
YOU MAY VIEW YOUR POLICY ONLINE AT WWW.AUTO-OWNERS.COM .
TO ENROLL, USE THE POLICY NUMBER 35022549 AND PERSONAL
ID CODE 78A 2N8 G3T.
BILLING TYPE: COMPANY BILL - FULL PAY ACCOUNT 009652074
ISSUED 5-12-2014
731 100
27377 (10-88)(WC000001A) AGENCY COPY 1415
/� PAGE 1
t4ut0-Owners WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY 16144
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014
AGENCY HIGH & RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
ITEM 1 CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
COMPANY FROM 12:01 A.M. 06-17-2014
ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015
CARRBORO NC 27510-1849 AT THE INSURED'S
MAILING ADDRESS
INSURED IS - CORPORATION
OTHER WORK PLACES NOT SHOWN ABOVE:
ITEM 3 A. WORKERS' COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO WORKERS'
COMPENSATION LAW OF THE STATES LISTED HERE: NC
B. EMPLOYERS LIABILITY INSURANCE: PART TWO OF THE POLICY APPLIES TO WORK IN EACH STATE
LISTED IN ITEM 3. THE LIMITS OF OUR LIABILITY UNDER PART TWO ARE:
BODILY INJURY BY ACCIDENT $100,000 EACH ACCIDENT
BODILY INJURY BY DISEASE $100,000 EACH EMPLOYEE
BODILY INJURY BY DISEASE $500,000 POLICY LIMIT
C. OTHER STATES INSURANCE: PART THREE OF THE POLICY APPLIES TO THE STATES, IF ANY,
LISTED HERE: AL, AR, A2, CO, FL, GA, IA, ID, IL, IN, KS, KY, MI, MN, MO, NC, NE,
PA, SC, SO, TN, UT, VA & WI UNLESS ALREADY LISTED IN ITEM 3A.
ITEM 4 THE PREMIUM FOR THIS POLICY WILL BE DETERMINED BY OUR MANUALS RULES, CLASSIFICATIONS,
RATES AND RATING PLANS. ALL INFORMATION REQUIRED BELOW IS SUBJECT TO VERIFICATION
AND CHANGE BY AUDIT.
CLASSIFICATIONS OF OPERATIONS PREMIUM BASIS RATES
ESTIMATED RATE ESTIMATED
CLASS TOTAL ANNUAL PER ANNUAL
CODE REMUNERATION $100 PREMIUM
STATE OF NORTH CAROLINA
ID# 0010 (SEE FED NUM 001) DESC 001
CLERICAL OFFICE EMPLOYEES NOC 8810 151,938 .30 456
TOTAL 456
1% MULTI-POLICY DISCOUNT 5- 451
EXPENSE CONSTANT 250 701
TERRORISM-SEE FORM 27317 15 716
CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) 15 731
SEE FORM 27322
TOTAL ESTIMATED ANNUAL PREMIUM 731
ISSUED 5-12-2014
27777 (10-88)(WCOOOOO1A) AGENCY COPY 1414
PAGE 1
to.O rs WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
INSURANCE COMPANY ATTACHED TO AND FORMING PART OF
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014
AGENCY HIGH & RUBISH INSURANCE AGENCY
15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER
ITEM 1 CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549
INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD
ADDRESS 200 N GREENSBORO ST STE C2 COMPANY FROM 12:01 A.M. 06-17-2014
CARRBORO NC 27510-1849 BILL TO 12:01 A.M. 06-17-2015
AT THE INSURED'S
MAILING ADDRESS
FED NUM 001 STATE NC
FED ID 561433933
ENTITY CORPORATION
NUMBER OF EMPLOYEES 1
ORANGE COUNTY LITERACY COUNCIL INC
200 N GREENSBORO ST STE C2
CARRBORO NC 27510-1833
ISSUED 5-12-2014
2762 (4-84) 1413
tAuto,.Owners Page 1 54643 (01-90)
Issued 10-02-2013
(MUTUAL) INSURANCE COMPANY BUSINESSOMNERS POLICY DECLARATIONS
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
AGENCY HIGH & RUBISH INSURANCE AGENCY Renewal Effective 11-20-2013
15-0936-00 MKT TERR 050 (919) 913-1144 POLICY NUMBER 91-159-372-01
INSURED ORANGE COUNTY LITERACY COUNCIL INC Company Use 35-57-NC-9311
Company POLICY TERM
ADDRESS 200 N GREENSBORO ST STE C2 Bill 12:01 a.m. 12:01 a.m.
CARRBORO NC 27510-1833 to
11-20-2013 11-20-2014
In consideration of payment of the premium shorn below, this policy is renewed. Please attach this
Declarations and attachments to your policy. If you have any questions, please consult with Your agent.
ENTITY: Corporation
PROPERTY COVERAGES - ALL DESCRIBED LOCATIONS DED LIMITS PREMIUM
Special Coverage Form
TERRORISM - CERTIFIED ACTS $.61
BUSINESS LIABILITY PROTECTION LIMITS PREMIUM
COVERAGES
Aggregate Limit $2,000,000 Included
(Other than Products-Completed Operations)
Products-Completed Operations Aggregate 11000,000 Included
Liability and Medical Expense 11000,000 Included
Medical Expense - Per Person 51000 Included
Personal Injury Included Included
Tenants Fire Legal - Any One Fire 50,000 Included
Hired Auto & Non-Owned Auto Liability 11000,000 831.78
TERRORISM - CERTIFIED ACTS .64
FORMS THAT APPLY TO ALL LOCATIONS: 54510 (08-09) BP0002 (01-87) BP0006 (01-87)
54961 (11-11) BP0009 (01-87) 54679 (06-92) 54709 (04-10) 54098 (05-07)
54319 (07-06) 54867 (03-08) 54656 (08-91) 54088 (09-09) 54663 (01-03)
Page 2 54643 (01-90)
AUTO-OWNERS (MUTUAL) INS. CO. Issued 10-02-2013
AGENCY HIGH & RUBISH INSURANCE AGENCY Company POLICY NUMBER 91-159-372-01
15-0936-00 MKT TERR 050 Bill Company Use 35-57-NC-9311
INSURED ORANGE COUNTY LITERACY COUNCIL INC Term 11-20-2013 to 11-20-2014
LOCATION 001
LOCATION: 200 N GREENSBORO ST STE C2 CARRBORO NC 27510-1833
COVERAGES DED LIMITS PREMIUM
Addl Insured - Managers or Lessors of Premises Included 822.07
Addl Insured - Controlling Interest Included 22.07
TERRORISM
CERTIFIED ACTS SEE FORM(S) 59350, 54309, 59390 3.28
ADDITIONAL FORMS FOR THIS LOCATION: BP0007 (01-90) BP0116 (03-87) IL0162 (04-90)
IL0269 (10-94) 54094 (03-07) 54238 (12-01) 54244 (05-07) 54309 (07-08)
54605 (11-88) 54661 (08-91) 59350 (01-08)
LOC 001 BLDG 0001
COVERAGES DED LIMITS PREMIUM
Business Personal Property - REPL. COST 8500 827,640 8115.23
Adjusted Value Factor 0.0170
Business Income And Extra Expense 12 Months Included
Limitation of Coverage for Fungi, Mold, See Form Included
Dry Rot, Wet Rot and Bacteria
Equipment Breakdown 500 See Form 4.38
ADDITIONAL FORMS FOR THIS BUILDING: 54841 (10-09) 54701 (08-94) 54703 (08-94)
BP1203 (06-89)
SECURED INTERESTED PARTIES: See Attached Schedule
t uto—Ownirs Page 3 54643 (01-90)
Issued 10-02-2013
(MUTUAL) INSURANCE COMPANY BUSINESSOWNERS POLICY DECLARATIONS
6101 ANACAPRI BLVD. , LANSING, MI 48917-3999
AGENCY HIGH 8 RUBISH INSURANCE AGENCY Renewal Effective 11-20-2013
15-0936-00 MKT TERR 050 (919) 913-1144 POLICY NUMBER 91-159-372-01
INSURED ORANGE COUNTY LITERACY COUNCIL INC Company Use 35-57-NC-9311
Company POLICY TERM
ADDRESS 200 N GREENSBORO ST STE C2 Bill 12:01 a.m. 12:01 a.m.
CARRBORO NC 27510-1833 to
11-20-2013 11-20-2014
In consideration of payment of the premium shorn below, this policy is renewed. Please attach this
Declarations and attachments to Your policy. If you have any questions, please consult with your agent.
RATING INFORMATION
Occupancy: Office Not Otherwise Classified Tenant Occupied
Class Code: 65121 Const: Non-Combustible, Sprinklered
Program: Office Protection Class: 03
Liability Rate Number: 00 Territory: 010 Orange County
Burglary Rate Group: 00 Inside City Limits
Construction Year: 1965
TERM
TOTAL ANNUAL PREMIUM 5200.06
MINIMUM PREMIUM EQUIPMENT BREAKDOWN ADJUSTMENT $30.62
MINIMUM PREMIUM ADJUSTMENT $173.85
TOTAL POLICY PREMIUM $404.53
PAID IN FULL DISCOUNT -9.75
TOTAL POLICY PREMIUM IF PAID IN FULL $394.78
The Paid In Full Discount does not apply to fixed fees or statutory charges.
The Paid In Full Discount is based on favorable loss experience for the collective group
of policyholders who choose to pay their premiums in full directly to the company.
Paid In Full Discount is available.
Discount Applies for Affiliation with: CHAPEL HILL - CARRBORO CHAMBER OF COMMER
A 4X Cumulative Multi-Policy Discount applies. Supporting policies are marked with
an (X): Comm Umb( ) Comm Auto( ) WC(X) Life( ) Personal( ) Farm( ).
Merit Rating Discount of 5% Applies
Page 4 54643 (01-90)
AUTO-OWNERS (MUTUAL) INS. CO. Issued 10-02-2013
AGENCY HIGH 8 RUBISH INSURANCE AGENCY Company POLICY NUMBER 91-159-372-01
15-0936-00 MKT TERR 050 Bill Company Use 35-57-NC-9311
INSURED ORANGE COUNTY LITERACY COUNCIL INC Term 11-20-2013 to 11-20-2014
SECURED INTERESTED PARTIES AND/OR ADDITIONAL INTERESTED PARTIES
Loc 001 Bldg 0001
OCE FINANCIAL SERVICES Loan: 200-5028065-000
5600 BROKEN SOUND BLVD NW
BOCA RATON FL 33487-3515
Interest: Loss Payable LEASED COPIER
Form: BP1203 PARAGRAPH A
SIP-ID: FL147731
Agency Code 15-0936-00 Policy Number 91-159-372-01
54701 (8-94)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CONTROLLING INTEREST
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Name of Person or Organization:
ORANGE COUNTY ATTN RISK MANAGER
PO BOX 8181
HILLSBOROUGH, NC 27278
The following is added to Paragraph C. WHO IS AN INSURED in the Businessowners Liability Coverage Form:
4. The person or organization shown in the Schedule or in the Declarations, but only for their liability arising out
Of.
a. Their financial control of you; or
b. Premises they own, maintain or control while you lease or occupy those premises.
This insurance does not apply to structural alterations, new construction and demolition operations performed
by or for that person or organization.
The limit of liability for the additional insured are those specified in the written contract or agreement between the
Insured and the Person or Organization named above, not to exceed the limits provided in this policy. These limits
are inclusive of and not in addition to the limits of insurance shown in the Declarations.
*Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara-
tions.
Includes copyrighted material of Insurance Services Office, Inc.,with its permission
Copyright, Insurance Services Office, Inc.,1985
Agency Code 15-0936-00 Policy Number 91-159-372-01
54703(8-94)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR LESSORS
OF PREMISES
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Designation of Premises(Part Leased to You):
200 N GREENSBORO ST STE C2
Name of Person or Organization (Additional Insured):
CARR MILL MALL LIMITED PARTNERSHIP
PO BOX 673
CARRBORO, NC 27510
Additional Premium:
A. The following is added to Paragraph C. WHO IS AN INSURED in the Businessowners Liability Coverage Form:
4. The person or organization shown in the Schedule is also an insured, but only with respect to liability aris-
ing out of the ownership, maintenance or use of that part of the premises leased to you and shown in the
Schedule.
B. The following exclusions are added:
This insurance does not apply to:
1. Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Sched-
ule.
2. Structural alterations, new construction or demolition operations performed by or for the person or organi-
zation designated in the Schedule.
The limits of insurance for the additional insured are those specified in the written contract or agreement between
the insured and the person or organization named above, not to exceed the limits provided in this policy. These
limits are inclusive of and not in addition to the limits of insurance shown in the Declarations.
Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara-
tions.
Includes copyrighted material of Insurance Services Office, Inc.,with its permission
Copyright,Insurance Services Office, Inc., 1984, 1985