HomeMy WebLinkAbout2016-415-E Aging - Nathaniel Shapiro for wellness instructor DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
[Departmental Use Only]
TITLE Wellness Instructor
FY 2016-17
ORANGE COUNTY
CONTRACT UNDER $15,000.00
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 15th day of July, 2016, ("Effective Date")by and
between Orange County, North Carolina, a political subdivision of the State of North Carolina, (the
"County"),party of the first part; and Nathaniel Shapiro (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: Seymour Fitness Studio management averaging nine hours per week
The term of this agreement rendered shall be from July 15, 2016 to June 30, 2017.
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 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 six-
thousand dollars for nine hours per week @ $13.15/hr, ($6,000). 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. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability
Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may
be required by County'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
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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
http://www.orangecountync.gov/departments/purchasing division/contra cts.php). if County's Risk
Manager determines additional insurance coverage is required such additional insurance shall consist of
personal liability insurance (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
County'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, its agents, or assigns directly or indirectly related to the Services to be performed
pursuant to this Agreement 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. County may suspend this Agreement upon
reasonable 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. Priority: In determining the basic services to be provided, should any documents be
referenced in or attached to 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.
9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the
State of 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 state and federal anti-discrimination laws,
policies, rules, and regulations and the Orange County Anti-Discrimination Policy. Any violation of this
requirement is a breach of this Agreement and County may immediately terminate this Agreement without
further obligation on the part of the County. This paragraph is not intended to limit and does not limit the
definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and
shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By
executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the
services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58.
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 venue with respect to such suits or actions. Binding
arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of
any dispute prior to the bringing of such suit or action.
11. 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.
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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
[SIGNATURE PAGE TO FOLLOW]
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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
IN WITNESS WHEREOF,County and the Provider have signed this Agreement, effective as of
the day first written above.
ORANGE COUNTY PROVIDER
,---DocuSigned by: r DocuSigned by:
By: IjNlabt,lt, t'a.wkwit,v'StUi By: •
Ca qtS9g :Hager Title!"`-1 FADFAC9AAA24FC_.
200 S. Cameron St. Nathaniel Shapiro
P.O. Box 8181 2701 Homestead Rd, Apt. 113
Hillsborough,NC 27278 Chapel Hill, NC 27516
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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
4„, , _,„
.., ., = K&K Insurance Group,Inc.
1712 Magnavox Way
Fort Wayne,IN 46804
Phone 1-800-506-4856
-. N'kS"liY t"/ `O' Fax 1-260-459-5590
Insuring ib r world's feint Claims 1-800-237-2917
Application Date : 07/31/2015
7 s t Ns; Fina��-Surnnle x
5 L e - i 7
tE Fitness Instructors,
_
-;Insured Information
2
;Are you an insurance agent or No
broker?
Named insured (as it should appear Nathaniel P Shapiro
on the policy):
Doing business as (DBA): nat Shapiro
Contact first name:
Contact last name: 1.
Mailing address: 2701 homestead rd.
City: chapel hill State: North Carolina Zip: 27516
Phone: 919-357-5392 Fax: Cell: 919-357-
5392
E-mail: natshapiro890gmaii.com t
is
Website:
This is a new account
Commercial General,Liability _
Eligibility
Selected operation(s): Personal training
Coverage effective date(s): 09/01/2015 to
09/01/2016
In which state does the insured reside? North Carolina
Does the insured employ other people? No
Is the insured under the age of 18? No
Is the insured currently certified? Yes
Who is the insured certified by?
NASM
Coverage&.Limits
Each Occurrence: $ 1,000,000
5,000,000
General Aggregate (other than Products-completed Operations): $ (per year) 1
Products-completed Operations Aggregate: $ 1,000,000 i
Personal and Advertising Injury: $ 1,000,000 i=
Legal Liability to Participants: $ 1,000,000
Professional Liability: $ 1,000,000
Damage to Premises Rented to You: $ 300,000
Medical Expense (other than participants): $ 5,000
Abuse, Molestation, Harassment or Sexual Conduct Defense Cost $ 100'000
Reimbursement
DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
Certification Infor'm'ation
Certification organization Certification number (if Expiration date (if any)
NASM 1501209331 07/07/2017
Total Commercial General Liability Premium $179.00'
Notable Exclusions:
The following exclusions are contained in the commercial general liability coverage provided by this
program. Abuse, molestation; harassment or sexual conduct; Aircraft/hot air balloon; Airport; Amusement'
devices (the ownership, operation,'maintenance or use of: any mechanical or non-mechanical ride, slide, or
water slide, any inflatable recreational device, any bungee operation or equipment, any vertical device or
equipment used for climbing-either affixed or temporarily erected,or dunk tank. Amusement,
devices do not include any video or computer games or any device that is specifically designed for the
training or instruction of the activity for which you are enrolled); Animals (injury or death to or injury,
or property damage caused by any animal owned, rented or hired by you); Any adult-themed
parties/meetings/trips, including but not limited to parties/meetings/trips during which demonstration of,'
products and/or services used in the adult entertainment industry takes place;,Asbestos; Commercial
general liability standard exclusions (CG0001 04/13 edition); Employment-related"practices; Fireworks;
Fitness/exercise operations related, in whole or in part, to performance as an exotic dancer or any similar,
occupation in the adult entertainment industry; Fungi or bacteria; Haunted attractions; Lead; Medical,,
therapy or health care services; Nuclear energy liability; Operation,ownership or management of a fitness,
dance or sports facility;.Performers; Physicals/stress testing; Physical therapy, massage or salon services;
Rodeos; Saddle animals; Sale or distribution of medicinal, herbal and/or nutritional products; Snowmobile;
Training programs for law enforcement, public safety and military personnel; Weight control programs;
Those operations listed as ineligible: Acrobatic/Partner yoga Instructors, Certified athletic trainers, Coaching
of organized competitive.athletic teams, Cycling (other than stationary),".Instructors under the age of 18,
Instructors operating outside of the U.S., Instruction of sports skills activities, Instructor's employment as
an exempt or non-exempt employee of a school, university or college; Instruction/activities held on or in
open water. - - - -
Terms &Conditions:
1. Premiums are 100%fully earned when coverage begins and non-refundable.
( 2. Any exposure changes that deviate from the original enrollment form must be reported in writing.
3. Acceptance of this quote confirms your desire to obtain liability insurance through the Sports, Leisure
and Entertainment Risk Purchasing Group. K&K reserves the right to decline any request for
coverage.
4. Coverage is contingent upon receipt of premium payment. No coverage will be deemed in effect until
premium is received by the company or their representative.
5. This program only provides coverage for your individual operations as an instructor. The policy does
not extend coverage for activities conducted by employees or anyone else assisting or performing on
your behalf.
6. Commercial General Liability Broadening Endorsement:
• Expected or intended bodily injury or property damage resulting from the use of reasonable
force to protect persons or property.
• Non-owned Watercraft-extended to 58 feet.
• Supplementary Payments- $2,500 bail bonds, $500 a day loss of earnings.
• Waiver of Right of Recovery.
• Bodily Injury definition expanded to include mental anguish, mental injury,shock,fright,
humiliation, emotional distress or death resulting from bodily injury, sickness or disease.
• Damage to Premises Rented to You - the term fire is replaced with fire, lightning, explosion,
smoke and leaks from sprinklers.
• Additional Coverage:
o Emergency Real Estate Consultant Fee-$25,000
o Identity Theft Exposure - $25,000
o Key Individual Replacement Cost- $50,000
o Lease Cancellation Moving Expense - $2,500
o Temporary Meeting Space- $25,000
o Terrorism Travel Reimbursement- $25,000
o Workplace Violence Counseling - $25,000
Additional Certificate Request
Do you need to request any additional Certificate(s) of Insurance to present to a No
third party?
Warranty, &'Discilosure, --
I understand that the insurance company, in determining whether to provide insurance coverage, will