HomeMy WebLinkAbout2015-500-E EMS - Console Cleaning Specialist for cleaning and furniture maintenance DocuSign Envelope ID:63F461C3-2BFE-44AE-B3D1-76B5DB35C3BD
[Departmental Use Only]
TITLE Console Cleaning
Specialist
FY 2015-2016
ORANGE COUNTY
CONTRACT UNDER$15,000.00
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 3rd day of September, 2015, ("Effective Date")
by and between Orange County, North Carolina, a body politic and corporate organized under the laws of the
State of North Carolina, (the "County"), party of the first part; and Console Cleaning Specialist (CCS) (the
"Provider"),party of the second part;
WITNESSETH:
For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby
contracts for the services of the Provider, and the Provider agrees to provide the following services to the
County in accordance with the terms of this Agreement,time being of the essence:
The services and/or materials (hereinafter referred to collectively as "Services") to be furnished
under this Agreement are as follows: See Exhibit a, CCS Preventative Maintenance Quote which is attached
and incoporated by reference.
The term of this agreement rendered shall be from September 3, 2015 to September 30, 2015.
Provider represents and agrees that Provider is qualified to perform and fully capable of performing and
providing the services required or necessary under this Agreement in a ftilly competent, professional and
timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in
the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies,
ambiguities,mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not
sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or
responsibility granted or required by this Agreement, without the prior written approval of the County.
SPECIFIC TERMS
1. Payment: The County agrees to pay at the rates specified for Services satisfactorily
performed in accord with this Agreement. The amount to be paid by the County shall not exceed Three
Thousand eight hundred fifty dollars, ($3850). Payment shall be made within thirty (30) days of an invoice
properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement,
County may, without fault or penalty, withhold any payment associated with the work to be performed until
such time as said work is completed.
2. Non—waiver: Failure by County at any time to require the performance by Provider of any
of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor
shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of
this Non-Waiver Clause,
3. Independent Contractor: The Provider shall operate as an independent contractor and the
County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated
as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or
workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of
any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider.
4. h7surance: Provider shall obtain, at its sole expense, Commercial General Liability
Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may
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DocuSign Envelope ID:63F461C3-2BFE-44AE-B3D1-76B5DB35C3BD
be required by Owner's Risk Manager as such insurance requirements are described in the Orange County
Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is
incorporated herein by reference and may be viewed at http://oi*aiigecouiltyjic.gov/pui,cliasiiigiconti'acts.asp).
If Owner's Risk Manager determines additional insurance coverage is required such additional insurance
shall consist of (if no additional insurance required mark N/A as being not applicable). Provider shall
not commence work until such insurance is in effect and certification thereof has been received by the
Owner's Risk Manager.
5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County
from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable
attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or
destruction of any property caused in whole or in part by any negligent or intentional act or omission on the
part of the Provider.
6. Termination: This Agreement may be terminated at any time by mutual written agreement of
the parties or by the County upon written notice to the Provider.
7. Entire Agreement and Signatures: The parties have read this Agreement and agree to be
bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the
Agreement between the parties unless and until modified in writing and signed by the parties. 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.
8. Priori : In determining the basic services to be provided, should any documents be
referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the
terms of referenced documents and the terms of this Agreement.
9. Governing Law:aw_Both parties agree that this Agreement shall be governed by the laws of the
State of North Carolina. Should either party initiate litigation to settle any dispute involving the terms of this
Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in
Orange County, North Carolina. Provider shall at all times remain in compliance with all applicable local,
state, and federal laws,rules, and regulations including but not limited to all anti-discrimination laws.
10. Dispute Resolution: Any and all suits or actions to enforce, interpret, or seek damages with
respect to any provision of, or the 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 venire 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. Non Appropriation: Provider acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the authority of its statutory
mandate. In the event that public funds are unavailable and not appropriated for the performance of County's
obligations under this Agreement, then this Agreement shall automatically expire without penalty to County
immediately upon written notice to Provider of the unavailability and non-appropriation of public funds.
[SIGNATURE PAGE TO FOLLOW]
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DocuSign Envelope ID:63F461C3-2BFE-44AE-B3D1-76B5DB35C3BD
IN WITNESS WHEREOF, County and the Provider have signed this Agreement, effective as of
the day first written above.
O TU TY PROVIVE,#goad y:B �6Vcl�t C1AAbtMLYS�,i? B
County Manager 1*24A—.027.1'
4484.._
200 S. Cameron St. Console Cleaning Specialists
P.O. Box 8181 1595 Bishop Rd
Hillsborough,NC 27278 Chehalis WA 98532
Revised 10/14 3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL , LESSEES
CONTRACTORS AUTOMATIC T T
REQUIRED T WITH
This endorsement modifies insurance provided under the following:
COMMERCIAL GE=NERAL LIABILITY COVERAGE
PRODUCTS/COMPLETED OPERATIONS LIAB ILITY COVERAGE
A. Section 11—Who Is An Insured is amended to include as an additional insured any person or organization for
whom you are performing operations when you and such person or organization have agreed in writing that such
person or organization be added as an additional insured. Such person or organization is an additional insured
only with respect to liability arising out of your ongoing operations performed for that additional insured. A
person's or organization's status as an additional insured under this endorsement ends when your operations for
the additional insured are completed.
B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions
apply:
1. "bodily injury"or"property damage" for which the additional insured(s)are obligated to pay damages by
reason of the assumption of liability in a contract or agreement;or
2. "bodily injury"or"property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the
project(other than service, maintenance or repairs)to be performed by or on behalf of the
additional insured(s)at the location of the covered operations has been completed;or
b. That portion of"your work"out of which the injury or damage arises has been put to its intended use
by any person or organization other than another contractor or subcontractor engaged in
performing operations for a principal as a part of the same project; or
3. "bodily injury" or"property damage" arising directly or indirectly out of the negligence of the additional
insured(s); or
4_ "bodily injury", "property damage", or"personal or advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering or surveying services, including,but not
limited to:
a. The preparing, approving, or failure to prepare or approve maps, shop drawings, opinions, reports,
surveys, filed orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
VCAS2011 11 12 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE
PROD UCTSICO M PLETED OPERATIONS LIABILITY COVERAGE
SECTION IV—COMMERCIAL GENERAL, LIABILITY CONDITIONS, 8. Transfer of Rights Of Recovery Against
Others To Us is amended and the following added:
We waive any rights of recovery we may have against any person or organization because of payments we make for
"bodily injury" or"property damage"caused by or resulting from"your product", your ongoing operations or your work"
done under a contract with that person or organization and included in the"products-completed operations hazard"if:
a. You agreed to such waiver; and
b. The waiver is included as part of a written construction contract, sales agreement, or lease;and
c. Such written contract, sales agreement or lease was entered into prior to any claim to which this insurance applies. .
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
VCAS9925 06 11 Page 1 of T
COMMERCIAL AUTO
CA 8810 01 10
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REAL]IT CAREFULLY.
BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the
endorsement.
COVERAGEINDEX
SUBJECT" PROVISION NUMBER
ADDITIONAL INSURED BY CONTRACT,AGREEMENT OR PERMIT 3
ACCIDENTAL AIRBAG DEPLOYMENT 12
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18
AMENDED FELLOW EMPLOYEE EXCLUSION 5
AUDIO,VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13
BROAD FORM INSURED 1
BODILY INJURY REDEFINED 21
EMPLOYEES AS INSUREDS(including employee hired auto) 2
EXTENDED CANCELLATION CONDITION 22
EXTRA EXPENSE—BROADENED COVERAGE 10
GLASS REPAIR—WAIVER OF DEDUCTIBLE 15
HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6
HIRED AUTO COVERAGE TERRITORY 20
LOAN/LEASE GAP 14
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16
PERSONAL EFFECTS COVERAGE 11
PHYSICAL DAMAGE—ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8
RENTAL REIMBURSEMENT 9
SUPPLEMENTARY PAYMENTS 4
TOWING AND LABOR 7
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 19
SECTION 11—LIABILITY COVERAGE is amended as follows:
I. BROAD FORM INSURED
SECTION If—LIABILITY COVERAGE, paragraph A.1.—WHO IS AN INSURED is amended to include the
following as an insured:
d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the
policy period. However, "insured" does not include any organization that:
(1) Is a partnership or joint venture; or
(2) Is an insured under any other automobile policy; or
(3) Has exhausted its Limit of Insurance under any other automobile policy.
Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of
this policy,
e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you
own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days
from the date of acquisition or formation. However, coverage under this provision does not apply:
(1) If there is similar insurance or a self-insured retention plan available to that organization;
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CA 88 10 01 10 includes copyrighted material of Insurance Services Office,with its permission. Page 1 of 7
(2) If the Limits of Insurance of any other insurance policy have been exhausted; or
(3) To "bodily injury" or "property damage" that occurred before you acquired or formed the
organization.
2. EMPLOYEES AS INSUREDS
SECTION II --LIABILITY COVERAGE, paragraph A.1. WHO IS AN INSURED is amended to include the
following as an insured:
f. Any"employee" of yours while using a covered "auto' you do not own, hire or borrow but only for acts
within the scope of their employment by you. Insurance provided by this endorsement is excess over
any other insurance available to any'employee",
g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or
agreement in that "employee's" name, with your permission, while performing duties related to the
conduct of your business and within the scope of their employment. Insurance provided by this
endorsement is excess over any other insurance available to the"employee".
3. ADDITIONAL INSURED BY CONTRACT,AGREEMENT OR PERMIT
SECTION II —LIABILITY COVERAGE, paragraph A.I. —WHO IS AN INSURED is amended to include the
following as an insured:
h. Any person or organization with respect to the operation, maintenance or use of a covered "auto",
provided that you and such person or organization have agreed in a written contract, agreement, or
permit issued to you by governmental or public authority, to add such person, or organization, or
governmental or public authority to this policy as an"insured".
However, such person or organization is an"insured":
(1) Only with respect to the operation, maintenance or use of a covered auto";
(2) Only for"bodily injury" or"property damage" caused by an "accident"which takes place after you
executed the written contract or agreement, or the permit has been issued to you; and
(3) Only for the duration of that contract, agreement or permit
4. SUPPLEMENTARY PAYMENTS
SECTION It —LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, paragraphs
(2)and (4)are replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of
an "accident"we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings up
to$500 a day because of time off from work.
5. AMENDED FELLOW EMPLOYEE EXCLUSION
In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the
employer by the workers compensation exclusivity rule, or similar protection, the following provision is
added:
SE=CTION It—LIABILITY, exclusion B.5. FELLOW EMPLOYEE=does not apply if the"bodily injury" results
from the use of a covered "auto"you own or hire.
SECTION III--PHYSICAL DAMAGE COVERAGE is amended as follows:
6. HIRED AUTO PHYSICAL DAMAGE
Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended
by adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of
Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto"you own,
then the Physical Damage coverages provided are extended to"autos":
a. You hire, rent or borrow; or
02010 Liberty Mutual Insurance Company. All rights reserved.
CA 88 10 01 10 Includes copyrighted material of Insurance Services Office,with its permiss"on. Page 2 of 7
b. Your"employee" hires or rents under a written contract or agreement in that "employee's"name, but
only if the damage occurs while the vehicle is being used in the conduct of your business,
subject to the following limit and deductible:
A. The most we will pay for"loss" in any one"accident"or"loss" is the smallest of:
(1) $50,000; or
(2) The actual cash value of the damaged or stolen property as of the time of the"loss"; or
(3) The cost of repairing or replacing the damaged or stolen property with other property of like kind
and quality,
minus a deductible.
B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that
coverage.
C. Subject to the limit, deductible and excess provisions described in this provision, we will provide
coverage equal to the broadest coverage applicable to any covered"auto"you own.
D. Subject to a maximum of $750 per "accident", we will also cover the actual loss of use of the hired
"auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial
loss.
E. This coverage extension does not apply to:
(1) Any"auto"that is hired, rented or borrowed with a driver; or
(2) Any"auto"that is hired, rented or borrowed from your"employee".
For the purposes of this provision, SECTION V—DEFINITIONS is amended by adding the following:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash
value.
7. TOWING AND LABOR
SECTION Ill—PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of
the following:
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto"
classified and rated as a private passenger type, light truck"or"medium truck" is disabled:
a. For private passenger type vehicles, we will pay up to$50 per disablement,
b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross
vehicle weight(GVW) of 10,000 pounds or less.
c. For"medium trucks" , we will pay up to$150 per disablement. "Medium trucks" are trucks that have a
gross vehicle weight(GVW)of 10,001 —20,000 pounds.
However, the labor must be performed at the place of disablement.
8. PHYSICAL DAMAGE.ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a., Coverage Extension of SECTION III -- PHYSICAL DAMAGE COVERAGE, is amended
to provide a limit of$50 per day and a maximum limit of$1,500
@2010 Liberty Mutual Insurance Company.All rights reserved.
CA 88 10 01 10 Includes copyrighted material of Insurance Services Once,with its permission. Page 3 of 7
9. RENTAL REIMBURSEMENT
SECTION 111—PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following.
a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an
"auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under
Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those
expenses incurred after the first 24 hours following the"accident" or"loss"to the covered "auto_"
b, Rental Reimbursement will be based on the rental of a comparable vehicle,which in many cases may
be substantially less than $75 per day, and will only be allowed for the period of time it should take to
repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days.
c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and
replace your tools and equipment from the covered"auto".
d. This coverage does not apply unless you have a business necessity that other"autos" available for
your use and operation cannot fill.
e. If."loss" results from the total theft of a covered "auto"of the private passenger type,we will pay under
this coverage only that amount of your rental reimbursement expenses which is not already provided
under Paragraph 4. Coverage Extension.
f. No deductible applies to this coverage.
For the purposes of this endorsement provision, materials and equipment do not include "personal
effects"as defined in provision 11_
10. EXTRA EXPENSE -BROADENED COVERAGE
Under SECTION III --PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of
returning a stolen covered"auto"to you. The maximum amount we will pay is$1,000.
11. PERSONAL EFFECTS COVERAGE
A. SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVE=RAGE=, is amended by adding the
following:
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto"
is stolen, we will pay, without application of a deductible, up to $600 for"personal effects"stolen with
the"auto."
The insurance provided under this provision is excess over any other collectible insurance.
B. SECTION V—DEFINITIONS is amended by adding the following:
For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by
an insured." "Personal effects"does not include tools, equipment,jewelry, money or securities.
12. ACCIDENTAL AIRBAG DEPLOYMENT
SECTION III—PHYSICAL DAMAGE= COVE=RAGE, B. EXCLUSIONS is amended by adding the following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss"
relating to mechanical breakdown does not apply to the accidental discharge of an airbag.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by
manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or
warranty.
13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III — PHYSICAL DAMAGE= COVERAGE, B. E=XCLUSIONS, exception paragraph a, to
exclusions 4.c. and 4.d. is deleted and replaced with the following:
02010 Liberty Mutual Insurance Company.All rights reserved.
CA 88 10 01 10 Includes copyrighted material of Insurance Services Office,with its permission. Page 4 of 7
Exclusion 4.c. and 4.d. do not apply to:
a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed
solely for the reproduction of sound, if the equipment is permanently installed in the covered"auto" at
the time of the"loss" and such equipment is designed to be solely operated by use of the power from
the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are
provided for the covered"auto"; or
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this
equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be
reduced by a$1010 deductible.
14. LOAN 1 LEASE GAP COVERAGE
A. Paragraph C., LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE is
amended by adding the following:
The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one
"accident" is the greater of the:
1. Balance due under the terms of the loan or lease to which the damaged covered "auto"is subject
at the time of the"loss" less the amount of:
a_ Overdue payments and financial penalties associated with those payments as of the date of
the"loss",
b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal
wear and tear,
c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance
purchased with the loan or lease,
d. Transfer or rollover balances from previous loans or leases,
e. Final payment due under a"Balloon Loan",
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a
covered"auto",
g. Security deposits not refunded by a lessor,
K All refunds payable or paid to you as a result of the early termination of a lease agreement or
as a result of the early termination of any warranty or extended service agreement on a
covered "auto",
L Any amount representing taxes,
j. Loan or lease termination fees; or
2. The actual cash value of the damage or stolen property as of the time of the"loss".
An adjustment for depreciation and physical condition will be made in determining the actual cash
value at the time of the"loss". This adjustment is not applicable in Texas.
B. ADDITIONAL CONDITIONS
This coverage applies only to the original loan for which the covered "auto" that incurred the loss
serves as collateral, or lease written on the covered"auto'that incurred the loss_
C. SECTION V—DEFINTIONS is changed by adding the following:
As used in this endorsement provision, the following definitions apply:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual
cash value.
A"balloon loan" is one with periodic payments that are insufficient to repay the balance over the term
of the loan, thereby requiring a large final payment.
@2010 Liberty Mutual Insurance Company.All rights reserved.
CA 88 10 01 10 4ncWdes copyrighted material of Insurance Services Office,with its permission. Page 5 of 7
IS. GLASS REPAIR-WAIVER OF DEDUCTIBLE
Paragraph D. Deductible of SECTION III — PHYSICAL [DAMAGE COVERAGE is amended by the
addition of the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
Paragraph D. Deductible of SECTION III — PHYSICAL. DAMAGE COVERAGE is amended by the
addition of the following:
The deductible does not apply to "loss" caused by collision to such covered "auto" of the private
passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the
manufacturer as maximum loaded weight the"auto" is designed to carry while it is:
a. In the charge of an "insured";
b. Legally parked; and
c. Unoccupied.
The"loss" must be reported to the police authorities within Zvi hours of known damage.
The total amount of the damage to the covered "auto" must exceed the deductible shown in the
Declarations.
This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or
organization engaged in the automobile business.
SECTION IV—BUSINESS AUTO CONDITIONS is amended as follows:
17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph 6.2, is amended by adding the following:
If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception
date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not
be prejudiced.
However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery,
and we have the right to collect additional premium for any such hazard or exposure.
18. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM,SUIT, OR LOSS
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the
following-,
a. In the event of"accident", claim, "suit"or"loss", you must promptly notify us when it is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. Member, if you are a limited liability company;
4. An executive officer or the "employee" designated by the Named Insured to give such notice, if
you are a corporation.
To the extent possible, notice to us should include:
(1) How, when and where the"accident"or"loss"took place;
(2) The"insureds" name and address; and
(3) The names and addresses of any injured persons and witnesses.
19. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
SECTION IV— BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery Against
Others to Us, is amended by the addition of the following:
If the person or organization has waived those rights before.an "accident" or "loss", our rights are waived
also.
@2010 Liberty Mutual Insurance Company.Ali rights reserved.
CA 88 10 01 10 Includes copyrighted material of Insurance Services Office,with its permission. Page 6 of 7
20, HIRED AUTO COVERAGE TERRITORY
SECTION IV -- BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is
amended by the addition of the following:
f. For "autos' hired 30 days or less, the coverage territory is anywhere in the world, provided that the
insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United
States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a
settlement we agree to.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a
driver.
SECTION V—DEFINITIONS is amended as follows:
21. BODILY INJURY REDEFINED
Under SECTION V—DEFINTIONS, definition C. is replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental
anguish, mental injury, shock, fright or death resulting from any of these at any tune.
COMMMON POLICY CONDITIONS
22. EXTENDED CANCELLATION CONDITION
COMMON POLICY CONDITIONS, paragraph A.—CANCELLATION condition applies except as follows:
If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured
written notice of cancellation at least 641 days before the effective date of cancellation. This provision
does not apply in those states which require more than 60 days prior notice of cancellation.
Q201 0 Liberty Mutual Insurance Company.All rights reserved.
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CONSO-1 OP ID: DB
CERTIFICATE OF LIABILITY INSURANCE
DATE 09/10D1YYYY)
CERTIFICATE Vr 091'10195
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s),
PRODUCER 360-748-0051 cNAME INTACT Debbie Buss _
Virgil R.Lee&Son _ _.
Lovsted Worthington LLC 360-748-3941HaNN�E�;380-748-0t}5I _ - No#:360-748-3941
P.O.Box 9226 A'0DRESs:dbuss@lovstedworthinqton.com
Chehalis,WA 98532 - -
Trevor J Elliott ---- INSt1RER(SLAFFORDtNG caVERAGE. E_ NAIC a
iNSURERA:Berk�Assurance Company
INSURED Console Cleaning INSURER p,American Fire&Casualty„ - __.__123507_
Specialists,Inc. INSURERC:Torus S ecial Ins Co.
1595 Bishop Rd ------ _.�_. �!
Chehalis,WA 98532 _ENSURER D: —
INSURE=R 6
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
' POLICY EFF
LTR TYPE OF INSURANCE I Pot-ICY NUMBER i MMlDL11YYYY i MMlDDlYYYY E LIMITS
GENERAL LIABILITY i E '
EACH OCCURRENCE $ 1,000,00
E bAnnA �T�RLN I LU _
A X�cnM1 RCIAL GENERAL LIABILITY X X i iVt3NIBD063151 06120/15 i 06120/16 f PREMISES(Wa arcurrencel s 100,00
CLAIMS-MADE ( X OCCUR I I I ME P(Any one person) 5 EXC
X $2500 Ded BI/PD E ; F I j--------.____ _
W.� .. e j ; PERSONAL&ADV INJURY ; s 1,000,000
GENERAL AGGREGATE_._.._1 ____._.._._...2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AGG 1 $ 2,000,00
�>
i X POLICY L^ PRO- € LOC ii _._..____._-------
_.
I
i
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i
Ea accident 1,000,00
ANY AUTO X X ifiAA56199907 06120115 061201160DILY INJURY{Per person} ;$
ALL OWNED SCHEDULED
i AUTOS X l AUTOS I i I I BOOJLY INJURY(Per accident)t$
NOWOWNEp �PROPEF2TYDAMAGE
HIRED AUTOS AUTOS S
Por acc€dsnt
I __.._�
I I
UMBRELLA LIAR i I OCCUR i EACH OCCURRENCE $ 2,000,00
' EXCESStEAB � CLAIMS � �85620JI51AL.1 06120115 1 06/20/96 i AGGREGATE $ 7,
X �_. _. __._. I AGGREGATE 000,00
1 DED 1 RETENTION$
WORKERS COMPENSATION I I [ WG STATU- 10TH•;
AND EMPLOYERS'LIABILITY I j I I_,_..,1.TER
A i ANY PROPRIETORIPARTNERIEXECUTIVE YIN I i VUMB0063151 06/20/15 ! 01/20115 _E.L.EACH ACCIDEN T_ '$ 1,000,00
nFFICERlMEMBER EXCLUDED? ;N!A I
(Mandatory in NH) (WA STOP GAP) E.L.DISEASE-EA EMPLOYEEi S 1,000,00
IF yes,desuit-e under F j I
E DESCRIPTION OF OPERATIONS below I E L.DISEASE-POLICY LIMIT $— 1,000,00
I i i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
Orange County Emergency Services shall be named additional insured's as
required by written contract., see VCAS2011 11/12 and CAS810 01/10, attached.
Waiver of Subrogation Applies, see VCAS9925 06111 and CAS$10 01/10,
attached.
LEE": Contract 2015-2016
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Orange OL7Urt Emergency SerV[C THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
g County 9 Y ACCORDANCE WITH THE POLICY PROVISIONS,
510 Meadowlands Drive
Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
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