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HomeMy WebLinkAbout2015-399-E Finance - Duke HomeCare & Hospice - 2015-16 Outside Agency Performance Agreement $1,000 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D 2015-16 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2015, ("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 Duke HomeCare & Hospice, a not-for-profit corporation, located at 4321 Medical Park Drive, Suite 101, Durham,NC 27704 ("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 Duke HomeCare &Hospice agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2015 to June 30, 2016. 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 S 1,000. 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 S 250. 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. d. The County's obligation to make the 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. (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page 1 of 7 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D 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 2015-16 performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 — December 31; January 1 — March 31 and April 1 - June 30. Reports are due on January 11, April 15, and July 8 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 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. (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page 2 of 7 Rev. 6115 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D 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 iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. 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 $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate 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 (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page 3 of 7 Rev. 6115 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 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 Duke HomeCare & Hospice 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 (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page 4 of 7 Rev. 6115 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D 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: Duke HomeCare &Hospice Orange County 4321 Medical Park Drive, Suite Post Office Box 8181 101 Hillsborough,NC 27278 Durham,NC 27704 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. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. 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 1 ^--DocuSigned by: 0 At, h6 vu 8/5/2015 S'1gMdfflftC200B6A466 Date Dale Horton Printed Name For and on behalf of Orange County Government DocuSigned by: jOV�,l�t tf �AaMw�t V S 8/7/2015 fl1�gHBafffiW6rsley, County Manager Date (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page S of 7 Rev. 6115 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D ATTACHMENT "A" Orange County Certifications—FY 2015-16 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. -DocuSigned by: Certified by �At, hV1t6vt Program specialist 8/5/2015 Title: Date: 14"4;deVV6Signature) (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Page 7 of 7 Rev. 6115 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D } EXI MIT"A" Scope of Services—FY 2015-16 Outside Agency Performance Agreement Agency Name: Duke Homecare&Hospice Program Name: Duke Hospice&Bereavement Services Funding Award: $1,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Program Services $1,000 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 30,2016. • Camp ReLEAF-two night camp for children K through 8th grade. • Family Connections - 4 week family focused grief support to enhance commmunication and coping skills. • Holiday Hurt workshops - two (2) for adults, one (1) family focused; designed to address grief issues arising during the holidays. • Grief Support Groups - support provided on-site to Orange County Schools as requested; grief group support for adults 6 to 8 times per year. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of personslunits 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 Parents express satisfaction in child's experience at Camp ReLEAF. 90% Children will report satisfaction in activities proveded at Camp ReLEAF. 90% Group participants will recomment group. 90% Families will report better understanding of family grief after attending family 90% connections. Participants will recomment holiday hurt workshop to others. 90% DocuSi ned by: Pau, t�bvfbvu HD64C200MA466... Certified by: Title: J-6. u Z: r""q.( Date: - I (Provider's Signature) DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D DUKEUNI-01 CHATURVEDIRN ACORO H DATE(MWDM-YYY) CERTIFICATE OF LIABILITY INSURANCE 7/1012016 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($),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 NAM£CT Willis Certificate Center Willis of North Carolina,Inc. PHONE ax CID 26 Century Blvd arc No Ext:(877)945-73T8 Arc No):(888)467-2378 P.O.Box 305191 a D ° RIESS: certificates Wiil1S.COm Nashville,TN 37230-6191 INSURER(S)AFFORDING COVERAGE NAiC If INSURER A:Duke University Risk Management Trust Fund B1512 INSURED INSURERB:Durham Casualty Company LTD-Bermuda C6616 Duke University INSURERC: Attn Chris Borosk) INSURERD: PO Box 104143 Durham,NC 27708 INSURER l; 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE PO ICY EFF OLICY EXP LIMITS IN D WV° POLICY NUMBER MMlD MMlD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,00 DAMAGE TO RENTE15 CLAIMS-MADE M OCCUR X GL-DURMRA 0110112016 01101/2016 PREMISES EaoWmence $ M ED EXP(Any one person) S PERSONAL&ADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIESPER: GENERALAGGREGATE $ 2,000,00 POLICY r]JECT LOG PRODUCTS-COMWOP AGO $ 2,000,40 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 2,000,000 i A X ANY 1-163 01101/2015 01/0112016 BODILY INJURY(Per person) $ ALLOANED SCHEDULED BODILY INJURY(Per acddont) S X AUTOS kX NON-OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS PeraCCideriF $ UMBRELLALIAS OCCUR EACHOCCURRENCE S EXCESS LIMB i CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ OTH WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.LEACHACCIDENT $ OFFICERAIEMBER EXCLUDED? (Mandatory in NH) E-L.DISEASE-EA EMPLOYE $ If es,descn'be urnder D SCRIPTIONOFOPERAT(ON5bolvo E.L DISEASE-POLICYLI MIT S B Professional Liab 16 LP 1025-P 0710112015 0710112016 Occ,.1,000,00OlAgg: 3,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 1 DI,Additional Remarks Schedule,may be attached H more space is required) With respects to Policy No.16 LP 1025-P,Named Insured Includes:Duke University Health System. With respects to the General Liability Insurance Orange County is included as an Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE Orange County �r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D Client#:506811 20DUKEUNI DATE JMMIDDIYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 711312015 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 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 Beth Wilkerson NAME: BB&T Insurance Services, Inc. PHDHE E,,): IC 919 281-4500 Ale,No 888-746-8761 A!C No Past Office Box 13941 n DRESS: bcwilkerson @bbandt.com Durham,NC 27709 INSURER(S)AFFOROING COVERAGE NAIC# 919 281-4500 INSURER A;Midwest Employers Casualty Comp 23612 INSURED INSURER B: Duke University INSURER C Box 104143 INSURER D: Durham, NC 27708 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IAfOMMDNY F MhUDpY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ CO!IMERCIAL GENERAL LIABILITY PR M15ES EaE rrence $ _ CLAIMS-NIADE E1 OCCUR MEO FXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LI61fT Ea acddant ANY AUTO 80DILY INJURY(Per person) $ ALL OWNED SCHEDULED 130DILY INJURY(Per acddent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS H AUTOS Peracddent S UMBRELLA LIAR HOOCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-A(ADE AGGREGATE $ DED RETENTION S $ A %YORKERS COMPENSATION EWC005735 110112014 011011201 TORYLI IT OTFf- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER;EXECUTfVE E.L.EACH ACCIDENT $ OFFICER!l.IEMREREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LI0.9€T $ DESCRIPTION OF OPERATIONS be:oN DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Duke Homecare and Hospice "Workers Comp Information** Excess WC(Lmt#11Ded#1--Each Accident; Lmt#21Ded#2-Each Emp for Disease)INC Lmt-Statutory Lmt-Statutory Deductible#1-750,000; Deductible#2-750,000 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Orange Count Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE OO 1-988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD #S144818441M11954805 BG3 DocuSign Envelope ID: D40ODC89-B8BF-484E-8158-24FOOA82920D DESCRIPTIONS (Continued from Page 1) Excess Empl Llab(Lmt#1IDed#1-Each Acc; Lmt#2/Ded#2-Ea Emp for Disease) NC Lmt-7,000,000 Lmt-1,000,000 Deductible#1-750,000; Deductible#2-750,000 Communicable Disease Endt(Lm##1-Workers Comp; Lmt#2-Employers Liab)Form#ISI242-AF Lmt-Statutory Lmt 1,000,000 Scheduled Aircraft Endorsement Coverage Form#IS1256 Limited Longshoremen&Harbor Workers Compensaton Act Coverage Form#ISI282 Foreign Workers Compensation Coverage ISI266 SAGITTA 25.3(2010105) 2 of 2 #S144818441M11954805