HomeMy WebLinkAbout2015-128-E AMS - Tile Restoration, Inc. for flooring restoration at 302 W. Tryon St., Central Rec & Parks Center (per proposal) $6,125 DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
[Departmental Use Only]
TITLE Central Rec Flooring
FY 2015
ORANGE COUNTY
CONTRACTUNDER S15,000.001
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 2nd day offebruary, 22015, ("Effective Date")by
and between Orange County, North Carolina, a body politic and corporate organized under the law's of the
State of North Carolina, (the "County"), party of the first part-, and Tile Restoration, fire (tile "'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
COLulty in accordance with the terms of this Agreement, time being of the essence:
Tile services and/or materials (hereinafter referred to collectively as "Services") to be furnished
under this Agreement are as follows: removal of contamination from the and grout surface, prep to grout
lines for restoration, and apply non-porous Resin to grout to the following floors-, Lobby women's, nien's,and
unisex restroonis, Men's Shower room with Janitor Closet, Women's Shower room, and Lobby entry air lock
tile floor, per included proposal dated October 16, 2014
The term of this agreement rendered shall be frorn Febrallry 2, 2015 to I`ebruary 28, 20115.
Provider represents au d agrees that Provider is qualified to perform and fully capable of performing and
providing the services required or necessary Linder this Ag•ectincrit 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 Agreernent, nor shall Provider assign any right or
responsibility granted or required by this Agreement,without the prior written approval of the County.
SPECIFIC TEEMS
1. Payinen - The County agrees to pay at the rates specified for Set-vices satisfactorily
performed in accord with this Agreement. The amount to be paid by the County shall not exceed six
thousand one hundred twenty five dollars, ($6,125). Payment shall be made within thirty (30) days of an
invoice properly submitted to County. Should Provider fail to pet-form its duties Linder the terms of this
Agreement, County tilay, without fault or perralty, 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 field to be a waiver of any succeeding breach or a waiver of'
this Non-Waiver Clause.
3. Independent Contractor: "I'he Provider shall operate as an independent contractor and the
County shall not be responsible fbr any ofthe Providers acts or onlissions, The Provider shall riot be treated
as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or
workers' corripensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of
any, kind shall be withheld or paid by the County oil belialf'ofthe Provider oi-the employees of the Provider.
Reviwd 10114 1
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
4� Insurance: Provider shall obtain,, at its sole expense, Commercial General Liability
Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may
be required by Owner',s Risk Manager as such insurance rccl it irem c tits are described in the Orange County
Risk Transfer Policy and Orange County Minnnurn Insurance Coverage Requirements (each document is
incorporated herein by reference and may be viewed at W I
i1qgov/ hasino/contract�
I _..= - '' s Y
._!�... ................=.�
If Owner's Risk Manager determines additi onal insurance coverage is required Such additional insurance
shall consist of n/a (if no additional insurance required mark N/A as being not applicable). Provider shall not
continence work until such insurance is in effect and certification thereof has been received by the Owner's
Risk Manager.
51. Indemnity: 'rh,e Provider agrees to defend, indernnify, and ]told harmless Orange County
from all losses, liabilities, claims, deniands, 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 tile Provider.
6. Terrnination: This Agreement may be terminated at any time by mutual written agreernent of'
the pat-ties or by the COWItY upon written notice to the Provider.
7. "En'I i'r"e A"gr ingtit j!,]L(t `3 The parties have read this Agreement arid agree to be
bound by all of its terms, and further agree that it constitutes the complete arid exclusive statement of the
Agreement between the parties unless and until modified in writing and signed by the parties. This
Agreement together with any amendments or modifications may be executed electronically, All electronic
signatures affixed hereto evidence the intent of tile Parties to comply with Article I IA and Article 40 of'
North Carolina General Statute Chapter 66.
8. Priority: In determining the basic services to be provided, Should arty documents be
referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between tile
terms of'referenced documents and the terms of this Agreement.
9. Governing LaYK:---Both parties agree that this Agreement shall be governed by tile 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 ill
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 riot limited to all anti-discrimination laws.
-1 0... Dispute Resolution: Any and all suits or actions to enforce, interpret, or seek damages with
respect to any provision of, or tile performance or non-performance of, this Agreement shall be brought in
the General Court Of Justice of'North Carolina sitting in Orange County, North Carolina. It is agreed by the
parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding
arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of
any dispute prior to the bringing of'such suit or action.
11. Mon A))�ropriation: Provider acknowledges that County is a govorrintental 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 riot 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,
ISIGNATURE PAGE TO FOLLOW]
Revised 10/14 2
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
IN WITNESS WHEREOF,County and the Provider have signed this Agreement,effective as of
the day first written above.
ORANGE COUNTY PROVIDER
— ig ed by: DocuSigned by:
�156V"tait, h*Kt'n mad. 0-kqA-
kk(w
By: '- By: FGOGAASB@
Counvmanager
200
S.Cameron St. Tile Restoration Inc
P.O.Box 8181 119 East Main Street
Hillsborough,NC 27278 Hookerton,NC 28538
Revised 10/14
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
TR14
00 YburF
Ion Wan
SaniGUIL on nrewurce
119 East Main Street ON106TV
Hookerton, NC 28538
Phone: 866-327-4600
Freddly Brooks Phone: 919-245-2636 Date: 10/16/2014
Orange County Public Works Fax: 919-644-3043 Rep.., Brad Albritton
600 Highway 816 North Email: tbrooks@olrangecountync.gov Cell 252-916-2045
Hillsborough, NC 27278 Fax: 252-74748931
Process Description of Area -Central Recreation Center
Price
1 Sani(1AZEC*out(iI.AZE Lobb y Men's R stroorn $qmoo
_ c
I Sani(31AZE("1rmt(1AZF Lobby Womens Restroom $900.00
1 SrmiGLAZEGrontG[AZF1' Lobby UnisexRestroom $500.00
1 SaniGLAZECirout(LAZE Men's Shower.Room mrith Janitor Closet $1,400.00
1 i Sani(IAZE GroutGLAZE Women's ShowerRoom $1,250.00
1-kaniGLAZEGrcrutG-AZE lobby lEnlry Air Lock Tile Flo or $1,175,00
San KrIAZE Grout(R-AZE
Removal of ccintamination froinlile and grout surface
Prep to grout lines for restoration
Application of Nort Porous Resin to gruut:qqigr TEID
Terms:Not 20 Da YS TOTAL $6,125,00
�Please Remit All Cororacts PO's and Paynients'fo:
'File Restoration Inc, 119 Fast Main St PO Box 160 Ifookerton NC 2R538,
Proposal Valid for 30 Days Delivery to Job,Sales Tax and Installation are included.
Ali services guaranteed as specified, All work to be complete in a workmanlike manner according to standard practices. Any alteration or deviation
from this proposal Involving extra costs will be executed only upon written orders,and will become an extra charge over and above the proposal All
agreements confingent upon strikes,accidents or delays beyond our control,Owner to carry fire,tornado and other necessary Insurance.
Our workers are fully covered by workman's Compensation Insurance. Evidence of Insurance will be provided upon request.Any special
requirements or endorsements may Incur additional charges.
We do not waive any rights of subrogation again%l contractor or owner for any loss covered by Insurance of any type,
All Tile Restoration,services require a minimum of 72 of cure time before they can be exposed to moisture.If Ns timeline is not adhered to the
customer takes full responsibility for any damage or performance Issues that may result.
SaNGLAZE Restoration Service is warranted against material defects and workmanship and extends indefinitely as long as the EverGLAZE
Program as prescribed is incorporated In the ongoing maintenance.Glazing Compound colors on color chart represent actual Glazing
Compound material.Once applied,colors may vary depending on ariginai grout color,porosity and other factors,**Tile Restoration will take
a4precaulron to protect adjoining flooring,walls,materials etcetera from exposure to water andVor chemicals.Any damage that may occur
from contact from water and/or chemical is riot the responsibility of Tile Restoration Inc,and it staff. Any changes of additional work required
or requested by the owner,will be done at an additional charge and must be written,I hereby give Tile Restoration Inc,authorization to do the
work specified and payment will be made as outlined above.
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F81947OB6
,,.,. ► DATE(MWDDNYYl
�CERTIFICATIE OF LIABILITY INSURAN'ICE F10/30/201Y4
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(les) must be endorsed. If SIUBROGATION 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 Molder in lieu of such endorsement(s).
PRODUCER CONTACT Beverly Pike, A.AawI
Jake A Parrott Insurance Agency Inc PriOwaE . (252)5231041 PA� N� czs2)S 3-C1145
2508 N HERRI TAGE STREET e«q l .bpi ke @parret,tins.com
PO BOX 3547 _ MSURER(S)AFFORDING COVERAGE NAIL#
KINSTON NC 28502 INSURER EMPLOYERS MUTUAL CASUALTY CO 21415
INSURED INSURER B.FIASCO INSURANCE COMPANY 21407
TILE, RESTORATION INC INSURER
C,/O ALBRITTON CO INSURER D: _I......
PO BOX 160 INSURER.E:
HOOKERTON NC 28588-09160 INSURER F:
COVERAGES CERTIFICATE NUMBER°-.CL14102908345 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 PERTACN,, 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.
........
IN'SR ........ ......... ............ATyDE.'UiBR...._... ......... ........... POLICY EFF ��POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER. MWDQ1YYYN MMIDDPYYYY
GENERAL.IUABIUTY EACH OCCUR'RE.NrE: 5 1,000,000
DA
A COMMERCIAL GENERAL
5D2054E MEEntwFlu
a uo=rrencpp S 500,000
Tf7/2014 11/7/2e1B yon Y 10 QOp pr�
d..........
Ptrf;;2NAI.YLADV INJURY F 1,000,000
GENERA At�ORFGATE t 2,000,000
{ENLAG GREGArE LIMIT APPLIESP''i:R�. PRGDUJ'•CT,:+...COMPa�JF�AGG 5.. 2,000,000
— POLICY X U}U 0- _.. LOC � _._..._ �. ._...
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
1 CLO
A X
.. ANY AUTO BODIL Y IN UR:Y CPe perscn) $
AUTO,ALL C ED SCHEDULED 5E20546 11/7/2014 11/7/2015 BODILYNJURY(PeracadenG) S
IiiTPEPTY DAMAGE .........AUTOS
NON14)MJE:
HIRED AUTOS AU-TbS, Pe accEtientl.L___ $
_..
Medical pavirnents $ 2,000
X UMBRELLA LIAB OCCUR BAC H OCCURRENCE $ 2,000,000
EXCESS LIAR CLAWS—MADE AGGREGATE S 2,000',000
LOet) RETENItON S J20546 11./7/2014 11/7/2015 s..
B WORKERS COMPENSA71ON ?C I VV C STATU} OT H-
AND EMPLOYERS'LIABILITY YIN 'Y"L .V1'`r' .....
ANY PROS RIETORIPARTt,9ERiF.�,NG:CUTIVIE E L.EACH Af,C ICU@ NT S TL�R��7�1 000
OI'PICERNEMREP E:xy",La.,uti.;c� Y II NIA H2O,.546 i.id4/2D1,4 llf4/201 _.. ..._ _ ......,_
)Mandatory In NN) E L..DISEASE-FA EMPLOYEE.00 6X000,
D blROnP7(wrdJwJFmCPERAPIeaIV Iaatw __ E.L.LISrA d°i eluu:'GLIMaT 4 1.p_ d9Q.r0049
DESCRIPTION OF OPERATION'S I LOCATIONS I VEHIICLES (Attach ACO'RD 141,Additional Remarks Schedule,PP more space is recpudred)
CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY, ON A PRIMARY
BASIS INCLUDING PRODUCTS & COMPLETED OPERATIONS, VIA. A WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT
INCLUDED. CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL IN'SURE'D AS PERTAINS TO AUTO! LIABILITY, VIA A
WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. WAIVER OF SUBROGATION IN FAVOR OF ADDITIONAL
INSURED APPLIES TO GENERAL AND AUTO LIABILITY AND WORKER'S COMPENSATION, VIA A WRITTEN CONTRACT IN PLACE
WITH THIS REQUIREMENT INCLUDED.
EXCLUDED OFFICERS IN WORKER'S COMPENSATION COVERAGE; DAVID ALBRITTON F CHARLES ALBRITTON III.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION (DATE THEREOF, NOTICE WILL BE DELIVERED IN
ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 8181
HILLSBOROUGH, NC 27278 AUT44ORIZEDREPRESENTAnVE
Allen Parrott✓LEANN'E
ACO�RD 25(2010105) Od 1988-20110 ACOORD CORPORATION. All rights reserved.
INSO25 rwrrurwi,� ni 'ITha.&r".r11f11 e"r mo mnrd tnnn nrua ranietrarnri rmm2rirc of Arr1Rr1
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT OR
AGREEMENT INCLUDING COMPLETED OPERATIONS - PRIMARY AND
NONCONTRIBUTORY
This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
A. Section 11 — Who Is An Inusuiredl is amended to surveys, field orders, change orders or drawings
include as an additional insured: and specifications; or
1. Any person or organization for whom you are b. Supervisory, inspection, architectural or
performing operations when you and such engineering activities.
person or organization have agreed in writing in This exclusion applies even if the claims against
a contract or agreement that such person or any insured allege negligence or other wrongdoing
organization be added as an additional insured in the supervision, hiring, employment, training or
on your policy' and monitoring of others by the insured, if the
2. Any other person or organization you are '.occurrence" which caused the "bodily injury" or
required to add as an additional insured under "property damage", or the offense which caused the
the contract or agreement described in "personal and advertising injury", involved the
Paragraph 1. above, rendering of, or the failure to render, any
Such person(s) or organization(s) is an additional professional architectural, engineering or surveying
insured only with respect to liability for "bodily services.
injury", "property damage" or "personal and C. With respect to the insurance afforded to these
advertising injury" caused, in whole or in part, by: additional insureds, the following is added to
a. Your acts or omissions; or Section III—Limits Of Insurance:
b,. The acts or omissions of those acting on The most we will' on behalf of the additional
your behalf; insured is the amount of insurance:
in the performance of: 1. Required by the contract or agreement
a. your ongoing operations for the additional described in Paragraph A.11.; or
insured- or 2. Available under the applicable Limits of
Insurance shown 41 the Declarations;
b. "Your work" for the additional insured and
included in the "products — completed whichever is less.
operations hazard". This endorsement shall not increase the applicable
However, the insurance afforded to such additional Lit-nits of Insurance shown in the Declarations.
insured described above: D. The following is added to the Other Insurance,
a. Only applies to the extent permitted by law„ Condition and supersedes any provision to the
and contrary-,
b. Will not be broader than that which you are Primary and Noncontributory Insurance
required by the contract or agreement to This, insurance is primary to and will not seek
provide for such additional insured, contribution from any other iinsurance available to
B. With respect to the insurance afforded to these an additional insured under your policy provided
additional insureds, the following additional that'.
exclusion applies: (1) The additional insured is a (Named Insured
This insurance does not apply to "bodily injury,' under such other insurance; and
"property damage" and! "personal and advertising (2) You have agreed in writing in a contract or
injury" arising out of the rendering of, or the failure agreement that this insurance would be primary
to render, any professional architectural, and would not seek contribution from any other
engineering or surveying services including: insurance available to the additional insured.
a. The preparing, approving, or fading to prepare E. All other terms and conditions of this policy remain
or approve maps, shop drawings, opinions, reports, unchanged.
CG7174 3,(10-13) Includes copyrighted material of ISO Properties,Inc,with its permission. Page 1 of 1
DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTO ELITE AMENDMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
The BUSINESS, AUTO COVERAGE FORM is amended to include the following clarifications and extensions of
coverage. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
A. TEMPORARY SUBSTITUTE AUTO PHYSICAL (1) Coverage under this provision is afforded
DAMAGE only up to 180 days after you acquire or
SECTION I - COVERED AUTOS paragraph C. form the organization, or to the end of the
Certain Trailers, Mobile Equipment, and policy period, whichever is earlier,
Temporary Substitute Autos is amended by (2) Any organization you acquire or form will
adding the following: not be considered an "insured" if,
If PHYSICAL DAMAGE COVERAGE is provided (a) The organization is a partnership or a
by this coverage form for an "auto" you own, the joint venture; or
Physical Damage Coverages provided for that (b) That organization is covered under
owned "auto"are extended to any"auto"you do not other similar insurance,
own while used with the permission of its owner as
a temporary substitute for the covered "auto" you (3) Coverage under this provision does not
own that is out of service because of breakdown, apply to any claim for "bodily injury" or
repair, servicing, "loss"or destruction, property damage" resulting from an
The coverage provided is the same as the accident" that occurred before you formed
coverage provided for the vehicle being replaced. or acquired the organization,
B. BLANKET ADDITIONAL INSURED E. SUBSIDIARIES AS INSUREDS
SECTION 11 - LIABILITY COVERAGE, A.1. Who
SECTION 11 - LIABILITY COVERAGE, A.I. Who Is An Insured is amended by adding the following:
Is An Insured: is amended by adding the following: Any legally incorporated subsidiary in which you
Any person or organization who is a party to a own more than 50% of the voting stock on the
written agreement or contract with you in which you effective date of this policy, However, "insured"
agree to provide the type of insurance afforded does not include any subsidiary that is an "insured"
under this Business Auto Coverage Form. under any other automobile liability policy or was an
This provision applies to claims for "bodily injury' or "insured" under such a policy but for termination of
`property damage" which occur after the execution that policy or the exhaustion of the policy's limits of
of any written agreement or contract. l�iability.
C. EMPLOYEES AS INSUREDS F. COVERAGE EXTENSIONS - SUPPLEMENTARY
The following is added to the Section 11 - PAYMENTS
LIABILITY COVERAGE, Paragraph A.1. Who Is SECTION 11 - LIABILITY COVERAGE, A.2.a.
Ain Insured Provision', Coverage Extensions, Supplementary Payments
Any"employee" of yours is an "insured"while using (2) and (4) are replaced by the following:
a covered "auto" you don't own:, hire or borrow in (2) Up to $5,000 for the cost of bail bonds
Your business or your personal affairs. (including bonds for related traffic law
11 NEWLY FORMED OR ACQUIRED violations) required because of an "accident"
ORGANIZATIONS we cover. We do not have to furnish, these
bonds.
SECTION 11 - LIABILITY COVERAGE, A.I. Who (4) All reasonable expenses incurred by the
Is An Insured is amended by adding the following: "insured" at our request, including actuali loss of
Any organization which you acquire or form after earnings up to $500 a day because of time off
the effective date of this policy in which you from work.
maintain ownership or majority interest. However:
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DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
G. FELLOW EMPLOYEE COVERAGE K. AUDIO, VISUAL, AND DATA ELECTRONIC
In those jurisdictions where, by law, fellow EQUIPMENT COVERAGE
employees are not entitled to the protection In addition to the Each Accident Limit of Insurance
afforded to the employer by workers compensation and subject to the provisions, of Paragraph C.2. of
exclusivity rule, or similar protection. The following Section III Physical Damage of the coverage
provision is added-, form, we will pay up to $5,000 for "loss" in any one
Subparagraph 5. of paragraph B. Exclusions in .accident" to all electronic equipment that
SECTION 11 LIABILITY COVERAGE does not reproduces, receives, or transmits audio, visual or
apply if the "bodily injury" results from the use of a data signals,
covered"auto"you own or hire. L. HIRED AUTO PHYSICAL DAMAGE
H. PHYSICAL DAMAGE—TOWING SECTION III — PHYSICAL DAMAGE COVERAGE,
SECTION III — PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions is amended by adding
A.2. Towing is replaced with the following: the following;
We will pay for towing and labor costs incurred, If hired "autos" are covered "autos" for Liability
subject to the following" Coverage, and if Comprehensive, Specified
Causes of Loss, or Collision coverage is provided'
a. Up to $100 each time a covered "auto" of the for any "auto' you own, then the Physical Damage,
private passenger type is disabled; or coverages, provided are extended to "autos" you
lb. Up to $500 each time a covered "auto" other hire, subject to the following limit and deductible,-
than the private passenger type is disabled. (1) The most we will pay for loss to any hired
However, the labor must be performed at the place "auto" is the lesser of Actual Cash Value or
of disablement. Cost of Repair, minus the deductible.
I. LOCKSMITH SERVICES (2) The deductible will be equal to the largest
SECTION III — PHYSICAL DAMAGE COVERAGE, deductible applicable to any owned "auto" for
A.4. Coverage Extensions is amended by adding that coverage. No deductible applies to "loss"
the following: caused by fire or Iliightning.
We will pay up to $250 per occurrence for (3) Subject to the above limit and deductible
necessary locksmith services for keys locked inside provisions, we will provide coverage equal to
a covered private passenger "auto". The the broadest coverage applicable to any
deductible is waived for these services. covered "auto"you own.
J. PHYSICAL DAMAGE — TRANSPORTATION We will pay up to $1,000, in addition to the limit
EXPENSES above, for loss of use of a hired auto to a
leasing or rental concern for a monetary loss
SECTION III— PHYSICAL DAMAGE COVERAGE, sustained, provided it results from an "accident"
A.4. Coverage Extensions subparagraph a. for which you are legally liable.
Transportation Expenses is replaced' the M. AUTO LOAN OR LEASE COVERAGE
following:
(1) We will pay up to $75 per day to a maximum of SECTION III — PHYSICAL DAMAGE COVERAGE
$2,500 for temporary transportation expense paragraph A.4. Coverage Extensions is amended
incurred by you because of the total theft of a by the addition of the following:
covered "auto" of the private passenger type. In the event of a total "loss" to a covered "auto"
We will pay only for those covered "autos" for which is covered under this policy for
which: you carry either Comprehensive or Comprehensive, Specified Cause of Loss, or
Specified Cause Of Loss Coverage. We will Collision coverage, we will pay any unpaid amount
pay for temporary transportation expenses due, including up to a maximum, of $500 for early
incurred during the period beginning 48 hours termination fees or penalties, on the lease or loan
after the theft and ending, regardless of the for a covered "'auto", less:
policy's expirations, when the covered "auto" is 1. The amount paid under the PHYSICAL
returned to use or we pay for its "loss", DAMAGE COVERAGE SECTION of the policy;
(2) If the temporary, transportation expenses you and
incur arise from your rental of an "auto" of the 2. Any:
private passenger type, the most we will pay is
the amount it costs to rent an "auto" of the a. Overdue lease/loan payments at the time
private passenger type which is of the same of the"loss";
like kind and quality as the stolen covered b. Financial penalties imposed under a lease
,.auto." for excessive use, abnormal wear and tear
or high mileage,
c. Security deposits not returned by the
lessor;
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DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6
cl. Costs for extended warranties, Credit Life 3• We will pay only for those expenses incurred
Insurance, Health, Accident or Disability during the policy period beginning 24 hours
Insurance purchased with the loan or lease, after the "loss" and ending, regardless of the
and policy's expiration, with the lesser of the
e. Carry-over balances from previous loans or following number of days,
leases. a. The number of days reasonably required to
repair or replace the covered "auto". If
Coverage does not apply to any unpaid amount "loss" is caused by theft, this number of
due on a loan for which the covered "'auto"' is not days is added to the number of days it
the sole collateral. takes to locate the covered "auto" and
N. PERSONAL PROPERTY OF OTHERS return it to you; or
SECTION III — PHYSICAL DAMAGE COVERAGE, lb. 30 days.
A.4. Coverage Extensions is amended by adding 4. Our payment is limited to the lesser of the
the following-. following amounts:
We wiilll pay up to $500 for loss to personal property a. Necessary and actual expenses incurred:
of others in or on your covered "auto." or
This coverage applies only in the event of "loss" to b. $75 per day, subject to $2,250 limit.
your covered "auto" caused by fire, lightning,
explosion, theft, mischief or vandalism, the covered 5. This coverage does not apply while there are
"auto's" collision with another object, or the covered spare or reserve "autos" available to you for
.auto's" overturn. your operations.
No deductibles apply to this coverage. 6. .I I f"loss" results from the total theft of a covered
O. PERSONAL EFFECTS COVERAGE auto" of the private passenger type, we will
pay under this coverage only that amount of
SECTION III — PHYSICAL DAMAGE COVERAGE, your rental reimbursement expenses which is
A.4. Coverage Extensions is amended by adding not already provided for under the Physical
the following; Damage — Transportation Expense Coverage
We will pay up to $500 for "loss" to your personal Extension included in this endorsement.
effects not otherwise covered in the policy or, if you 7. Coverage, provided by this extension is excess
are an individual, the personal effects of a family over any other collectible insurance and/or
member, that is in the covered auto at the time of the endorsement to this policy.
"Moss'". R. AIRBAG COVERAGE
For the purposes of this extension personal effects
means tangible property that is worn or carried by an SECTION III — PHYSICAL DAMAGE COVERAGE,
insured including portable audio, visual, or electronic B.3.a. Exclusions,is amended by adding the following:
devices. Personal effects does not include tools, If you have purchased Comprehensive or Collision
jewelry, guns, money and securities, or musical Coverage under this (policy, the exclusion relating to
instruments mechanical breakdown does not apply to the
P. EXTRA EXPENSE FOR STOLEN AUTO accidental discharge of an airbag,
SECTION III — PHYSICAL DAMAGE COVERAGE, S. NEW VEHICLE REPLACEMENT COST
A.4. Coverage Extensions is amended by adding The following is added to Paragraph C. Limit of
the following: Insurance of SECTION III — PHYSICAL DAMAGE
We will pay up to $1,000 for the expense incurred COVERAGE
returning a stolen covered "auto" to you because of In the event of a total "loss" to your new covered
the total theft of such covered "auto". Coverage auto of the private passenger type or vehicle having
applies only to those covered "autos" for which you a gross vehicle weight of 20,000 pounds or less, to
carry Comprehensive or Specified Causes Of Loss which this coverage applies, we will pay at your
Coverage, option,-
Q. RENTAL REIMBURSEMENT a. The verifiable new vehicle purchase price you
SECTION III — PHYSICAL DAMAGE COVERAGE, paid for your damaged vehicle, not including
A.4. Coverage Extensions is amended by adding any insurance or warranties,
the following: b. The purchase price, as negotiated by us, of a
1. This coverage applies only to a covered "auto"for new vehicle of the same make, model, and
which PHYSICAL DAMAGE COVERAGE is equipment, or most similar model available, not
provided on this policy. including any furnishings, parts, or equipment
2. We Wil pay for rental reimbursement expenses not instalied by the manufacturer or their
incurred by you for the rental of an "auto" dealership.
because of "loss" to a covered "auto". Payment
applies in addition to the otherwise applicable
amount of each coverage you have on a covered
"auto". No deductibles apply to this coverage.
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c. The market value of your damaged vehicle, not W. WAIVER OF TRANSFER OF RIGHTS OF
including any furnishings, parts, or equipment not RECOVERY
installed by the manufacturer or their dealership. Subparagraph 6.of paragraph A. Loss Conditions of
We will not pay for initiation or set up costs associated SECTION IV BUSINESS AUTO CONDITIONS is
with a loans or leases, deleted in its entirely and replaced:with the following.
For the purposes of this coverage extension a new 5. Transfer of Rights of Recovery Against
covered auto is defined as an "auto" of which you are Others to Us
the original owner that has not been previously titled If any person or organization to or for whom we
which you purchased less than 180 days prior to the make payment under this Coverage Form has
date of loss. fights, to recover damages from another, those
T. LOSS TO TWO OR MORE COVERED AUTOS rights are transferred to us. That person or
FROM ONE ACCIDENT organization must do everything necessary to
SECTION III — PHYSICAL DAMAGE COVERAGE, secure our rights and must do nothing after
D.Deductible is amended by adding the following: "'accident""or"loss"to impair them.
It a Comprehensive, Specified Causes of Loss or However, we waive any right of recovery we
Collision Coverage"loss"from one"accident" involves may have against any person, or organization
two or more covered "autos , only the highest with whom you have a written contract,
deductible applicable to those coverages will be agreement or permit executed prior to the
applied to the"accident". "'loss" that requires a waiver of recovery for
This provision only applies if you carry payments made for damages arising out of
Comprehensive, Collision or Specified Causes of your operations done under contract with such
Loss Coverage for those vehicles, and does not person or organization.
extend coverage to any covered "autos"for which you X. UNINTENTIONAL FAILURE TO DISCLOSE
do not carry such coverage. EXPOSURES
U. WAIVER OF DEDUCTIBLE — GLASS REPAIR OR SECTION IV — BUSINESS AUTO CONDITIONS,
REPLACEMENT B.2. Concealment, Misrepresentation:, or Fraud
SECTION III — PHYSICAL DAMAGE COVERAGE, is amended by adding the following:
D.Deductible is amended by adding the following: If you unintentionally fail to disdose any exposures
If a Comprehensive Coverage deductible is shown in existing at the inception date of this policy, we will
the Declarations, it does not apply to the cost of not deny coverage under this Coverage Part solely
repairing or replacing damaged glass. because of such failure to disclose. However, this
V. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, provision does not affect our right to collect
SUIT,OR LOSS additional premium or exercise our right of
cancellation or non-renewal.
SECTION IV — BUSINESS AUTO CONDITIONS,
A.2. Duties in the Event of Accident,Claim, Suit or Y. MENTAL ANGUISH
Loss is amended by adding the following: SECTION V— DEFINITIONS, C. is replaced by the
d. Your obligation to notify us promptly of an following:
.accident", claim, "suit" or"loss" is satisfied if you "Bodily injury" means bodily injury, sickness or
send us the required notice as soon as disease sustained by a person, including mental
practicable after your Insurance Administrator or anguish or death resulting from bodily injury,,
anyone else designated by you to be responsible sickness or disease.
for insurance matters is notified, or in any manner Z. LIBERALIZATION
made aware, of an "accident" claim, "Suit" or
"loss". If we revise this endorsement to provide greater
coverage without additional premium charge, we
will automatically provide the additional coverage to
all endorsement holders as of the day the revision
is effective in your state.
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy, We will'
not enforce our right against the person or organization named in the Schedule. (This agreement applies
only to the extent that you perform work under a written contract that requires you to obtain this
agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Any person or organization that you perform work for that is liable for an injury, covered by this policy, that
prior to the injury has written contract requiring a waiver of our right to recover from them.
NORTH CAROLINA
This endorsement changes the poflcy to which It Is attached and is effective on the date Issued unless otherwise stated.
(The information below is required only when this endorsement Is Issued subsequent to preparation of the policy)
Endorsement Effective 11/4/2014 Policy No. 5H20546 Endorsement No.
Insured TILE RESTORATION, INC. Premium$
Insurance Company EMASCO INSURANCE COMPANY Countersigned by
WC 00 03 13
(Ed. 4-84) Copyright 1983 National Council on Compensation Insurance,