HomeMy WebLinkAbout2018-290-E Planning - Hazen & Sawyer Lake Orange damDocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
[Departmental Use Only]
TITLE L.O.Daminspect.2018
FY 17 -18
NORTH CAROLINA
SERVICES AGREEMENT UNDER $90,000.00
NO RFP/RFQ
ORANGE COUNTY
This Services Agreement (hereinafter "Agreement "), made and entered into this 12th day of
July, 2018, ( "Effective Date ") by and between Orange County, North Carolina a political
subdivision of the State of North Carolina (hereinafter, the "County ") and Hazen and Sawyer,
P.C., (hereinafter, the "Provider ").
WITNESSETH:
That the County and Provider, for the consideration herein named, do hereby agree as
follows:
1. Services
a. Scope of Work.
i) This Agreement is for services to be rendered by Provider to County with respect to
(insert type ofproject): Lake Orange Dam Inspection Services, 2018.
ii) By executing this Agreement, the Provider represents and agrees that Provider is
qualified to perform and fully capable of performing and providing the services
required or necessary under this Agreement in a fully competent, professional and
timely manner.
iii) Time is of the essence with respect to this Agreement.
iv) The services to be performed under this Agreement consist of Basic Services, as
described and designated in Section 3 hereof. Compensation to the Provider for
Basic Services under this Agreement shall be as set forth herein.
2. Responsibilities of the Provider
a. Services to be provided. The Provider shall provide the County with all services
required in Section 3 to satisfactorily complete the Project within the time limitations set
forth herein and in accordance with the highest professional standards.
b. Standard of Care.
i) The Provider shall exercise reasonable care and diligence in performing services
under this Agreement in accordance with the highest generally accepted standards
of this type of Provider practice throughout the United States and in accordance
with applicable federal, state and local laws and regulations applicable to the
performance of these services. Provider is solely responsible for the professional
Revised 10/17
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
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): An inspection of the Lake Orange dam and
appurtenances and a report of findings and recommendations, as described in the
detailed quote from Hazen and Sawyer, P.C., dated June 28, 2018 (see Attachment A).
See Attachment B for map of limits of work.
4. Duration of Services
a. Term. The term of this Agreement shall be from July 12, 2018 to November 12, 2018.
b. Scheduling of Services.
i) The Provider shall schedule and perform its activities in a timely manner.
Revised 10/17
2
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
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 no later than
August 2, 2018.
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 FIFTEEN
THOUSAND Dollars ($15,000.00). Payment for Basic Services shall become due and
payable within thirty (30) days of Provider properly invoicing County. Payment shall be
subject to provisions of Section 5(b).
b. Disputes. In the event the amount stated on an invoice is disputed by the County, the
County may withhold payment of all or a portion of the amount stated on an invoice
until the parties resolve the dispute. Should Provider fail to perform its duties under the
terms of this Agreement, County may, without fault or penalty, withhold any payment
associated with the work to be performed until such time as said work is completed.
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 (Christopher J. Sandt, Staff
Engineer) 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
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3
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
effect and certification thereof has been received by the County's Risk Manager.
8. Indemnity
a. Indemnity. The Provider agrees, without limitation, 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.
Revised 10/17
4
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
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
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 identified, on the list created by the State Treasurer pursuant to
G.S. 147 - 86.58. By executing this Agreement Provider certifies that Provider has not
been identified, and has not utilized the services of any agent or subcontractor identified,
on the list created by the State Treasurer pursuant to G.S. 147 - 86.81.
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.oran ecountync. og v /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.
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.
Revised 10/17
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DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
f. Severability. If any provision of this Agreement is held as a matter of law to be
unenforceable, the remainder of this Agreement shall be valid and binding upon the
Parties.
g. Ownership of Work Product. Should Provider's performance of this Agreement generate
documents, items or things that are specific to this Project such documents, items or
things shall become the property of the County and may be used on any other project
without additional compensation to the Provider. The use of the documents, items or
things by the County or by any person or entity for any purpose other than the Project as
set forth in this Agreement shall be at the full risk of the County.
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.
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 11 A 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: Christopher J. Sandt, P.E. Christopher Phillips, P.E.,
P.O. Box 8181 Hazen and Sawyer, P.C.
Hillsborough, NC 27278 4011 WestChase Blvd., S 500
Raleigh, NC 27607
[SIGNATURE PAGE TO FOLLOW]
Revised 10/17
6
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
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:
IMruS"xjnM hy:
f-'637904B7fL=477...
County Manager
Revised 10/17
7
PROVIDER:
1). uS pned by:
Christopher Phillips, P.E., Associate VP
Printed Name and Title
DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
Attachment A - Detailed Quote
Hazen
June 28, 2018
Hazen and Sawyer
4011 Westchase Boulevard, Suite 500
Raleigh, NC 27607 • 919.833.7152
Christopher J. Sandt, P.E.
Staff Engineer
Planning & Inspections Department
Orange County
Engineering /Stormwater Division
131 W. Margaret Lane
P.O. Box 8181
Hillsborough, NC, 27278
Via email: csandt @orangecountync.gov
Re: Lake Orange Dam Inspection Services
Dear Mr. Sandt:
Hazen is pleased to submit our proposal to Orange County to provide inspection services associated with
Lake Orange Dam. The scope of services is based on the Request for Estimate dated June 7, 2018 and
subsequent email correspondence.
The purpose of the 2018 inspection is to make a general assessment of the condition of the dam and
appurtenances based on a visual inspection, and to identify any potential areas of concern that might
warrant closer examination and /or remedial attention. The level of effort that we propose is somewhat
elevated from that of the 2015 inspection. In addition, the County has requested an assessment of the level
of alkali silica reaction (ASR) within the concrete spillway and concrete side channel.
Scope of Services
As requested, Hazen has developed a list of tasks that represent the total scope of services indicated in the
Request for Estimate. It is our understanding that the County may select a limited number of tasks based
on available funding and follow up at a later date to complete the full scope of services. We have included
the service numbering from the Request for Estimate for your reference
Task 1 — Visual Inspection (Request for Estimate Items 1 & 2)
Qualified Hazen structural and dam engineers will complete a reconnaissance -level inspection of the dam
embankment, abutment contacts, and downstream areas to identify any indicators of excess seepage or
unusual embankment performance. In addition, the inspection team will inspect the above -water portion
of the intake structure, access bridge, and related equipment to identify any unusual conditions or areas of
concern. The team will also visually inspect the concrete spillway, including the 2011 repairs, to identify
any unusual conditions or areas of concern, inclusive but not limited to joint deterioration and evidence of
potential ASR.
hazenandsawyer.com
DocuSign Envelope ID: 80EOOD3A- B06E -49BE- 9975- 1947B52242CA
Hazen
Christopher J. Sandt, P.E.
June 28, 2018
Although we expect that the majority of these deficiencies will be readily detectible in the field, we
recommend that Orange County personnel flag any known deficiencies and/or that Orange County
personnel attend the inspection.
The inspection documentation will be provided as part of the Task 3 services. Any issues requiring
immediate attention will be discussed with County personnel directly after the inspection.
Task 2 — Intake Structure Inspection (Request for Estimate Item 3)
Orange County has requested a scope of services and fees associated with a detailed below -water and
interior inspection of the existing intake structure and pipe. This scope of work is beyond the traditional
routine visual inspection and will require the services of a subconsultant specializing in underwater
inspection services and the support of a standby rescue team during the underwater inspection and
confined space entry within the structure. We anticipate coordinating both of these services to take place
simultaneously in order to reduce costs and that the local fire service staff can act as the standby rescue
team.
Hazen will coordinate the underwater intake structure and outlet pipe inspections with a subconsultant to
ensure a comprehensive inspection. The below water inspection of the intake structure will include a
visual and/or tactile inspection of all exposed and accessible external surfaces of the structure to
document observed material conditions, defects, and potentially hidden signs of distress, degradation, or
erosion. The inspection of the outlet pipe will be conducted using a Remotely Operated Vehicle (ROV).
Upon completion of these services, the subconsultant will provide a detailed video and photographic
record along with report documentation.
Hazen structural staff will conduct the interior inspection of the intake structure. The inspection of the
interior of the intake structure will include a visual inspection of all exposed and accessible internal
surfaces to document observed material conditions, defects, and potentially hidden signs of distress,
degradation, or erosion. The interior inspection will be conducted using confined space procedures and
will require the support of a standby rescue team.
The inspection documentation will be provided as part of the Task 3 services. Any issues requiring
immediate attention will be discussed with County personnel directly following the inspection.
Task 3 — Report of Findings and Recommendations (Request for Estimate Items 5, 6, & 7)
Upon completion of Tasks 1 & 2, Hazen will provide a detailed Report of Findings that will include the
inspection observations and photographic documentation from both the Task 1 & 2 inspections. This
information will establish a photographic record for comparison and review during future inspections.
Photographs taken during previous inspections will also be provided as part of the historic documentation.
The Report of Findings will include Hazen's recommendations for additional monitoring, facility
maintenance, and/or remedial repair related to Task 1 & 2. A prioritized list of repairs along with scaled
exhibits and estimated budget costs will be included.
Page 2 of 3
hazenandsawyer.com
DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
Hazen Christopher J. Sandi, P.E.
June 28, 2018
Fees
Hazen will perform the services summarized above for the following Not to Exceed fees. The fees
associated with the underwater subconsultants are estimates based on our previous experience and will be
finalized based on the specific project conditions determined as part of the Task 1 Visual Inspection.
• Task 1 — Visual Inspection $3,500
• Task 2 — Intake Structure Inspection
Interior Inspection & Coordination $2,500
Underwater Exterior Inspection & Pipe Inspection $5,000
(Subconsultant Services - estimated 2 days at $2,500 /crew /day)
• Task 3 — Report of Findings and Recommendations $4,000
Schedule
We are available to schedule Task 1 services upon receipt of Notice to Proceed and anticipate that the field
work can be completed within three weeks. Tasks 2 will be scheduled upon the completion of Task 1, as
requested. Task 3 will be completed within four weeks of the completion of Tasks 1 & 2.
Please let us know if you have any questions.
Very truly yours,
Jeffery G. Powers, PE
Senior Associate
Page 3 of 3
hazenandsawyer.com
DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
ACbRi>*
CERTIFICATE OF LIABILITY INSURANCE
DATE jMMODNYYYj
06128/2018
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, EX'T'END 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
Marsh USA, Inc.
1166 Avenue of the Am ericas
CONTACT
NAME:
PHONE FAX
N :
WL
New York, NY 10036
Attn: NewYork.certs@Marsh.com Fax: (212) 946 -0500
10 UUN UU0890
0312912018
0312912019
INSURER(S) AFFORDING COVERAGE
NAIC p
INSURER A : Hartford Fire Insurance Compan
19682
$
INSURED HAZEN AND SAWYER
INSURER B : Hartford Casual Insurance Company
29424
INSURER c: Twin Cily Fire Insurance Company
29459
498 SEVENTH AVENUE
INSURER D! Zurich American Insurance Company
16535
NEW YORK, NY 10018
INSURER E!
PRODUCTS - COMP(OP AGG
$ 2.000.000
INSURER F :
$
13
A
COVERAGES CERTIFICATE NUMBER. NYC010311127 -01 REVISION NUMBER: 3
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.
INSIR
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POLICY NUMBER
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LIMITS
A
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COMMERCIALGENERALUABILIY
CLAIMS -MADE F_x1 OCCUR
10 UUN UU0890
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0312912019
EACH OCCURRENCE
$ 1A40,000
DAMAGE TO RENTED
PREM SES E&occu ro
$
MED EXP An one rsan
$ 10,000
PERSONAL 3 ADV INJURY
$ 1,00000
GENL AGGREGATE LIMIT APPLIES PER:
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GENERAL AGGREGATE
$ 2,000,OOD
PRODUCTS - COMP(OP AGG
$ 2.000.000
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13
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AUTOMOBILE
LIABILITY
ANY AUTO
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AUTOS ONLY AUTOS
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AUTOS ONLY AUTOS ONLY
1OUEN000960 (AOS)
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COMBINED SINGLE LIMIT
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$ 1.000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
P acted n4
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$ 1,000
X
UMBRELLA LIAR
EXCESS LIAB
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ANYPROPRIETORIPARTNER (EXECUTIVE
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DESCRIPTION OF OPERATIONS I LOCATIONS F VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached if more space is required)
Orange County Planning and inspections Department is included as additional insured (except workers' eampensation) where required by written contract.
CERTIFICATE HOLDER CANCELLATION
Orange County Planning and Inspections
Deparlmenl
PO Box 8181
131 W. Margaret Lane
Hillsborough, NC 27278
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AtITHORIZE.D REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee _rA ML AM.D" �'p�.+a�rc w eel•
V 19135 -ZO1 ti AQUKU L:UKPOKA I IUN. All rights reservea.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA
HAZE &SA -01
CERTIFICATE OF LIABILITY INSURANCE
DATE 07 /02f2018Yj
a7rouaol a
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($), 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 CWCT
.NAME:_
Ames & Gough PHONE FAR
8300 Greensboro Drive IA+C,No, Exta: (703) 827 -2277 (AIC�NOI.(703) 827 - 279
Suite 980 >-Md'L . admin@amosgough.com
McLean, VA 22102 ___- --•-•- -- •._ -- -- 1 .
INSURED
Hazen and Sawyer
498 Seventh Avenue
New York, NY 10018
A
nnVFRA(_1FC r PRTIFIr:ATF NI IIUIRFR- 0F=VICIn1d III IBARr-R-
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.
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OPER Yt AMAGE
yyNEp
AUTOS ONLY AUOTOS SNLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
H
" AGGREGATE _
EXCESS LIAB
CLAIMS -MADE
DIED RETENTIONS
WORKERS COMPENSATION
PER 4TH
AND EMPLOYERS' LIARI.LITY YIN
ECUTIVE
ANY PRRMIEETOR EXCLUDED?
;Mandatary fn VIII
N I A
E.L, EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
S
If yes describe under
' DESCRIPTION OF OPERATIONS beelnw
E.L. DISEASE • POLICY LIMIT
A
Liab
AEHDO8231489
03/29/2018
0312912019
Per Claim/Aggregate
1,040,000
S jCyberLiability
002880201
I
08109/2017
08/0912018
Aggregate
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 191, AddlUorml Reroerko Schedule, maybe attached If more apace is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Orange County Planning & Inspections Department
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 8181
131 W Margaret Lane
Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
ACORD 25 (2015103) O 1988 -2015 ACORD CORPORATION. All rights reserved.
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