Loading...
HomeMy WebLinkAbout2016-576-E AMS - ASD (Asphalt Services On Demand) for repaving parking lot at Skills Development DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D [Departmental Use Only] TITLE Skills Dev Parking Lot FY 2016-17 NORTH CAROLINA CONSTRUCTION AGREEMENT UNDER$250,000.00 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter called "Agreement"), made as of the 20th day of October, 2016, by and between ASD (Asphalt Services On Demand), (hereinafter called the "Contractor"), and Orange County, a body politic and a political subdivision of the State of North Carolina, (hereinafter called the "Owner"). WITNES SETH: That the Contractor and the Owner, for the consideration herein named, agree as follows: 1. CONTRACT DOCUMENTS; PRIORITY The Contract Documents consist of this Agreement, the Request for Proposals, Proposal, Construction Drawings, and Written Specifications. The Contract Documents form the Contract. In the event of any inconsistency between or among the Contract Documents the Contract Documents shall be interpreted in the following order of priority: a. This Agreement. b. Designer Approved Bulletins and/or Field Orders. c. Request for Proposals and addenda thereto. d. Proposal. 2. SCOPE OF WORK The Contractor shall furnish and deliver all of the materials, and perform all of the work required by this Agreement within the time period stipulated in a written Notice-to-Proceed to be executed by the Contractor and Owner and in accordance with the following enumerated documents, which are made a part hereof as if fully contained herein: a. Construction Drawings prepared by CRA(Sheet C1.0, C1.1,C2.0, C3.0 dated 6/21/16) b. Written specifications prepared by the project engineer. c. ASD proposal dated October 5, 2016 which fully describes the work to be performed. Such work will hereafter be called the "Work". d. Related documents listed under Section 1 above. 3. TERM AND SCHEDULING Revised 6/16 1 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D a. The Contractor agrees to commence work pursuant to the written Notice to Proceed. b. The Contractor agrees to complete substantially all Work by December 31, 2016. c. Time is of the essence with respect to all dates specified in the Contract Documents as Completion Dates. d. The Contractor shall perform the Work in the time, manner, and foam required by the Contract Documents and as stipulated in a written Notice-to-Proceed to be executed by the Contractor and Owner. e. It is expressly understood that the Owner will employ other contractors to perform work as a part of the Project whose work will be performed simultaneously and sequentially with the performance of the Work by the Contractor. It shall be necessary for the Contractor to coordinate its activities with such other contractors, particularly with respect to access to work areas, storage of materials and other common facilities. f. Should the Owner determine that the Contractor is behind schedule Owner may require, at no additional cost to the Owner, the Contractor to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform the Work in accordance with the approved project schedule. 4. STANDARD OF CARE a. The Contractor shall exercise reasonable care and diligence in performing the Work in accordance with the highest generally accepted standards of this type of Contractor practice throughout the United States and in accordance with.applicable federal, state and local laws and regulations applicable to the performance of these services. Contractor is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work. b. The Contractor shall not load or permit any part of the Work to be loaded with a weight that will endanger its safety, intended performance or configuration. c. Contractor shall be responsible for all errors or omissions caused by its employees, agents, contractors, or assigns in the performance of the Agreement. Contractor shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the Owner. d. Contractor is an independent contractor of Owner. Any and all employees of the Contractor engaged by the Contractor in the performance of any work or services required of the Contractor under this Agreement, shall be considered employees or agents of the Contractor only and not of the Owner, 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 Contractor. e. If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Contractor represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, Revised 6/16 2 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. 5. PAYMENT & TAXES a. The Owner hereby agrees to pay to the Contractor for the faithful performance of this Agreement, and the Contractor hereby agrees to perform all of the Work for a sum not-to- exceed One Hundred Thousand Seven Hundred Two Dollars and Fifty Cents (This is base bid minus "Removal of Existing Dumpster Fencing, and Intallation of New Dumpster Pad Chain-link fence and 4' gate, includes acceptace of add alternate G-1. Base Bid $65285.00 - Fence related work $4000.00 + Add Alt G-1 $39,417.50 = Total NTE $100,702.50) Dollars ($100,702.50). Not later than the fifth (5th) day of each calendar month the Contractor shall submit to the Owner's Representative, generally the architect if an architect is retained on the Work, a Request for Payment for work done during the previous calendar month. i. The Request for Payment shall be in form of a standardized invoice or AIA Document G702-703 appropriately addressed to Owner's Representative at CRA 222 Cloister Court, Chapel Hill, NC 27514 and shall show substantially the value of work done during the previous calendar month. ii. The amount due for payment shall be ninety-five percent (95%) of the value of work completed since the last Request for Payment and this amount shall be paid by the Owner on or before the last business day of the month. Owner shall retain five percent(5%). 1. Upon Owner's Representative's certification that ninety percent (90%) of the Work has been satisfactorily completed retainage may be discontinued. Retainage may be discontinued, at Owner's Discretion, so long as work continues to be completed satisfactorily and on schedule. iii. Final payment shall not be due to the Contractor until thirty (30) days after one hundred percent (100%) of the Work, including punch list work, has been satisfactorily completed and an appropriate affidavit as required in Section 7(c) below has been received by Owner. b. Should Owner reasonably determine that Contractor has failed to perfoini the Work related to a Request for Payment, Owner, at its discretion may provide the Contractor ten (10) days to cure the breach. Owner may withhold the accompanying payment without penalty until such time as Contractor cures the breach. i. Should Contractor or its representatives fail to cure the breach within ten (10) days, or fail to reasonably agree to such modified schedule, Owner may immediately telininate this Agreement in writing, without penalty or incurring further obligation to Contractor. ii. This section shall not be interpreted to limit the definition of breach to the failure to perform the Work related to a Request for Payment. c. The Contractor has included in the Contract Price and shall pay all taxes assessed by any authority on the Work or the labor and materials used therein. It shall be the Contractor's responsibility to furnish the Owner documentary evidence showing the materials used and sales and use tax paid by the Contractor and each of its subcontractors. 6. INSURANCE AND BONDS Revised 6/16 3 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D a. Minimum requirements — Contractor 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 herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing division/contracts.php). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall be designated here NA (if no additional insurance required mark N/A as being not applicable). Contractor shall not commence construction work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. b. Performance Bonds — Contractor shall furnish bonds covering the faithful performance of the Contract and payment of all obligations arising under any of the Contract Documents or related in any way to the Work. Contractor shall immediately furnish a copy of such bonds to any requesting person who appears to be a potential beneficiary of bonds covering payment obligations arising under any of the Contract Documents. This subsection 6(b) applies only to Contracts of fifty thousand dollars ($50,000.00) or more where the total cost for the project is three hundred thousand dollars ($300,000.00) or more. 7. INDEMNITY a. The Contractor shall indemnify and hold harmless to the extent permitted by law the Owner and its agents and employees from and against any and all claims, damages, losses and expenses, including attorney's fees, arising out of or resulting from the performance or nonperformance of the Work, provided that any such claim, damages, loss or expense (A) is attributable to bodily injury, sickness, disease or death or injury to, or destruction of, property, including the loss of use resulting therefrom; and (B) is caused in whole or in part by any breach of any provision of the Agreement or by any negligent or wrongful act or omission of the Contractor, any Subcontractor, or supplier of the Contractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The indemnification obligation under this paragraph shall not be limited in any way by any limitation of the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' compensation acts, disability benefits acts or other employee benefit acts. b. The Contractor shall indemnify and hold harmless Owner from any lien of whatever type through the purchase of appropriate bonds and insurance as designated in Section 6 above. In the event any such lien is filed against Owner's property Contractor shall, through such bonds and insurance or at Contractors expense, defend Owner against all such claims of lien. c. Upon completion of the Work the Contractor shall execute an affidavit stating there are no unpaid debts for any work that has been done or materials that have been furnished to the Project prior to and as of the date of substantial completion and further stating that Contractor shall indemnify, save and protect Owner and Owner's lender, if any, harmless from and against any and all claims, liabilities, losses, damages, causes of action, and expenses (including court costs and reasonable attorney's fees related thereto) arising out Revised 6/16 4 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D of, in connection with, or resulting from any such debts and liens. Such indemnification shall be in a form and substance acceptable to Owner. d. By executing this Agreement Contractor agrees to abide by and be bound by the indemnification provisions herein and of Section 7(c) specifically. S. DISPUTE RESOLUTION AND GOVERNING LAW a. Any dispute with respect to any provision of, or the performance or non-performance of, this Agreement shall be subject to the Dispute Resolution Rules and Procedures for Orange County Design, Building Construction, Renovation, and Repair Projects which rules and procedures are incorporated herein. b. The laws of the State of North Carolina shall apply to the interpretation and enforcement of this Agreement. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or nonperformance of, this Agreement or the Contract shall be brought in the General Court of Justice of North Carolina sitting in Orange County,North Carolina and it is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. c. Notice of any claim by Owner or Contractor must be initiated by written notice to the other Party within thirty (30) days of the occurrence of the event giving rise to the claim or within thirty (30) days of the discovery of the event or condition giving rise to the claim, whichever is later. i. Should any claim be made, regardless of whether such claim is made by Owner or Contractor, Contractor shall continue to faithfully and diligently perform the Work in such a manner as to meet all scheduled timelines. Any failure to faithfully and diligently perform the Work may be deemed, by the Owner, a breach of the Contract. ii. If a claim is made such claim shall be made to the initial decision maker, if applicable, who may request more supporting data, reject the claim in whole or in part, approve the claim in whole or in part or advise the parties the claim is unable to be resolved. iii. If a claim is made by the Owner the Owner may, but is not obligated to, notify the surety. 9. NON—APPROPRIATION a. Contractor acknowledges that Owner 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. b. In the event that public funds are unavailable and not appropriated for the performance of Owner's obligations under this Agreement, then this Agreement shall automatically expire without penalty to Owner immediately upon written notice to Contractor of the unavailability and non-appropriation of public funds. It is expressly agreed that Owner 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. Revised 6/16 5 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D c. In the event of a change in the Owner's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects Owner's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to Owner upon written notice to Contractor of such limitation or change in Owner's legal authority. 10. NOTICES Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Owner: Contractor: Orange County ASD (Asphalt Services On Demand) Attn: Angel Barnes 959 Short Journey Road P.O. Box 8181 Smithfield, NC 27577 Hillsborough,NC 27278 11. MISCELLANEOUS a. Duties and Obligations imposed by the Contract Documents shall be in addition to any Duties and Obligations imposed by state, federal or local law, rules, regulations and ordinances. b. No act or failure to act by the Owner or Contractor shall constitute a waiver of any right or duty granted them under the Contract Documents, nor shall any act or failure to act constitute any approval except as specifically agreed in writing. c. The Work shall be tested and inspected as required by the Contract Documents and as required by law. Unless prohibited by law the costs of all such tests and inspections related to state and federal codes such as ADA, Administrative, Electrical, Plumbing, Mechanical and Building Codes shall be borne by the Contractor. The costs for material and structural testing shall be conducted by an independent third party at the expense of the Owner. Delays related to any of the aforementioned tests and inspections shall not be grounds for delaying the completion of the work. If any such tests and inspections reveal deficiencies in the Work such that the Work does not comply with terms or requirements of the Contract Documents and/or the requirements of any code or law the Contractor is solely responsible for the cost of bringing such deficiencies into compliance with the terms of the Contract Documents and/or any code or law. d. Should the Architect, if an architect is retained for the project involving the Work, or Owner reject any portion of the Work for failing to comply with the Contract Documents Contractor shall immediately, at Contractor's expense, correct the Work. Any such rejection may be made before or after substantial completion. If applicable, any additional expense borne by the Architect under this section shall be paid at Contractor's expense. e. The Contractor shall not assign any portion of this Agreement nor subcontract the Work in its entirety without the prior written consent of the Owner. f. By executing this Agreement Contractor affirms that Contractor and any subcontractors of Contractor are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. Revised 6/16 6 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D g. By executing this Agreement Contractor certifies that Contractor 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. h. Contractor 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. i. 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. 12. CONSEQUENTIAL AND LIQUIDATED DAMAGES a. Owner and Contractor mutually waive any claim against each other for consequential damages. Consequential Damages include: i. Damages incurred by Owner for loss of use, income, financing, or business. ii. Damages incurred by Contractor for office expenses, including personnel, loss of financing, profit, income, business, damage to reputation, or any other non-direct damages. b. Liquidated damages shall be in accord with the Contract Documents. 13. TERMINATION OR SUSPENSION a. The Owner may, without cause, order the Contractor to terminate, suspend, delay or interrupt the Work in whole or in part for such period of time as the Owner may determine. In the event of termination by the Owner under this Agreement, the Contractor shall be entitled to receive its reasonable and documented direct costs prior to termination, including the cost of materials purchased for the Work which purchases cannot be canceled or which material cannot reasonably be used by the Contractor on other work, and the cost of closing down the work in a safe and efficient manner. i. If Owner orders a delay, suspension or interruption of the Work, and such order is not due to or as a result of any fault on the part of the Contractor, the Contractor may recover a per diem amount at a rate calculated by NA. ii. If Contractor elects to accept the amount listed in the General Conditions provision of the Construction Documents Contractor waives any right to further claims for payment of damages sustained as a result of Owner's order to delay, suspend or interrupt the Work. b. Contractor may terminate the Contract if, at the Owner's written direction, the Work is stopped for thirty (30) consecutive days through no act or fault of the Contractor, their Revised 6/16 7 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D agents or employees, or a subcontractor or their agents or employees or any other person performing work pursuant to the Contract Documents. Contractor may terminate the Contract if a Court or other Public authority having jurisdiction enters a lawful order that requires all work to be stopped and such stoppage lasts for thirty(30) consecutive days. 14. ENTIRE AGREEMENT All of the documents listed, referenced or described in this Agreement, the written Notice-to- Proceed, together with Modifications made or issued in accordance herewith are the Contract Documents, and the work, labor, materials and completed construction required by the Contract Documents and all parts thereof is the Work. The Contract Documents constitute the entire agreement between Owner and Contractor. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. If any provision of the Agreement shall be declared invalid or unenforceable, the remainder of the Agreement shall continue in full force and effect. [SIGNATURE PAGE TO FOLLOW] Revised 6/16 8 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the day and date first above written wholly or in a number of counterparts each of which shall, without proof or accounting for other counterparts, be deemed an original contract. ORANGE COUNTY CONTRACTOR i—UOCUSignetl by: —UOCUSignetl by: 660-1/,it.hAnt rsk Ovo—GCI Signature Signature County Manager Tim O'Donnell Project Manager Printed Name and Title Revised 6/16 9 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D AmSL PROPOSAL REVISED ASPHALT SERVICES ON DEMAND NCDOT Certified DBE/WBE NCDOT Reporting 1191110 959 Short Journey Road Smithfield,NC 27577 PROJECT: Skills Development Center parking Lot Repair COMPANY: DATE: 10/5/2016 CONTACT: LOCATION: 503 West Franklin Street Chapel Hill x 9 ` x .rx t ti "' `r° - -!?f9: p -v:*#.3§ max' ,.;'orve ft" -xrFr� fi" �.t'dv r�" f „r ,?.. .�...,..�..'ri hM, .-,.. .�..�,.�:. ..,.x a.�..�5'"..au.��.?;�-„,'Ye„��:.v..„�.�,�tex,�. .�., �...,.w �,..,�...,�, �M._x....?M.,�,�„�`�.�'-��t`",�. '�,c.^s.�u... ���.'v,.�..�%r'� '��.�s, .C'..e�.nw .k�',.�„�,.t� ,.,. ASD,Inc is pleased to provide the following proposal for the above mentioned project.Proposal includes all labor,equipment, materials and management for each scope listed below per plans noted below. Skills Development Center parking Lot Repair Description Qty Units Unit Price Total BASE BID Mobilization/Supervision 1 LS $ 5,000.00 $ 5,000.00 Mill existing Asphalt for Tapers 1 LS $ 5,500.00 $ 5,500.00 Remove Existing Dumpster Fencing 1 LS $ 1,500.00 $ 1,500.00 ({¢ Install New 6”Concrete Curb(WATERPROOFING EXCLUDED) 80 LF $ 100.00 $ 8,000.00 Install New Dumpster Pad Chain-link Fence&4'Gate 1 LS $ 3,000.00 $ 3,000.00 U;,,t• Overlay Existing parking lot 2”S9.5B 2320 SY $ 16.00 $ 37,120.00 Remove ex Parking Bumpers 11 EA $ 15.00 $ 165.00 Install Concrete Parking Bumpers 16 EA $ 75.00 $ 1,200.00 Paint Ex Bollards 4 EA $ 75.00 $ 300.00 Restrip Ex Parking Lot after Overlay(PAINT NO THERMO) 1 LS $ 3,500.00 $ 3,500.00 Total Base Bid Price: $ 65,285.00 $ - ADD ALTERNATE G-1 Mobilization/Supervision 1 LS $ 1,500.00 $ 1,500.00 Sawcut existing Concrete Paving&Remove 1 LS $30,000.00 $ 30,000.00 Finegrade&Compact Subgrade 467 SY $ 2.50 $ 1,167.50 8”ABC 225 TN $ 30.00 $ 6,750.00 Total ADD ALT G-1 Price: $ 39,417.50 — Total Base Bid&ADD Alt G-1 Price: $ 104,702.50 DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D Notes: a ASPHALT INDEX CLAUSE: Asphalt prices are based upon the September 2016 NCDOT terminal asphalt binder grade PG 62-22 FOB price of$337.50 per ton. Due to thaw market volatility in price of this material,this proposal is subject to a unit price adjustment for all bid items requiring asphalt binder.For each$1.00/ton change in the binder index,asphalt bid Item pricing will change at$0.06/ton accordingly.The most current available index price at the time of asphalt placement will be used in determining the price adjustment.If asphalt paving is to be measured by the square yard,then 115 Ib/sy per inch of pavement thickness will be used in determining hot mix tonnage. • PRICES: Pricing is this proposal is valid until 10/27/2016.We reserve the right to revise or withdraw this proposal if pricing is not accepted within 15 days of receipt,and work does not commence due to delays outside our control within 30 days of acceptance. • PROPOSAL TERMS OF USE: This proposal and/or attachments is confidential,and is for the sole use of the addressee(s)and associates Involved in evaluating scope of work and determining a project award.Bid items and/or unit prices in this proposal are applicable to this project only as per the bidding documents listed below. • BID QUANTITIES PER: Planswift Takeoff • NOTES: 1 Mobilizations included. Any Mobilizations past 1 Ea will be charged at$1,500.00 EA. • PLANS:Estimate based on plans noted below. Titled: Prepared By: Stamped By: Dated: Exclusions • Exclusions listed below are only for assistance in clarifying the scope of work listed above. All work titled to be constructed by others. erosion control Asbestos abatement Backfill of Building Walls Bonds,Permits,Tap fees,impact fees,meter fees and meter. Adjustments Backfill of 6"Curb Clean up behind other trades and spoil haul off. Cleaning asphalt prior to final lift of asphalt Fees/Permits Liquidated Damages. Permits of any kind Testing Traffic Control Waterproofing Payment Terms: Due upon receipt. If you have any questions please call me at(919)524-1979. Thank you for the opportunity to quote this project I Proposed for ASD,Inc.by Tim O'Donnell DocuSign Envelope ID:6EED282B-AE99-4E23-8F12-8D5CFC79F06D ASPHA-1 OP ID: DO C-4 CERTIFICATE F LIABILITY I DATE(MM/DD/YYYY) 10/12/2016 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 REPRESEN°'ATIVE 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 Danielle Ohlendorf Pittman Insurance Group,LLC PHONE FAX 5838 Faringdon Place (A/c.No.ExtY.919-878-8028 (WC,No): 919-876-4567 Raleigh,NC 27609 E-MAIL ADDRESS:danielle P ittmaninsurance rou IIc.com Hasten McDermott INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:NW Mutual Fire Insurance Co. 23779 INSURED Asphalt Services on Demand INSURER B:Accident Fund Insurance Co of 10166 959 Short Journey Road Smithfield,NC 27577-8266 INSURER c Selective Insurance Co,of Ame 12572 INSURER D:Mt.Hawley 37974 INSURER E:NW Mutual Insurance Company 23787 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ACP3017155310 06/21/2016 06/21/2017 DAMAGES(RENTED 100,000 PREMISES{Ea occurtence) $ , CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X FRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 (Ea accident) $ , e C X ANY AUTO S2218622 04/13/2016 04/13/2017 BODILY INJURY(Per person) $ X ALL OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUUTOSWNED PROPERTY ACCIDENMAGE X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 D EXCESS LIAB CLAIMS-MADE EMX0321560 04/14/2016 04/14/2017 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE WCV 611323100 06/21/2016 06/21/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Inland Marine ACP3017155310 06/21/2016 06/21/2017 Limit 970,522 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.Box 8181 HOsborough, NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD