HomeMy WebLinkAbout2018-163-E Animal Services - ForensiVet mobile servicesDocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
TITLE ForensiVet
FY 2017 -18
NORTH CAROLINA
ORANGE COUNTY
AN AGREEMENT FOR THE PROVISION OF CONSULTING VETERINARY
SERVICES
This Agreement is between the County of Orange ( "County ") through the Animal Services
Department ( "Department ") and ForensiVet Mobile Veterinary & Forensic Consulting, PLLC,
( "Provider ") whose address is P.O. Box 250, Oak Ridge, NC 27310, for the provision of
consulting veterinary services and forensic examinations.
WITNESSETH
WHEREAS, the County has a need for the services of a veterinarian with expertise in forensic
examination of animals; and
WHEREAS, ForensiVet Mobile Veterinary & Forensic Consulting is owned by and employs a
Iicensed forensic veterinarian in the State of North Carolina and desires to provide consultation
to Orange County through the Animal Services Department.
NOW, THEREFORE, in consideration of the promises and of the mutual covenants hereinafter
set forth, Orange County and ForensiVet Mobile Veterinary & Forensic Consulting agree to the
following terms and conditions:
A Veterinarian:!: The services of the Provider shall be provided by Clarissa Noureddine,
DVM, the owner of ForensiVet Mobile Veterinary & Forensic Consulting, who is
designated as, under this Agreement. There shall be no substitution of the
Veterinarian without the express written consent of the County.
B The Veterinarian shall provide the following services:
1, Work with Staff as required for medical and investigative needs to provide
examination services and reporting for specific cases where such expertise is
needed or required.
2. Maintain a license to practice veterinary medicine, that is current and in good
standing, in the state of North Carolina as well as the level of expertise and
education necessary to keep abreast of current industry standards and practices;
and
3. Maintain professional liability insurance coverage with coverage of at least $1
million, per occurrence, $1 million aggregate while providing services to the
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
Department, proof of such insurance shall be submitted annually to the
Department; and
4. Be a member in good standing of the American Veterinary Medical Association;
and
5. The Veterinarian agrees to defend, indemnify, and hold harmless the County, its
elected officials, employees or volunteers for all loss, liability, claims or expense
(including reasonable attorney's fees) 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 section
to require Provider to indemnify the County to the extent permitted under North
Carolina law; and
6. Comply with all applicable federal, State, and local laws, including non-
discrimination laws as may be applicable in fulfilling this agreement; and
7. The Veterinarian shall submit an invoice for services rendered to the Department
on a monthly basis.
C. The County agrees to:
1. Payment. Orange County shall reimburse the Provider for an amount not to
exceed Twenty -Five Hundred dollars ($2,500.00) at a rate of Seventy , dollars
{$70.00) per hour for services rendered from July 1, 2017 to June 30, 2018, and as
provided herein.
D. The Parties Agree to:
I . Term. The term of this Agreement shall be from July 1, 2017 through June 30,
2018, unless terminated sooner.
2. Terms of Payment.
a. The County shall pay the Provider for consultation services at a. rate of
Seventy Dollars ($70.00) per hour; and
b. The Department shall pay the Provider for services rendered within thirty
(30) days of an invoice properly submitted.
3. Termination of Prior Agreements and Amendments. This agreement supersedes
and nullifies any and all prior agreements or any amendments to the Agreements
between the County and Provider.
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
4. Termination. This Agreement may be terminated at anytime without penalty by
either party, with or without cause, upon delivery of written notice of termination
furnished to the other party at least thirty days prior to termination of the
Agreement. In the event of such termination, any payment due shall be prorated
to the date of termination.
5. Notice. Notice shall be provided to and sent as follows:
a. For Orange County: Robert A. Marotto, Animal Services Director,
Orange County, Animal Services Center, 1601 Eubanks Road, Chapel
Hill, North Carolina 27516.
b. For Provider: Clarissa Noureddine, DVM, whose address is PO Box 250,
Oak Ridge, North Carolina, 27310.
6. OSHA Compliance. Orange County controls the facilities where the Veterinarian
works. It is agreed Orange County is primarily responsible for compliance with
the Occupational Safety and Health Act (OSHA) and comparable state laws and
regulations to the extent those laws apply to the Veterinarian.
7. Workers Compensation. Veterinarian is responsible for her own workers'
compensation.
8. Independent Contractor. The services which Veterinarian shall render under this
Agreement shall be as an independent contractor with respect to Orange County.
Nothing contained in this Agreement shall be construed to create the relationship
of principal and agent, or employer and employee, between Provider or
Veterinarian and Orange County.
9. Non - Appropriation. No provision of this Agreement shall be construed or
interpreted as creating a pledge of the faith and credit of the Orange County
within the meaning of any constitutional debt limitation. No provision of this
Agreement shall be construed or interpreted as creating a delegation neither of
governmental powers nor as a donation by a lending of the credit of Orange
County within the meaning of the Constitution of the State of North Carolina.
This Agreement shall and does not directly or indirectly or contingently obligate
the Orange County to make any payments beyond those appropriated in the sole
discretion of Orange County for any fiscal year in which this Agreement shall be
in effect. No deficiency judgment may be rendered against Orange County in any
action for breach of a contractual obligation under this Agreement and the taxing
power of Orange County is not and may not be pledged directly or indirectly or
contingently to secure any monies due under this Agreement.
10. Entire Agreement. This Agreement contains the entire understanding of the
parties and shall not be altered, amended or modified except by an agreement in
writing executed by the duly authorized officials of both parties.
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
11. 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,
12. Compliance with Laws and Anti - Discrimination. Provider shall at all times
remain in compliance with all applicable local, state, and federal laws, rules, and
regulations. 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 pail of the County. This paragraph is
not intended to limit and does not limit the definition of breach to discrimination.
13. 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.
14. 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 11A and Article 40 of North Carolina
General Statute Chapter 66.
IN WITNESS WHEREOF, the parties have hereunto signed this Agreement on the day and
year listed below.
FOR FORENSIVET MOBILE VETERINARY
& FORENSIC CONSULTING, PLLC
OacuSignecE by,
26BC7450D4124F0...
V1A.113JLl 1 V V Ul l.uum%,, v dM
5/11/2018
Date
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
FOR AND ON BEHALF OF ORANGE COUNTY
F�60
GwVt �{,% Ae.V�
5/14/2018
v -ange County Manager Date
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
AV M A I P L I T' Veterinary Professional Liability
p1=aWetifiy yott tillydttgh it till Insurance Policy
Certificate of Insurance
This policy provides occurrence coverage. Please review the policy carefully.
ITEM 1: Insured by the stock company below and hereinafter called the Company
Zurich American Insurance Company
ITEM 2: Named Certificate Holder, member number, species, and address I Master Policy Number;
EOL 5241302 -13
Clarissa Green Nollreddine, DVM
D
ZURICH
U- VPL- 103 -A -CW (07104)
Certificate Number:
VETPR0037091
FOR INFORMATION OR TO FILE A CLAIM
PLEASE CALL (800) 228 -7548
ITEM 3: Policy Period
From: 01/01/2018
To: 01/01/2019
12:01 am Standard time at the address of the Named Certificate Holder
as stated herein
ITEM 4: Limits of Liability
Member Name Member No. Species Type Each claim $ 2,000,000
Clarissa Noureddine 211908 [IV] Small Animal Exclusive Aggregate $ 4,000,000
ITEM 5: Premium and coverage summary
Primary Professional Liability
$238.00
Excess Professional Liability
$102.00
Veterinary License Defense
$85.00
Professional Extension Endorsement (Animal Bailee)
$86.00
TOTAL DUE:
$511.00
ITEM 6: Forms Attached at Issuance:
U -VPL -100 -A CW (07104); U- VPL -I03 -A CW (07/04); GU- 1191 -A -CW (3115); U-
VPL -128 -A NC (10104); U- VPL -155 -ANC (10/04); U- VPL -101 -A CW (07/04); U-
VPL -102 -B CW (06/11); U -GU -319 -F (01109); U -GU -I 194 -A CW (08/15)
ITEM 7: Schedule of Plan Numbers and location(s) for Professional Extension
Endorsement (Animal Bailee) / Embryo and Semen Storage (if purchased):
For additional locations, please see the attached page
Location Number /Address
Extension Plan Embryo Plan
Plan 8
ITEM 8: Veterinary Professional Liability Regulatory Action License Defense
Coverage endorsement (if purchased): This Certificate of Insurance is issued off the Master Policy held by the American
Veterinary Medical Association (AVMA) Professional Liability Insurance Trust. By
Limit: $ 25,000 acceptance of this policy the Named Certificate Holder agrees that the statements in
the certificate and the application and any attachments hereto are the Named
Authorized Signature Certificate Holder's agreements and representations and that this policy embodies all
agreements existing between the Named Certificate holder & the Company or any
of its representatives relating to this insurance.
A-1 �' /��' -
Neil R. Hughes, President
HUB International Midwest Limited
Notice to the Company: Zurich American Insurance Company
P.O. Box 968041
Schaumburg, IL 60196 -8041
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
SANCTIONS EXCLUSION
ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
The following exclusion is added to the policy to which it is attached and supersedes any existing sanctions
language in the policy, whether included in an Exclusion Section or otherwise:
SANCTIONS EXCLUSION
Notwithstanding any other terms under this policy, we shall not provide coverage nor will we make any
payments or provide any service or benefit to any insured, beneficiary, or third party who may have any rights
under this policy to the extent that such cover, payment, service, benefit, or any business or activity of the
insured would violate any applicable trade or economic sanctions law or regulation.
The term policy may be comprised of common policy terms and conditions, the declarations, notices, schedule,
coverage parts, insuring agreement, application, enrollment form, and endorsements or riders, if any, for each
coverage provided. Policy may also be referred to as contract or agreement.
We may be referred to as insurer, underwriter, we, us, and our, or as otherwise defined in the policy, and shall
mean the company providing the coverage.
Insured may be referred to as policyholder, named insured, covered person, additional insured or claimant, or
as otherwise defined in the policy, and shall mean the party, person or entity having defined rights under the
policy.
These definitions may be found in various parts of the policy and any applicable riders or endorsements.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED
U -GU- 1191 -A CW (03/15)
Page 1 of E
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF54OE10
Endorsement
BM
North Carolina Amendatory Endorsement ZURICH
Certificate No.
Ef€ Date of Cerr.
Exp. Date of Cert.
Eff. Date of End.
Add'1 Prem.
Return Prem.
VETPR0037091
01/01/2018
01/01/2019
$511.00
$0.00
Named Certificate Holder and Mailing Address: Producer:
HUB International Midwest Limited
Clarissa Green Noureddine, DVM 55 East Jackson Boulevard
Chicago, IL 60604 -4187
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Veterinary Professional Liability Insurance Policy
It is agreed that Section 1V — CONDITIONS, Paragraph D is deleted in its entirety and replaced with the following:
1. CANCELLATION
a. This policy may be canceled by the Named Certificate Holder by surrender of the policy to the Company or by mailing
written notice to the Company stating when such cancellation shall take effect. If canceled by the Named Certificate
Holder, the Company shall retain the customary short -rate proportion of the premium, In no event may the requested date of
cancellation be greater than ten (10) days prior to the date the request is received by the Company.
b. If this policy has been in effect less than sixty (60) days, the Company may cancel this policy for any reason by mailing
written notice by certified snail to the Named Certificate Holder at the address shown in the Certificate of Insurance, and
mailing to the producer of record, if any. Such cancellation shall be no fewer than fifteen (15) days from the date the notice
is mailed. Such notice shall state the reason for cancellation and if applicable be accompanied by a refund of unearned
premium, except a premium that has been financed.
c. If this policy is in effect sixty (60) days or more, the Company may cancel this policy for the following reasons:
(1) Nonpayment of premium in accordance with the policy terms;
(2) An act or omission by the Named Certificate Holder or his representative that constitutes material misrepresentation
or nondisclosure of a material fact in obtaining the policy, continuing the policy, or presenting a Claim under the
policy;
(3) Increase hazard or material change in the risk assu►ned that could not have been reasonably contemplated by the parties
at the time of assumption of the risk;
(4) Substantial breach of contractual duties, conditions, or warranties that materially affects the insurability of the risk;
(5) A fraudulent act against the company by the Named Certificate Holder or his representative that materially affects the
insurability of the risk;
(6) Willful failure by the Named Certificate Holder or his representative to institute reasonable loss control measures that
materially affect the insurability of the risk after written notice by the company;
(7) Loss of facultative reinsurance, or loss of or substantial changes in applicable reinsurance as provided in G.S.58- 41 -30;
(S) Conviction of the Insured of a crime arising out of acts that materially affect the insurability of the risk; or
(9) A determination by the commissioner that the continuation of the policy would place the Company in violation of the
laws of the state of North Carolina.
If the Company cancels subject to c(1) through c(9) above, the Company will mail by certified mail to the Named
Certificate Holder at the address shown in the Certificate of Insurance, and mail to the producer of record, if any.
Written notice of cancellation shall take effect fifteen (15) days from the date of mailing for the reasons set forth in c(l)
through c(9) above.
Any written notice of cancellation subject to c(1) through c(9) will state the reason for such cancellation and will be
accompanied by a refund of unearned premium, except a premium that has been financed.
d. If notice is mailed, proof of mailing will be sufficient proof of notice.
e. The Company shall refund the unearned premium computed at customary short rates if the policy is terminated by
the Named Certificate Holder. Under any other circumstances the refund shall be computed pro rata.
U- VPL- 128 -A -NC (09104)
Page 1 of 2
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
2. NONRENEWAL
a. If the Company elects not to renew this policy, the Company shall mail by certified mail to the Named Certificate Holder at
the address shown in the Certificate of Insurance, and mail to the producer of record, if any, written notice of nonrenewal.
The Company may refuse to renew a policy that has been written for a Policy Period of one (1) year or less at the policy's
expiration date by mailing written notice of nonrenewal to the Named Certificate Holder at the address shown in the
Certificate of Insurance at least forty-five (45) days prior to the expiration date of the policy. The Company may refuse to
renew a policy that has been written for a Policy Period of more than one (1) year at the policy anniversary date by mailing
written notice of nonrenewal to the Named Certificate Holder at the address shown in the Certificate of Insurance at least
forty-five (45) days prior to the anniversary date of the policy.
b. The Company must file a plan with the commissioner at least fifteen (15) days before the issuance of a nonrenewal because
of loss or reduction of reinsurance.
c. If notice is mailed, proof of mailing will be sufficient proof of notice,
d. if either one of the following occurs, the company is not required to provide written notice of nonrenewal:
(1) The Named Certificate Holder has insurance elsewhere;
(2) The Named Certificate Holder has obtained replacement coverage or agreed in writing to do so; or
(3) The Named Certificate Holder has requested or agreed to nonrenewal.
e. The policy may not be extended to meet nonrenewal notice requirements in a. above.
d. The transfer of a policy between companies within the same insurance group or changes in premium, Limit of Liability or
coverage are not refusals to renew.
3. CONDITIONAL RENEWAL
a. If the Company elects to renew this policy and the renewal is subject to the following:
(1) reduction in coverage;
(2) impose any kind of surcharge; or
(3) increase premium rate.
b. If the policy being conditionally renewed was written for a Policy Period of one (1) year or less, the renewal terms and
statement of premium due must be mailed at least forty -five (45) days before the expiration date of the policy. If the policy
being conditionally renewed was written for a Policy Period of more than one (1) year, the renewal terms and statement of
premium due must be mailed at least forty-five (45) days before the anniversary date of that policy. The Company shall mail
or deliver by certified mail written notice of the changes to the Named Certificate Holder at the address shown in the
Certificate of Insurance, and mailed to the producer of record, if any.
c. If the Company fails to furnish the conditional renewal terms and statement of premium due in the manner required in b
above, the Named Certificate Holder may cancel the renewal policy within the thirty (30) day period following receipt of
the conditional renewal terms and statement of premium due. For refund purposes, earned premium for any period of
coverage shall be calculated pro -rata upon the premium applicable to the policy being renewed instead of the renewal policy.
d. If the Company fails to comply with the forty-five (45) day written notice requirement in b, above, the Named Certificate
Holder is entitled to the option of coverage under the policy being renewed and at the same cost of that policy until forty -five
(45) days have elapsed after the Company has provided the Named Certificate Holder with the notice.
e. if a policy has been issued for a Policy Period longer than one (1) year, and for additional consideration a premium has been
guaranteed for the entire Policy Period, it is unlawful for the Company to increase that premium or other policy or coverage
provisions less favorable to the Named Certificate Holder during the term of the policy.
All other terms, conditions and exclusions of this policy remain unchanged.
Signed by:
Authorized Representative
10/9/2017
Date
U -VPI. -128 -A NC (09 / 04)
Page 2 of 2
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
Endorsement
North Carolina Amendatory Endorsement ZURICH
Certificate No.
Eff. Date of Cert.
Exp. Date of Cert.
Ef. . Date of End.
Add'1 Prem.
Return Prem.
VETPR0037091
01/01/2018
1 01/01/2019
$511.00
$0.00
Named Certificate Holder and Mailing Address: Producer:
HUB International Midwest Limited
Clarissa Green Noureddine, DVM 55 East Jackson Boulevard
Chicago, II, 60604 -4187
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Veterinary Professional Liability Insurance Policy
It is agreed that the Veterinary Professional Liability Bailee Extension Endorsement, U -VPL -101 -A CW (07104), Section IV —
ADDITIONAL CONDITIONS, Paragraph I is deleted in its entirety and replaced with the following:
I. SUIT
No suit, action or proceeding for the recovery of any Claim under this endorsement shall be sustainable in any court of law or
equity unless the same be commenced within three (3) years after discovery by the Insured of the event which gives rise to the
Claim. The three (3) year period of time will be extended by the number of days between the date proof of loss was submitted and
the date the Claim is denied in whole or in part.
All other terms, conditions and exclusions of this policy remain unchanged.
Signed by: A 10/9/2017
Date
Authorized Representative
U-VPL- 15 5-A-NC (09104)
Page 1 of 1
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
P
Important Notice to Policyholders
The address for the headquarters of Zurich North America will change after August 1, 2016 due to a relocation of our
office in the same city. The new address is:
Customer Inquiry Center
Zurich North America
1299 Zurich Way
Schaumburg, IL 60196
1- 800382 -2150
For specific questions regarding your policy, please contact your agent or broker. For other questions, you may contact
the Customer Inquiry Center of Zurich North America. Any references to post office boxes previously provided remain
unchanged.
U -GU- 1194 -A CW (08/15)
Page 1 of 1
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
HUB INTL MIDWEST LTD /AVMA /PLIT
55 EAST aACKSON BLVD STE 14A
CHICAGO IL 60604
FORENSIVET MOBILE VETERINARY &
SULTING PLLC
ACORD 25 (2016163)
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
CERTIFICATE OF LIABILITY INSURANCE
3/27/2018'
THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or 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
HUB INTL MIDWEST LTD /ANNA /PLIT
550728 P: (800) 228 -7548 F: (866) 229 -3296
55 EAST JACKSON BLVD STE 14A
CHICAGO IL 65604
CONTACT
NAME:
INCN,Lxt): (800) 228 -7548
ca .Nor. (866) 229 -3296
naa ess:
INSURLR(S) AFFORDING COVERAGE NAICa
INSURLRA: Twin City Fire Ins Co
29459
INSURED
FORENSIVET MOBILE VETERINARY be
la ORENSTC CONSULTING PLLC
INSURER B:
83 SBM 7X9422
INSURERC:
08/30/2018
INSURLRD:
$1, 000, 0 0 0
INSURER E :
DAMAGE TO R£NTED
PREMISES (£a occurrence}
INSURER F :
X
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.
IN.SR
TYPE OF IN.SURANCF-
ADDL
SVBR
POLTCYNUMBER
POLICYEFF
AIMID
POLICFEXP
LIMITS
A
COMMERCIAL GENERAL LIABILITY
CLA MS -MADE OCCUR
General Liab
83 SBM 7X9422
08/30/2017
08/30/2018
EACH OCCURRENCE
$1, 000, 0 0 0
DAMAGE TO R£NTED
PREMISES (£a occurrence}
S1,000,()00
X
MED EXP (Any one person)
$10,000
PERSONAL &ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY PR� n LOC
OTHER:
G£NERALAGGRECATE
s2,000,
PRODUCTS - COMPIOP AGG
S2, 000/ 000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
H RED fx NON -OWNFO
AUTOS ONLY AUTOS ONLY
83 SBM TX9422
08/30/2017
08/30/2018
COMB NED S INGLE LIMIT
(Ea accident)
$1,000,000
BODILY NJURY (Per person)
S
BODILY NJURY(Per accident)
$
PROPERTY DAMAGE
(Per accWdenl)
$
$
UMBRELLA LiAB
EXCESS LIAB
OCCUR.
CLA MS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
OEV RETENTIONS
$
TT'OxXERS CoII/PBNSAT)ON
ANOEMPLOYERSLL4BILITY
ANY PROPR ETOWPARTNEWEXECUT€VE YIN
OFFICE WMEMBER EXCLUDED?
(Mandatory in NH) F1
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
_.........,._.
PER OTH-
STATUTE Eft
E L. EACH ACC DENT
$
E L. DISEASE - EA EMPLOYEE
$
E L. DISEASE- POLICY L MIT
$
DESCRIPTION OF OPERATIONSILOCA TIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attacked if more space is required)
Those usual to the insured's Operations.
RFIM:i111 1.11 CAS111 �NiL•J lqkl�l Ms'E. tN 71•I�>r rtld
U 1988 -2015 ACORD CORPORATION. All rights reserved.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
ORANGE COUNTY ANIMAL SERVICES
1601 EUBANKS RD
AUrHORIZED REPRESENTATIVE
CHAPEL HILL, NC 27516
U 1988 -2015 ACORD CORPORATION. All rights reserved.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
HUB INTL MIDWEST LTD /AVMA /PLIT
55 EAST JACKSON BLVD STE 14A
CHICAGO IL 60604
ORANGE COUNTY ANIMAL SERVICES
1601 EUBANKS RD
CHAPEL HILL NC 27516
ACORD 25 (2076103)
DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10
CERTIFICATE OF
INSR
LIABILITY INSURANCE
3/2 /2018)
THIS CERTIFICATEIS 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(fes) must have ADDITIONAL INSURED provisions or 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 ondorsement s .
PRODUCER
HUB INTL MIDWEST LTD /AVMA /FLIT
550728 P: (800) 228 -7548 F: (866) 229 -3296
CONTACT
NAllE:
Pr, °NE
(AIC,Nc,Exl): (800) 228 -7548
ia,No): (866) 229 -3296
A'D`DR'ss:
55 EAST JACKSON BLVD STE 14A
CHICAGO IL 60604
INSURER(S) AFFORDING COVERAGE NAIC#
INSURERA: Twin City Fire Ins Co
29459
INSURED
INSURER B:
EACH OCCURRENCE
FORENSIVET MOBILE VETERINARY S[
INSURERC:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
FORENSIC CONSULTING PLLC
INSURERO:
INSURER E:
$10,000
INSURERF:
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 OFIN.4URANCE
ADDL
SUBR
POT,ICYNUbfBER
POLICYEFA
1hf/OD
POLIC'YEXP
LIAfITS
A
COMMERCIAL GENERAL LIABILITY
CLA MS -MADE OCCUR
General Liab
83 S8M IX9422
08/30/2017
08/30/2018
EACH OCCURRENCE
$1,000, 0 0 0
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$1,000,000
X
MED EXP (Any one Person)
$10,000
PERSONAL &ADVIN31JRY
$1, 000, 000
AGGREGATE LIMIT APPLIES PER:
POLICY PRO - LOG LOG
dEG7
GEN'L
GENERAL AGGREGATE
$2, 000, 000
PRODUCTS • COMPIOP AGG
s2,000, 0 0 0
OTHER:
S
AUTOMOBILE LIABILITY
COMB NED 5 NGLE LIMIT
(Ea accident)
$1,000, 000
A
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X H RED X NON-OWNED
AUTOS ONLY AUTOS ONLY
B3 SBM IX9422
08/30/2017
08/30/2018
BODILY NJURY (Perperson)
$
BODILY NJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
S
UMBRELLA LlAB OCCUR
EACH OCCURRENCE
g
EXCESS LIAR CLA MS -MADE
AGGREGATE
$
DED RETENTION$ $
$
WORKERS COAfPENSA?ION
ANUEMPLOyERS LIABILITY
ANY PROPR ETORIPARTNERIEXECUTIVE YIN
OFFICERIMEMHER EXCLUDED? El
I'Mandaforyin NH)
W!l
PER OTH-
STATUFE ER
E L. EACH ACC DENT
$
E L. DISEASE- EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E L. DISEASE- POLICY L MIT
$
I-l-
L�7_
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Those usual to the Insured's Operations.
HOLDER
ORANGE COUNTY ANIMAL SERVICES
1601 EUBANKS RD
CHAPEL HILL, NC 27516
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PRnvic;inIUC
07 1988-2015 ACORD CORPORATION. All rights
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD