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HomeMy WebLinkAbout2017-345-E Health - El Futuro, Inc. for outpatient mental health, substance abuse treatment services DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E [Departmental Use Only] TITLE El Futuro-Ment. Health FY 2017-2018 NORTH CAROLINA SERVICES AGREEMENT UNDER$90,000.00 NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter "Agreement"), made and entered into this first day of July, 2017, ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and El Futuro, Inc. a not- for-profit corporation, located at 136 E Chapel Hill Street, Durham, NC 27701, (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 of project): outpatient mental health and substance abuse treatment 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 Revised 2/17 1 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E performance of these services. Provider is solely responsible for the professional 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) 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. vi) 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): as outlined in the attached Exhibit A Scope of Services - FY 2017-18. 4. Duration of Services a. Term. The term of this Agreement shall be from July 1, 2017 to June 30, 2018. b. Scheduling of Services. i) The Provider shall schedule and perform its activities in a timely manner. Revised 2/17 2 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E 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 July 1, 2017. 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. The maximum amount payable for Basic Services shall not exceed Fifty Two Thousand Two Hundred Fifty Dollars ($52,250). 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 (Rebecca Crawford) 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 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 http://www.orangecountync.gov/departments/purchasing_division/contracts.php). If County's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of N/A (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. Revised 2/17 3 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E 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 property damage or bodily injury including death 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 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. e. Suspension. County may suspend the Basic Services and this Agreement at any time for County's convenience and without penalty to County upon three (3) days' notice to Revised 2/17 4 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E Provider. Upon any suspension by County, Provider shall discontinue work on the Basic Services and shall not resume the Basic Services until notified to proceed by County. 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. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are 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. c. Non-Discrimination. 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 non-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Any violation of the Orange County Non-Discrimination Policy 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. 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. 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. e. Entire Agreement. 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. Revised 2/17 5 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E 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. 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 consent of the Parties to utilize electronic signatures and the intent of the Parties to comply with Article 11A 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: Kimberlee Quatrone El Futuro, Inc. P.O. Box 8181 136 E. Chapel Hill Street Hillsborough,NC 27278 Durham,NC 27701 [SIGNATURE PAGE TO FOLLOW] Revised 2/17 6 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E 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: riDocuSigned by: DocuSigned by: tlAA/Lit, Nuit la'SkAi ripkt, Swat By: 0637994B755E477.. By C2F60264R503461 County Manager Luke Smith, Executive Director Printed Name and Title Revised 2/17 7 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: El Futuro, Inc. Party/Vendor Contact Person: Kerry Brock Contact Phone: 919-688-7101 x632 Party/Vendor Address: 136 E. Chapel Hill Street City Durham State: NC Zip: 27701 Department: Health Amount: $52,250 Purpose: Outpatient mental health and substance abuse treatment services Budget Code(s): 10414020-63000 Vendor#57915 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7-1-17 Approved by Board Yes No ❑ Agenda Date: 6/20/17 This agreement is approved as to to caf u ' nm fbt d• 'co�,tent: Vat (�t (I�t 7/26/2017 Department Director's Signature 5145A2CD945C40F... Date: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficient 11481tig 'standards,specifications, and requirements: MSA. rbvvutl6 7/26/2017 Office of the Risk Management Officer 7FDCF9176800498... Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: 6j a7, A.446,. 7/26/2017 Office of the Chief Financial Officer 7 0e Date: Legal Services This agreement is approved as to e :7„i`1'?Indd"lY�d'-��sufficiency: A. r” 'tL SGb 7/26/2017 Office of the County Attorney 0,�A48�2 cO5 FB... Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 2/17 8 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E Revised 2/17 9 DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E EXHIBIT"A" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: El Futuro, Inc. Program Name: Avanza: Mental Health Access and Engagement for Latino Immigrant Youth and Families Funding Award: $52,250 ($31,250 MoE Funds; $21,000 Public Health) Outline how the agency will spend Orange County's funding award. Ex E erase Desert E Lion Amount Wages and benefits for mental health clinicians(psychiatrists and therapists) $47,250 Wages and benefits for Bilingual Clinical Coordinator $5,000 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018, • Clinical Treatment: Psychiatrists and mental health therapists provide clinical treatment in school- based setting at A.L. Stanback Middle School • • Clinical 'Treatment: Psychiatrists and mental health therapists provide clinical treatment h outpatient clinic in Durham • • Program Coordination: Bilingual Clinical Coordinator manage school-based relationships, scheduling within the school and with El Futuro clinicians, and related program activities Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County,only(all Towns and municipalities).If you use percentages,you must also provide the total number of participants within that measure's description or for an earner performance measure. Anticipated Performance Measures Results Outpatient mental health and substance abuse treatment provided in bilingual and culturally 215 welcoming approach(unduplicated persons served) Culturally appropriate mental health services provided to Latino children in school-based setting 40 (unduplicated persons served) Psychoeducational groups for Latino adolescents and their parents held in school-based setting or 30 • co-located at allied agency(unduplicated persons served) Percentage of Orange County clients receiving treatment who experience a reduction or 75% stabilization in clinical symptoms Percentage of Orange County clients receiving treatment who experience functional 75% improvements or stabilization Certified'b A,. (' Title: c �c r c c° '.�' Date: / d ( 17 rovider s Signature) DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E _r-""N CERTIFICATE DATE OP I©.KR .4C�►Rn __.RNSU_INSURANCE eakVDDrYWYI_ a �� C ER MATTER OF ONLY AND CONFERS St NO RIGHTS UPON ..__... 09C2312d18 THIS CERTIFICATE IS ISSUED N 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,they i (l .. be end_ _ S_. _____N I._._�_ VED, _.,b)ect to ertiflcate' ,_...__m � popsy{les) mutst be erndolxed. If SUBROt3ATION IS WAIVED,suM�-___.___ the terms and conditions of the policy,certain policies may require an endorsement. A.statement on this certificate does not confer rights to the _µ,a__ficat oldeLi ) of such antdDrsement s, PRODUCER INS IN5t1RANCEiAGENCY . _.._..w � ,_ HENDERSON,NC Le sMS�2$2+49-4dFiO m„m.._... . �Luc,,Nal 252-492-,625fi _...._µ 27Tr38 enLcom House Account/Joel T.Cheatham AplODOtt kima+mnca l colN~��w'U” ELFGT 1 ..._... _.__._ _...___ R _00.!c N.,._..._ It'ISGRsD El FGtJrv,Inc. NUERA Scottsdale InuraneCompar Insurance 136 E Chapel Hill Street eraU, ;/LIBERTY MUTUAL INSURANCE jmm Durham,NC 27701 i I NBURSR D INSURER E: IN91Rf_. .OVER ._,...-�..«,,.�....._.,._ .,CERTIFICATE NUMBER :a CERTIFICATE NUMBS REVISION NUMBER: NOTWITHSTANDING RtAT E ANY RE-6F IN URA TERM OR _6W HAVE _N„i, UE „ INSURM H ICY RI THIS IS Tq CERTIFY THAT THE POLICIES OF INSURANCE LIS'7ED BELOW HAWS BEEN ISSUED TO THE INSURED NAMLIJ�A8C3VE FOR THE PpLIC',Y P[RE�1C2 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 INSRr ....;MrrDL ISUR __...,_._. — _proLferEIrP._.r'�1r P ,,. ,._.� ,.,.. _...—.—., ,��_, Mm,µ TYPE OF INSURANCE e,S . � PO'LICYTiI'WAi�ER M_iMl'D 1 LNIA1Te GENERAL LIABILITY EACH OCCURRENCE S 1,600r00rl A X COMMERCIAL GENERAL LtAeltlrY X ' CIPS001B8450 10)05/2016 10/05/2017 nr ETOTSEFI'rErr l3 ^^�.S�L!dN_ r=" k �i 30000 J CU41MS�-IMDE X 'occuR i r+>ED 'P{Any one Ea w,2 s _.. '5,000{ � l PERSONAL a ADV INJURY s 1 000 000, .. I GENERAL AGGREGATE s s oaa,MU 1,' OEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG S 3000 000` ix I PCLICY.1_,im..Id;.1:;1L.-/---117PC .w.,._..� m_,.... � 7 I S AUTOMOBILE LIABILITY T. COieNED SINGLE LIMIT S 1 000�00fl AHY AUTO V I(Ea accident: BODILY INJURY(Per pers0r4 S ALL OWNED AUTOS . _IOOIL.._.,-.,.e_,_ -ST”— _..._. ......,,..,. SCHEDULED AUTOS . — --? BODILY INJURY(Purr aetMard, PROPERTY DAMAGE - ,--- A 1 X HIRED AUTOS PS0058460 10/05/2016 10/0512017 IPERACCtDENTI A X NON-OWNED AUTOS OPS0065460 10/05/2016 1010'5/2017 I s II Tri s ' UMBRELLA UAB OCCUR EACH OCCURRENCE S _ ffxcESa lue CLAIMS-rtkADE AGGREGATE S DEDUCTIBLE s WORKERS C MPEWSAmf}N ._..._. M,_....,.... ..��,..._.-,._ .w,..M ..w.m.___.a_.._..., �VVC STA'TMI,.w 2- $ ..w __RN,iE_NT „_„„ AND EMPLOYERS'UABK.JTY Y N �,Q¢yy�,ilr}ln� B '.ANY PROPRIETORFPARTNERIEXECUTOVE El , C2441.435700-015 11/12120155 11/12/2016 EL EACHACCIDENT s ,.�,.m..,.1,000 000u OFFIGERAIIENBER EXCLUDED? N T A I ,..._ ,._.._.,., 'IMandato.Y In MO E L DISEASE EA EMPLOYEE;i 1,000,000; 14 yet,describe und el' DESCRIPTION OF_gPERATIONTt bedew V 4 17�1SEASE.-POLICY LIMIT S.,,,_��1,Dd0, 0C A iProfesslonalLiab I OPS0058480 1010512016110/05/2017 IlEa Claim —1,006,006 Claims Made �R ETRO 10105/05 1 Aggregate 3,000,0001 _ .. _..., A. _._.General Liability,but uI,If man up .. ._...� ,. .�......w. DEED WPnON OF OPERATIONS F LOCATIONS I VEHICLES IMMO,ACORD 101,AdelMansl Remarks Soh_ _ _...o woos is reeturraiN ,. Certificate holder is additional insured der a Gene , only with respects to operations of the Named Insured.. CERTIFIC1,T..'a a ..!..': CANCELLATI e'>) SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ty ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Finance Dept 1 200 S Cameron Street AUTHORIZED aelsPRCaeNIAYnre Pd}BOX 8181 1 House AccountlJoel T.Cheatham Hillsboro,NC 27278 (D 1980-2009 ACORD CORPORATION. Ail rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:78BE6605-1 CDA-4976-978A-2870E79AD11 E SUMMARY OF INSURANCE HE I "FORD„ FOR: EL FUTURO Prepared:7/12/2017 136 E CHAPEL HILL ST DURHAM NC 27701 Phone: FAX: BY: HOME OFFICE PAYCHEX INSURANCE AGENCY INC/PAC 250881 PO BOX 33015 SAN ANTONIO TX 78265 Phone: FAX: (888) 443-6112 ACCOUNT POLICY RECAP Policy Number Eff Date Exp Date Premium . Workers' Compensation 76 WBG ZS2911 11122016 11122017 $2, 987 .00 Trumbull Ins Co POLICY DETAIL Policy . Workers' Compensation Policy States: NC Location 01 Premises Address 136 E CHAPEL HILL ST DURHAM, NC 27701 Location 02 Premises Address 319 A EAST 3RD STREET SILER CITY, NC 27344 Worker's Compensation Coverages Employer's Liability Limits Limit Disease - Policy Limit $1, 000, 000 Disease - Each Employee $1, 000, 000 Each Accident $1, 000, 000 Individual Included/Excluded Class/Payroll Detail Class Description Class code Payroll #of Emp Location 01 - NC °oo000°m`79'97 m,, '9'9'9'9'9'9'9'9 0930 Location 01 - NC PHYSICIAN & CLERICAL 8832 883719 Location 02 - NC '?'?'?'?'?`'`'`'`'`'` 7-?7'>7-?7-?????'?'?'�'? 0930 Location 02 - NC PHYSICIAN & CLERICAL 8832 714 This summary and its attachments provides high level overview of policy coverages and does not include all conditions, limitation or exclusion. Please refer to the actual policy forms for detailed coverages, limits and deductibles.