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HomeMy WebLinkAbout2015-546-E AMS - Mechanical Solutions INC. - preventative maintenance service water system at Animal Services DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD [Departmental Use Only] TITLE Water System PM FY 2016 NORTH CAROLINA SERVICES AGREEMENT UNDER$90,000.00 ORANGE COUNTY This Services Agreement (herinafter "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 of the State of North Carolina (hereinafter, the "County") and Mechanical Solutions, INC, (hereinafter,the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Agreement is for services to be rendered by Provider to County with respect to (insert type ofproject): Preventative maintenance service for the rainwater/well water system located at 1601 Eubanks Road Chapel Hill (Animal Services) ii) By executing this Agreement, the Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. Provider is solely responsible for the professional Revised 7/14 1 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD quality, accuracy and timely completion and/or submission of all work related to the Basic Services. ii) Provider shall be responsible for all errors or omissions of its agents, contractors, employees, or assigns 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. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) Provider agrees that Provider, its employees, agents and its subcontractors, if any, shall be required to comply with all federal, state and local antidiscrimination laws, regulations and policies that relate to the performance of Provider's services under this Agreement. vi) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. vii) In determining the basic services to be provided, should any documents be referenced in this Agreement, the terms of this Agreement shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. Should a request for proposals and a proposal be referenced the terms of the request for proposals shall have priority over the terms of any proposal. 3. Basic Services a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): P lease see det ailed description in attached proposal. 4. Duration of Services a. Term. The term of this Agreement shall be from September 03, 2015 to September 03, 2016. Revised 7/14 2 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD b. Scheduling of Services. i) The Provider shall schedule and perform its activities in a timely manner. ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be Septeber 3rd, 2015. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services under this Agreement except for any authorized Reimbursable Expenses which are defined herein. The maximum amount payable for Basic Services shall not exceed One Thousand Four Hundred Fifty Dollars ($1450.00). Payment for Basic Services shall become due and payable within thirty (30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). b. Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. 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. c. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Paul Sorrell, Facility Maintenance Supervisor) to act as the County's representative with respect to the Project and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance a. General Requirements. 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 requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated Revised 7/14 3 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD herein by reference and may be viewed at http://oran ecg ountync.gov/purchasing/contracts.asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. 8. Indemnity a. Indemnity. The Provider agrees to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from bodily injury including death or property damage to any person or persons caused in whole or in part by the negligence or 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 provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days' prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. ii) Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. d. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement Revised 7/14 4 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 11. Additional Provisions a. Limitation and Assignment. The County and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. c. Compliance with Laws. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all anti-discrimination laws. Pursuant to the terms of North Carolina General Statute 153A-449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Provider's breach of this Agreement. By executing this Agreement Provider affirms Provider is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. d. 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 venue with respect to such suits or actions. The Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. e. Entire Aueement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. Revised 7/14 5 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD h. 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. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. 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 I IA and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail,return receipt requested to the following: Orange County Provider's Name Attention:Paul Sorrell Mechanical Solutions INC P.O. Box 8181 503 Cornerstone Ct Hillsborough,NC 27278 HIllsborough,NC 27278' [SIGNATURE PAGE TO FOLLOW] Revised 7/14 6 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: DocuSigned by: (:Y21 uSigned by: By: joV�,i�t tf ( ammvs By:County Mari 37994B755E477.._ A88075DAF483... J Vincent Tesoro II President Printed Name and Title i Revised 7/14 7 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD Mechanical Solutions . Water Purification Systems 503 Cornerstone ct, Hillsborough, NC 27278•Ph: 919-644-6465• Fax: 919-640-8878 Preventative Maintenance Contract For: Orange County Animal Services Center Water System This Preventative Maintenance Contract is made on this day, , between Orange County Animal Services Center and Mechanical Solutions, Inc. The term of this Contract is 24 Months,as of the date stated above. I. This contract shall provide preventative maintenance service for the rainwater/well water system located at 1601 Eubanks Road Chapel Hill. This contract includes parts, labor and services listed below at the indicated intervals. Any additional services for upgrading or repairing broken or defective equipment are outside the scope of this maintenance contract and will be billed separately. Upon initiation of this contract, Mechanical Solutions,Inc.agrees to provide the following services,at the intervals described below: A. Contract Services Provided: 1. 24/7 Emergency Answering Service 2. On Site Emergency Response with in 6 hours 3. Service Rates$105.00 an hour 4. Minor repairs as needed while onsite 5. Service rates after 6pm nights and weekends$150.00/hr 6. Emergency call out same day service onetime fee$110.00 7. Develop log sheet for onsite personnel to monitor system operation and Provide training on log entry Website: WWW.THEWATERGURU.COM ® ' DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD Mechanical Solutions , Inc . Page 2 B. Quarterly Service 1 Test system water feed for Ph,TDS, hardness, iron and SDI (Silt Density Index) 2 Visually inspect operating system for damage and leaks. Verify proper operation of all mechanical components, make necessary adjustments or minor repairs 3 Inspect chlorine injection pump system for any operational issues.Clean delrin seats,check ball and injector. 4 Test site chlorine levels at end use levels. Make any necessary adjustments to chlorine injection system 5 Inspect Micro Z filter operation, manually test backwash cycles and check timer. 6 Test system water feed for Ph,TDS, hardness,iron and SDI (Silt Density Index) and Chlorine post Micro Z filter 7 Replace(7) post filter cartridges 5um-30in 8 Inspect Siemens ultraviolet light confirm all bulbs are burning and record hours of operation 9 Sample water for Nationwide Colony Count test at point of use. 10 Provide written report of quarterly services performed and results of testing to facilities manager, Report issues to facilities manager C. Semi-Annual Service 1 Provide(1)replacement 14.5 gallon Tote chlorine D. Annual Service 1 Replace(6) UV lamps 2 Replace(6) UV quartz jackets 3 Replace(12) UV o-rings 4 Provide (1)bottle Chlorine test strips for on-site monitoring and log records 5 Replace post filter oring Services,including parts and labor are to be provided at an annual cost of$2900.00 plus applicable taxes. Billed Quarterly at$725.00 payment is expected net 30 days of invoice date. Website: WWW.THEWATERGURU.COM • DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD Mechanical Solutions , Inc . Page 3 11. Orange County Animal Services Center may dissolve this Contract with a 30-day written notice,if dissatisfied with the quality of service provided by Mechanical Solutions, Inc. Orange County Animal Services Center agrees to make written complaint first,of any dissatisfaction,and to allow 24-hours for response,from Mechanical Solutions,Inc., before requesting termination of the Contract. III. Mechanical Solutions,Inc.agrees to provide and maintain General Liability Insurance of$1,000,000.00 throughout the term of this Contract. IV. Mechanical Solutions,Inc.,and Orange County Animal Services Center may agree to extra services,work,or supplies,outside the scope of this Contract. Any such additions will be set out and agreed upon in writing by both Mechanical Solutions,Inc.,and Orange County Animal Services Center. V. If either Mechanical Solutions,Inc.,or Orange County Animal Services Center should fail to meet the terms of the Contract as they are described herein,the breaching party shall pay and discharge all costs,attorneys'fees,and expenses that shall arise from enforcing the covenants of this Contract. VI. No modification of this Contract will be effective, unless it is in writing,and is signed by both parties. This Contract requires a 30-day written notice for termination by either party. This Contract binds and benefits both parties and any successors. Time is of the essence of this Contract. This document including any attachments is the entire Contract between the parties. This Contract is governed by the laws of the State of North Carolina. Mechanical Solutions,Inc.and Orange County Animal Services Center have signed this Contract,and these signatures are representative of the authority of these parties to represent this agreement,as of the date at the top of the first page. Orange County Animal Services Center Date Mechanical Solutions,Inc. Date Website: WWW.THEWATERGURU.COM • 0 0 °o DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD ACS" CERTIFICATE OF LIABILITY INSURANCE 8/17/2015W' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Colonial Insurance Agency Hillsborough PHONE (919)732-2191 FAA/C No:(919)732-2192 E-MAIL ADDRESS: PO BOX 490 INSURERS AFFORDING COVERAGE NAIC# HILLSBOROUGH NC 27278 INSURER AAuto-Owners 18988 INSURED INSURERS Owners 32700 Mechanical Solutions Inc INSURERC: 503 Cornerstone Ct INSURER D: INSURER E: Hillsborough NC 27278-8546 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1532000964 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 CLAI MS. INSR TYPE OF INSURANCE ADDL 5 BR POLICY EFF POLICY EXP LIMITS LTR S D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE I—]OCCUR MED EXP(Any one person) $ PERSONAL&ADV I NJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY EOMaBIINdEDtSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALLOWNED SCHEDULED 4973490201 /20/2015 /20/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE 0 N/A E.L.EACH ACCIDENT $ 500,000 OFFICEWMEMBER EXCLUDED? 5165925 /20/2015 /20/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,desa be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE CARLA MOORE/CARLA ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN3n25 r2mnnsi m Thn ARr1Rr1 name nnA Inn^arc renicfnrnrll mnrlrc^f ARr)pn DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Pape: 1. Employee Benefit Liability Coverage..................................................................................................2 2. Unintentional Failure to Disclose Hazards............................................................ .............................7 3. Damage to Premises Rented to You...................................................................................................8 4. Supplementary Payments...................................................................................................................9 5. Medical Payments. ........., ............... ... ...... ......... .........................................................9 6. Voluntary Property Damage(Coverage a.)and Care, Custody or Control Liability Coverage (Coverage b.).........................................................................................................9 7. 180 Day Coverage for Newly Formed or Acquired Organizations ..................................................10 8. Waiver of Subrogation .......................................................................................................................10 9. Automatic Additional Insured -Specified Relationships: ................................................................ 10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions -Permits Relating to Premises; • State or Political Subdivisions -Permits;and • Contractors'Operations 10. Broadened Contractual Liability -Work Within 50'of Railroad Property.........................................14 11. Property Damage to Borrowed Equipment....................................................................................... 14 12. Employees as Insureds-Specified Health Care Services: ............................................................ 14 • Nurses; • Emergency Medical Technicians;and • Paramedics 13. Broadened Notice of Occurrence...................................................................................................... 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment,except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 S. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD i) Reports all, or formance of investment any part, of the vehicles;or act, error or 3 Advice given to an omission o er ) person with respect to in any other that person's decision insurer; to participate or not to il) Receives a participate in any plan written or ver- Included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or omis- and Similar Laws sion;and Any claim arising out of b) There is no other your failure to comply with applicable insur- the mandatory provisions of ance. any workers' compensation, unemployment compensa- (2) Exclusions tion insurance, social secu- rity or disability benefits law This insurance does not apply or any similar law. to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of liability imposed on a fiduci- "Bodily injury", property ary by the Employee Re- damage or personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits committed by any insured, are available, with reason- including the willful or reck- able effort and cooperation less violation of any statute, of the insured, from the ap- (c) Failure to Perform a Con- plicable funds accrued or tract other collectible insurance. Damages arising out of fail- (i) Taxes,Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment-Related meet any obligations under any plan included in the Practices "employee benefit pro- Any liability arising out of gram". any: (e) Inadequacy of Perform- (1) Refusal to employ; ance of Investment / Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, demotion, evaluation, reassign- 1) Failure of any invest- ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formafion on past per- tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 3 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations c Persons or organizations applies to all damages ( ) g sustained by any one "em- making claims or bringing ployee", including such "suits' employee's" dependents (d) Acts,errors or omissions;or and beneficiaries, because of all acts, errors or omis- (e) Benefits included in your sions to which this insur- "employee benefit pro- anoe applies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement defend the insured is the most we will pay for all against any "suits" damages because of acts, er- seeking those dam- rors or omissions negligently ages;and committed in the "administra- tion" of your "employee benefit 2) Your duties, and the program". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act,error or Limit shown in Section B. Limits omission,or claim, of Insurance, 1. Employee apply irrespective of the Benefit Liability Coverage of application of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries,as a result of: claim or "suit" and, upon notification of the action (a) An act,error or omission;or taken, you shall promptly (b) A series of related acts, er- reimburse us for such part rors or omissions, regard- of the deductible amount as less of the amount of time we have paid. that lapses between such d. Additional Conditions acts,errors or omissions, committed in the As respects Employee Benefit Li- negligently, ability Coverage, SECTION IV - "adminlstration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as However, the amount paid un- follows: der this endorsement shall not (1) Item 2. Duties in the Event of exceed, and will be subject to Occurrence, Offense, Claim or the limits and restrictions that Suit is deleted in its entirety and apply to the payment of benefits replaced by the following: in any plan included in the em- ployee benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission,or Claim or Suit a. You must see to it that we are noti- (a) Our obligation to pay dam- fied as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a claim. To the extent possible, no- amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred; and Each Employee. The limits 2 of insurance shall not be ( ) The names and addresses of reduced by the amount of anyone who may suffer dam- this deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD in any benefit included benefits, workers' com- in the "employee bene- pensation and disability fit program". benefits;and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- grams; leave of ab- s. Handling payroll sence programs, in- ductions;or cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transpor- coverage of insurance, tation and health club including but not limited subsidies. to unemployment in- (2) The following definitions are surance,social security deleted in their entirety and re- benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit" means a civil pro- ceeding in which money 2. "Cafeteria P damages because of an plan authorized by applica- act, error or omission to ble law to allow "employ- which this insurance applies ees" to elect to pay for cer- are alleged. "Suit" includes: tain benefits with pre-tax dollars. a. An arbitration pro- ceeding in which such 3. "Employee benefit P ro- damages are claimed grams means a program and to which the in- providing some or all of the sured must submit or following benefits to "em- does submit with our ployees", whether provided consent; through a "cafeteria plan" or otherwise: b. Any other alternative a. Group ife insurance; dispute resolution pro- p ceeding in which such group accident or damages are claimed health insurance; den- and to which the in- tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil other than an "em- proceeding. ployee" may subscribe to such benefits and g, "Employee" means a per such benefits are made son actively emptoyed, for- generally available to merly employed, on leave those "employees"who of absence or disabled, or satisfy the plan's eligi- retired. "Employee" in- cludes a leased worker". bility requirements; "Employee" does not in- b. Profit sharing plans, clude a"temporary worker". employee savings plans, employee stock 2. Uninlentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV- COMMERCIAL GENERAL subscription plans, LIABILITY CONDITIONS, 7. Represen- provided that no one tations is hereby amended by the addi- other than an em- tion of the following: ployee" may subscribe to such benefits and Based on our dependence upon your such benefits are made representations as to existing hazards, if generally available to unintentionally you should fail to disclose all "employees" who all such hazards at the inception date of are eligible under the your policy, we will not reject coverage plan for such benefits; under this Coverage Part based solely on c. Unemployment insur- such failure. ance, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD caused by or resulting 5. Medical Payments from rain, snow, sleet The Medical Expense Limit of An One or ice, whether driven p Y by wind or not. Person as stated in the Declarations is amended to the limit shown in Section B. c. Limit of Insurance Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to ments of this endorsement. You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for"property damage" to property of others arising out of opp 6. Subject to 5. above, the orations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- COVERAGE A. BODILY sured;or INJURY AND PROPERTY (2) Damage occurs while in the in- DAMAGE LIABILITY, for sured's possession. damages because of "property damage" to With your consent, we will make premises while rented to these payments regardless of fault. you or temporarily occupied by you with permission of b. Care, Custody or Control Liability the owner, arising out of Coverage any one "occurrence" to SECTION I - COVERAGES, COW which this insurance ap- ERAGE A. BODILY INJURY AND plies. PROPERTY DAMAGE LIABILITY,2. (3) The amount we will pay is lim- Exclusions,j. Damage to Pro erty, ited as described in Section B. Subparagraphs (3), (4) and r5) o Limits of Insurance, 3. Dam- not apply to "property damage" to age to Premises Rented to the property of others described You of this endorsement. therein. 4. Supplementary Payments With respect to the insurance provided by this section of the endorsement, the fol- Under SECTION I - COVERAGE, SUP- lowing additional provisions apply: PLEMENTARY PAYMENTS - COVER- AGES A AND B: a. The Limits of Insurance shown in the Declarations are replaced by the lim- a. Paragraph 2. is replaced by the fol- its designated in Section B. Limits of lowing: Insurance, 6. Voluntary Property U to the limit shown in Section B. Damage and Care, Custody or Up Control Liability Coverage of this Limits of Insurance, 4.a. Bail Bonds endorsement with respect to cover- of this endorsement for cost of bail age provided by this endorsement, bonds required because of accidents These limits are inclusive of and not or traffic law violations arising out of in addition to the limits being re- the use of any vehicle to which the placed. The Limits of Insurance Bodily Injury Liability Coverage ap- shown in Section B. Limits of Insur- plies. We do not have to furnish ance, 6. Voluntary Property Dam- these bonds. age and Care, Custody or Control b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse- lowing: ment fix the most we will pay in any one "occurrence regardless of the All reasonable expenses incurred by number of: the insured at our request to assist us in the investigation or defense of (1) Insureds; the claim or "suit", including actual (2) Claims made or "suits" brought; loss of earnings up to the limit shown or in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- (3) Persons or organizations mak- dorsement per day because of time ing claims or bringing "suits". off from work, Includes copyrighted material of Insurance GA 233 02 07 Services Office,Inc.,with its permission. Page 9 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD you cease to be a ten- c) Any physical or ant in that premises. chemical change in the product 2) Structural alterations, made intentionally new construction or by the vendor; demolition operations performed by or on be- d) Repackaging, un- half of such additional less unpacked insured. solely for the pur- pose of inspection, (b) Any P g demonstration, from which you lease testing, or the equipment with whom you substitution of have agreed per Paragraph parts under in- 9.a.(1) above to provide in- structions from the surance, Such person(s) or manufacturer, and organizations) are insureds then repackaged solely with respect to their in the original liability arising out of the container; maintenance, operation or use by you of equipment e) Any failure to leased to you by such per- make such in- son(s) or organizations(s). spections, adjust- However, this insurance ments, tests or does not apply to any "oc- servicing as the currence"which takes place vendor has after the equipment lease agreed to make or expires. normally under- takes make in (c) Any P 9 the usual course (referred to below as ven- of business, in dor) with whom you have connection with agreed per Paragraph the distribution or 9.a.(1) above to provide in- sale of the prod- surance, but only with re- ucts• spect to "bodily injury" or "property damage" arising f) Demonstration, in- out of"your products"which stallation, servic- are distributed or sold in the ing or repair op- regular course of the ven- erations, except dor's business, subject to such operations the following additional ex- performed at the clusions: vendor's premises 1 The insurance afforded in connection with the sale of the the vendor does not product; apply to: g) Products which, a) "Bodily injury" or after distribution or "property damage" sale by you, have for which the ven- been labeled or dor is obligated to relabeled or used pay damages by as a container, reason of the as- part or ingredient sumption of liabil- of any other thing ity in a contract or or substance by or agreement. This for the vendor. exclusion does not apply to liability for 2) This insurance does damages that the not apply to any in- vendor would sured person or or- have in the ab- ganization: sence of the con- tract or agree- a) From whom you ment; have acquired such products, or b) Any express war- any ingredient, ranty unauthorized part or container, by you; entering into, ac- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD of the additional in- spects any other insurance sured;or policy issued to the addi- tional insured, and such 2) The rendering of, or other insurance policy shall failure to render, any be excess and /or noncon- professional architec- tributing, whichever applies, tural, engineering or with this Insurance. surveying services, in- cluding: (b) Any insurance provided by this endorsement shall be a) The preparing, primary to other insurance approving or fail- available to the additional ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, in SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS,S.Other and specifications; Insurance, b. Excess and Insurance;or b) Supervisory, in- 2) For any other valid and spection, archi- collectible insurance tectural or engi- available to the addi- neering activities, tional insured as an additional insured by 3) "Your work" for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is been provided by the written on an excess primecontractor-project basis. In such case, manager or owner of the coverage provided the construction project under this endorse- in which you are in- ment shall also be ex- volved, cess. b. Only with regard to insurance pro- (2) Condition 11. Conformance to vided to an additional insured desig- Specific Written Contract or nated under Paragraph 9.a.(2) Sub- Agreement is hereby added: paragraph (f) above, SECTION III - LIMITS OF INSURANCE is amended 11. Conformance to Specific to include: Written Contract or The limits applicable to the additional Agreement insured are those specified in the With respect to additional written contract or agreement or in insureds described in Para- the Declarations of this Coverage graph 9.a.(2)(f)above only: Part,whichever are less. If no limits are specified in the written contract If a written contract or or agreement,or if there is no written agreement between you contract or agreement, the limits ap- and the additional insured plicable to the additional insured are specifies that coverage for those specified in the Declarations of the additional insured: this Coverage Part. The limits of in- a. Be provided by the In- surance are inclusive of and not in surance Services Of- addition to the limits of insurance fice additional insured shown in the Declarations. form number CG 20 10 c. SECTION IV - COMMERCIAL GEN- or CG 20 37 (where ERAL LIABILITY CONDITIONS is edition specified);or hereby amended as follows: b. Include coverage for (1) Condition 5. Other Insurance is completed operations; amended to include: or (a) Where required by a written c. Include coverage for contract or agreement, this 'your work"; insurance is primary and / and where the limits or cov- or noncontributory as re- erage provided to the addi- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD TIONS) is hereby deleted and replaced (2) The names and addresses of by the following: any injured persons and wit- a. You must see to it that we are noti- nesses;and fied as soon as practicable of an (3) The nature and location of any "occurrence" or an offense which injury or damage arising out of may result in a claim. To the extent the"occurrence"or offense. possible,notice should include: This requirement applies only when (1) How, when and where the "oc- the 'occurrence"or offense is known currence" or offense took place; to an "authorized representative". I Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-AO7CF92FB7AD A CERTIFICATE OF LIABILITY' INSURANCE D08/17/201 YY► 08/1712015 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: N the cartifcate holder is an ADDITIONAL INSURED,the Pollcy(ias)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 carocate does not corder rights to the certificate holder in lieu of such endorsomen a. 7R UCM NAME Sharon English ASHBY INSURANCE AGENCY ENE .919-732-1052 Aa 919-732-1574 StateFarrn 206 Millstone Drive sh919-73 id5hby.net owl Hillsborough, NC 27278 INSUR 6 AFFORDING COVERAGE NAIC M _ INSURERA�e Farm Fire and Casualty Canpany 26143 INSURED MECHANICAL SOLUTIONS,INC. INSURER B; 503 Cornerstone Ct. mSURERC: Hillsborough, NC 27278 INSURER q; INSURER E: NSURER 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. NOTWTHSTANDING 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. L SR TYPE OF INSURANCE Y NUMBER Y F M Y (� X COMMERCIALGENERALLU&LITY Y LIM1T8 ��y--�� EACHOOCURRENCE ; 2,000,000 CLAIMS-MADE L"1 OCCUR 93-BR-U760-6 12/0112014 12MI12015 PREMISES Ea oa�rrrenoa $ MEO EXP(Arty one person) f 5,D00 PERSONAL&ADVINJURY ; 2,000,000 GEN'L AQ(#tEGATE UMIT APPLIES PER; GENERAL AGGREGATE y 4,000,000 POLICY PRI- LOC JECT PRODUCTS-COMPIOPAGG ; 4,000,ODD OTHER: S AUTOMOeILEL1AeRJTY B! ED SING U R S a ANY AUTO BODILY INJURY(Per person) ; ALL AUTOS AUTOS AUTOSLEb NON-OWNED BODILY INJURY(Per al adeM) S AUTOS � S DAMAG S UNBRFiLALIAa OCCUR FXCESSUAS EACHOCCURRENCE $ AGGREGATE ; DED RETENTIONS WORKERS COMPENSATION $ AND EMPLOYERS'LIASiLITY YIN SAT E ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ED NIA E-L.EACH ACCIDENT g (Mandatory In NH) II yyeaa,,de""u under E.L DISEASE-EA EMPLOYE S DESCRIPTION OF OPERATIONS below t L - E DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEIIKl ES iACORD 101,AddM.d Ramada fte",may be aka(rlad K,non spay Is hrqulrad) ADDITIONAL INSURED:ORANGE COUNTY PO BOX 8181 Hillsborough,NC 27278 CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY PO BOX 8181 SHOULD ANY OF THE ABOVE DESCRIBED POUCIE$BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, HILLSBOROUGH,NC 27278 ACCORDANCE WITH THE POLICY PROViB ON$NOTICE WILL BE DELIVERED IN, A EOREPRE7E ®9988-2014 ACO RPOfiATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 132849.9 02-04-2014 DocuSign Envelope ID: CCB5CCD8-1AB9-4C00-B1 F6-A07CF92FB7AD A °°® CERTIFICATE OF LIABILITY INSURANCE 8%17%2015`' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Colonial Insurance Agency Hillsborough (PA HONE (919)732-2191 A/C No:(919)732-2192 E-MAIL ADDRESS: PO BOX 490 INSURERS AFFORDING COVERAGE NAIC# HILLSBOROUGH NC 27278 INSURER AAuto-Owners 18988 INSURED INSURER B:Owner8 32700 Mechanical Solutions Inc INSURERC: 503 Cornerstone Ct INSURERD: INSURER E: Hillsborough NC 27278-6546 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1532000964 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADS L 5 BDR POLICY NUMBER MM/�DY� POLICY//YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE F OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea BINEDISINGLE LIMIT 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED 4973490201 /20/2015 /20/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N IM TS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERWEMBER EXCLUDED? N/A (Mandatory in NH) 35165425 /20/2015 /20/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) i 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 AUTHORIZED REPRESENTATIVE CARLA MOORS/CARLA ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 lgntnn51 n1 Tha A(1)Pr)name and Innn mra ranicfararl mnr4c of Ar-npn