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2017-661 OPT - Triangle Office furniture
Revised 10/17 1 NORTH CAROLINA CONSTRUCTION SERVICES AGREEMENT UNDER $50,000 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter “Agreement”), is made and entered into this 18th day of December, 2017 by and between Orange County, North Carolina (hereinafter the "Owner") party of the first part; and Triangle Office Equipment (hereinafter the "Contractor"), party of the second part; W I T N E S S E T H: For the purpose and subject to the terms and conditions hereinafter set forth, the Owner hereby contracts for the construction services of the Contractor, and the Contractor agrees to provide the construction services to the Owner in accordance with the terms of this Agreement. 1. TERM AND MAXIMUM AMOUNT PAYABLE Beginning and ending dates of contract: December 18, 2017 through June 30, 2018. The Project Commencement Date shall be December 18, 2017. Dollar Amount Not to Exceed: Seventeen Thousand Three Hundred Three Dollars and Twenty Seven Cents ($17,303.27) 2. SERVICES Contractor agrees to provide the following construction services (the “Work”): Provide and install furniture and rework areas per proposal for OC Transp dated 10/12/2017 pages 1 thru 5, proposal for OC-Trans-Front Area dated 12/6/2017 pages 1 thru 2, and proposal for OC Trans Conf dated 10/12/2017 pages 1 thru 4. Contractor shall not sub-contract all or any part of the construction services provided for in this Agreement without prior written approval of the Owner. Contractor shall be responsible for all errors or omissions, in the performance of the Agreement. Contractor shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to Owner. 3. PAYMENT Contractor shall submit an invoice for construction services provided. The invoice shall contain Contractor's name and federal tax identification number and shall be signed and dated by an officer of Contractor. It shall detail all construction services provided in payment requests. The Owner will make payments to Contractor within thirty (30) days after receipt of and approval of the invoice by the contracting department. In the event the amount stated on an invoice is disputed by Owner, then Owner may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. In addition, should Contractor fail to perform its duties under the terms of this Agreement, Owner may, without fault or penalty, withhold any payment associated with the Work to be performed until such time as said work is completed. 4. RELATIONSHIP OF PARTIES Contractor is an independent contractor of the Owner. Contractor represents that it has or will secure, at its own expense, all personnel required in performing the construction services under DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800 Revised 10/17 2 this Agreement. Such personnel shall not be employees of or have any contractual relationship with the Owner. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized or permitted under state and local law to perform such construction services. It is further agreed that Contractor will obey all State and Federal statutes, rules and regulations which are applicable to provisions of the construction services called for herein. Neither Contractor nor any employee of the Contractor shall be deemed an officer, employee or agent of the Owner. 5. SUSPENSION AND TERMINATION This Agreement may be terminated by Contractor upon thirty (30) days' written notice to the Owner, and the Owner may terminate this Agreement upon thirty (30) days' written notice to Contractor. Owner may suspend the Work at any time for Owner’s convenience and without penalty to Owner upon three (3) days’ notice to Contractor. Upon any suspension by Owner Contractor shall discontinue the Work and shall not resume the Work until notified to proceed by Owner. The notice required by this section or any other notice shall be delivered via certified mail, return receipt requested to the parties at the addresses as shown on the signature page to this Agreement. Such notice is deemed given upon its delivery to, or deposit in a receptacle of, the United States Post Office. 6. INSURANCE 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 N/A (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. 7. INDEMNIFICATION Contractor agrees, without limitation, to defend, indemnify, save, and protect Owner and Owner’s lender, if any, harmless from and against any and all claims, liens, liabilities, losses, damages, causes of action, and expenses (including court costs and reasonable attorney’s fees related thereto) arising out of, in connection with, or resulting from any negligence, act or failure to act by the Contractor, the Contractor’s agents, assigns or employees resulting in property damage or personal injury, including death, or other loss related to the Work. Contractor is responsible for all errors or omissions caused by its agents, contractors, employees, or assigns in the performance of this Agreement. It is the intent of this section to require Contractor to indemnify the Owner to the full extent permitted under North Carolina law. 8. NON-ASSIGNMENT Contractor shall not assign all or any part of this Agreement, including rights to payments, to any other party without the prior written consent of the Owner. 9. NON–APPROPRIATION DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800 Revised 10/17 3 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. 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. 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. DISPUTE RESOLUTION 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. The policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). 11. ENTIRE AGREEMENT The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it, together with specifically referenced documents, constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified by a written amendment to this Agreement signed by the parties. Modifications may be evidenced by telefacsimile signatures. Should any conflict arise in the terms of any documents referenced herein and this Agreement the terms of this Agreement shall be given priority and shall control over all other such documents. Should a request for proposals and a proposal be referenced the terms of the request for proposals shall have priority over the terms of the proposal. 12. COMPLIANCE WITH LAW/GOVERNING LAW Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina and any action brought under this Agreement shall be brought in the General Court of Justice of the State of North Carolina in Orange County. 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 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. 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. By executing this Agreement Contractor certifies that Contractor has not been DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800 Revised 10/17 4 identified, and has not utilized the services of any agent or subcontractor identified, on the lists created by the State Treasurer pursuant to G.S. 147-86.58 and G.S. 147-86.81. 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 intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. [SIGNATURE PAGE TO FOLLOW] DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800 Revised 10/17 5 IN WITNESS WHEREOF Orange County and the Contractor have signed this agreement, effective as of the day and date first above written. ORANGE COUNTY CONTRACTOR By _________________________ By ________________________________ County Manager Triangle Office Equipment 200 S. Cameron St. 300B South Elliott Road P.O. Box 8181 Chapel Hill, NC Hillsborough, NC 27278 27514 DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800 7UH\-RQHV $X G U H \ - D F N V R Q 2U D Q J H & R X Q W \ 3 X E O L F 7 U D Q V S R U W D W L R Q 1 & + L J K Z D \ 1 RI I L F H 7UH\-RQHV % 6 R X W K ( O O L R W W 5 G &K D S H O + L O O 1 & 3 ) ZZ Z W U L D Q J O H R I I L F H H T X L S P H Q W F R P 5H S 3 K R Q H 5H S 3U H S D U H G ) R U ) 3 3U H S D U H G % \ ,W H P 4 W \ 3 U R G X F W 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : && 1 ' % ' ( * 5 ( ( & 2 9 ( 5 + * ) )$ % 5 , & * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 75 : 57 : 6 * < :2 5 . 6 8 5 ) $ & ( 5 ( & 7 $ 1 * 8 / $ 5 : * 5 2 0 0 ( 7 ' ; : 3 *5 2 0 0 ( 7 & 2 / 2 5 3 ( % % / ( * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 )6 ( ' * ( 7 < 3 ( 9 , 1 < / ( ' * ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ?* , = $ ? & ' % ? 2 & 7 5 $ 1 6 & 2 1 ) Y L V X D O VS Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W 75 : :6 6 5 &+ 2 , & ( 6 : 2 5 . 7 2 3 6 8 3 3 2 5 7 5 , * + 7 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( 75 : :6 6 / &+ 2 , & ( 6 : 2 5 . 7 2 3 6 8 3 3 2 5 7 / ( ) 7 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( 75 : 36 3 3$ & . : 2 5 . 6 8 5 ) $ & ( 6 8 3 3 2 5 7 , 1 * 3 ( ' ( 6 7 $ / / 38 / / 6 7 < / ( & / $ 6 6 , & $ 3 3 / , ( ' 3 8 / / 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 5 /2 & . 2 3 7 , 2 1 6 , / 9 ( 5 / 2 & . 5 $ 1 ' 2 0 75 : 57 ) ; 7 % & 1 5( & 7 7 5 $ , 1 , 1 * 7 $ % / ( ) , ; ( ' 7 2 3 : & $ 6 7 ( 5 6 1 2 ( / ( & 1 2 * * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : )6 8 )/ , 3 3 ( 5 ' 2 2 5 6 7 2 5 $ * ( 8 1 , 7 : 3 ) '2 2 5 ) , 1 , 6 + 2 3 7 , 2 1 3 $ , 1 7 ) , 1 , 6 + ) 5 2 1 7 a 7 '2 2 5 3 $ , 1 7 & 2 / 2 5 ) R U 5 H Q G H U L Q J 2 Q O \ 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 a 7 3 a7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( $ 1 $& & ( 1 7 6 7 5 , 3 2 3 7 , 2 1 1 2 $ & & ( 1 7 6 7 5 , 3 4 1 48 $ 5 7 ( 5 % $ & . 1 2 4 8 $ 5 7 ( 5 % $ & . 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ?* , = $ ? & ' % ? 2 & 7 5 $ 1 6 & 2 1 ) Y L V X D O VS Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W & + /2 & . 7 < 3 ( & + 2 , & ( 6 % / $ & . / 2 & . 5 ' 0 /2 & . 2 3 7 , 2 1 & + 2 , & ( 6 5 $ 1 ' 2 0 75 : 57 : 6 * < :2 5 . 6 8 5 ) $ & ( 5 ( & 7 $ 1 * 8 / $ 5 : * 5 2 0 0 ( 7 ' ; : 3 *5 2 0 0 ( 7 & 2 / 2 5 3 ( % % / ( * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 )6 ( ' * ( 7 < 3 ( 9 , 1 < / ( ' * ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : $: 6 5 $' - 8 6 7 $ % / ( : $ / / 6 7 $ 5 7 ( 5 5 $ , / ) , 7 6 3 $ 1 ( / + * 7 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( // 5 // 5 &+ $ , 5 7 5 $ , 1 0 ( 6 + // 5 // 5 &+ $ , 5 + , % $ & . 6 / , ' ( 6 < 1 & 5 + 75 : 36 / $ 7 3$ & . / $ 7 ( 5 $ / ) , / ( : 7 2 3 + , * + : / 38 / / 6 7 < / ( & / $ 6 6 , & $ 3 3 / , ( ' 3 8 / / 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 5 /2 & . 2 3 7 , 2 1 6 , / 9 ( 5 / 2 & . 5 $ 1 ' 2 0 75 : 36 % & 3$ & . % 2 2 . & $ 6 ( + , * + : 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( ,Q V W D O O D W L R Q ,Q V W D O O D W L R Q 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? 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' R F X P H Q W V ?* L ] D ? & ' % ? 2 & 7 5 $ 1 6 ) 5 2 1 7 $ 5 ($ Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W 7K H D W W D F K H G T X R W D W L R Q L V J R R G I R U G D \ V $ Q \ G U D Z L Q J R U V S H F L I L F D W L R Q U H Y L V L R Q V D U H V X E M H F W W R U H T X R W H D W W K H F X U U H Q W S U L F L Q J L Q H I I H F W D W W K H W L P H R I R U G H U 7K H D E R Y H T X R W H G U D Z L Q J D Q G V S H F L I L F D W L R Q V V K R X O G E H U H Y L H Z H G F D U H I X O O \ E H I R U H R U G H U L Q J $ O O R U G H U V D U H F X V W R P D Q G F D Q Q R W E H U H W X U Q H G X Q O H V V D UH V W R F N L Q J I H H L V D S S O L H G 7U L D Q J O H 2 I I L F H V G H V L J Q D Q G V D O H V W H D P K D Y H P D G H H Y H U \ H I I R U W WR F R P S O H W H D F F X U D W H S O D Q V D Q G V S H F L I L F D W L R Q V ( Q G 8 V H U D S S U R Y D O D Q G V L J Q D W X U H L V U H T X L U H G EH I R U H R U G H U V D U H S O D F H G &/ , ( 1 7 6 , * 1 $ 7 8 5 ( B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B ' $ 7 ( BB B B B B B B B BB B B B B B B B B B 'H O L Y H U \ & R Q W D F W 3 H UV R Q B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B ' H O L Y H U \ 3K R Q H BB B B B B B B BB B B B B B B B B B B B B 'H O L Y H U \ $ G G U HV V B BB B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B B B B B B BB B B B B B B B B B B B B B B B B B B B B B B B B %L O O L Q J $ G G U HV V B BB B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B B B B B B BB B B B B B B B B B B B B B B B B B B B B B B B B B 3DJHRI & ? 8 V H U V ? 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' R F X P H Q W V ?* L ] D ? & ' % ? 2 & 7 5 $ 1 6 ) 5 2 1 7 $ 5 ($ Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 7UH\-RQHV $X G U H \ - D F N V R Q 2U D Q J H & R X Q W \ 3 X E O L F 7 U D Q V S R U W D W L R Q 1 & + L J K Z D \ 1 RI I L F H 7UH\-RQHV % 6 R X W K ( O O L R W W 5 G &K D S H O + L O O 1 & 3 ) ZZ Z W U L D Q J O H R I I L F H H T X L S P H Q W F R P 5H S 3 K R Q H 5H S 3U H S D U H G ) R U ) 3 3U H S D U H G % \ ,W H P 4 W \ 3 U R G X F W 75 : :6 6 5 6 &+ 2 , & ( 6 : 2 5 . 7 2 3 6 8 3 3 2 5 7 6 + $ 5 ( ' 5 , * + 7 + $ 1 ' 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : 57 : 6 * < :2 5 . 6 8 5 ) $ & ( 5 ( & 7 $ 1 * 8 / $ 5 : * 5 2 0 0 ( 7 ' ; : 3 *5 2 0 0 ( 7 & 2 / 2 5 3 ( % % / ( * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ? * , = $ ? & ' % ? 2 & 7 5 $ 1 6 3 Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 )6 ( ' * ( 7 < 3 ( 9 , 1 < / ( ' * ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : :6 6 / &+ 2 , & ( 6 : 2 5 . 7 2 3 6 8 3 3 2 5 7 / ( ) 7 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( 75 : :6 6 5 &+ 2 , & ( 6 : 2 5 . 7 2 3 6 8 3 3 2 5 7 5 , * + 7 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 75 : 7$ % 6 )$ % 5 , & & 2 9 ( 5 ( ' $ & 2 8 6 7 , & $ / 3 $ 1 ( / : ; + 6 *5 $ ' ( 6 ( / ( & 7 , 2 1 * 5 $ ' ( 6 $ 0 ( 3 $ 1 ( / ) $ % 5 , & $ / / 6 , ' ( 6 * ) $/ / 6 , ' ( 6 * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( $ / / % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 6 $ $& 2 8 6 7 , & 6 6 7 $ 1 ' $ 5 ' $ & 2 8 6 7 , & 6 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ? * , = $ ? & ' % ? 2 & 7 5 $ 1 6 3 Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W 75 : 57 : 6 * < :2 5 . 6 8 5 ) $ & ( 5 ( & 7 $ 1 * 8 / $ 5 : * 5 2 0 0 ( 7 ' ; : 3 *5 2 0 0 ( 7 & 2 / 2 5 3 ( % % / ( * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 )6 ( ' * ( 7 < 3 ( 9 , 1 < / ( ' * ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : :6 % . 5 &+ 2 , & ( 6 : 2 5 . 6 8 5 ) $ & ( 6 8 3 3 2 5 7 % 5 $ & . ( 7 5 , * + 7 + $ 1 ' 75 : 36 3 3$ & . : 2 5 . 6 8 5 ) $ & ( 6 8 3 3 2 5 7 , 1 * 3 ( ' ( 6 7 $ / / 38 / / 6 7 < / ( & / $ 6 6 , & $ 3 3 / , ( ' 3 8 / / 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 5 /2 & . 2 3 7 , 2 1 6 , / 9 ( 5 / 2 & . 5 $ 1 ' 2 0 75 : 36 3 3$ & . : 2 5 . 6 8 5 ) $ & ( 6 8 3 3 2 5 7 , 1 * 3 ( ' ( 6 7 $ / / 38 / / 6 7 < / ( & / $ 6 6 , & $ 3 3 / , ( ' 3 8 / / 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 5 /2 & . 2 3 7 , 2 1 6 , / 9 ( 5 / 2 & . 5 $ 1 ' 2 0 75 : )' )/ , 3 3 ( 5 ' 2 2 5 8 1 , 7 : 3 ) '2 2 5 ) , 1 , 6 + 2 3 7 , 2 1 3 $ , 1 7 ) , 1 , 6 + ) 5 2 1 7 a 7 '2 2 5 3 $ , 1 7 & 2 / 2 5 ) R U 5 H Q G H U L Q J 2 Q O \ 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 a 7 3 a7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( $ 1 $& & ( 1 7 6 7 5 , 3 2 3 7 , 2 1 1 2 $ & & ( 1 7 6 7 5 , 3 4 1 48 $ 5 7 ( 5 % $ & . 1 2 4 8 $ 5 7 ( 5 % $ & . & + /2 & . 7 < 3 ( & + 2 , & ( 6 % / $ & . / 2 & . 5 ' 0 /2 & . 2 3 7 , 2 1 & + 2 , & ( 6 5 $ 1 ' 2 0 75 : ': 0 '8 $ / : $ / / 0 2 8 1 7 + 3 75 , 0 & 2 / 2 5 3 ( % % / ( 75 : 7% 7$ & . % 2 $ 5 ' : ; + 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ? * , = $ ? & ' % ? 2 & 7 5 $ 1 6 3 Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W * ) )$ % 5 , & * 5 $ ' ( 3 $ 7 7 ( 5 1 7 % * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 75 : 57 : 6 * < :2 5 . 6 8 5 ) $ & ( 5 ( & 7 $ 1 * 8 / $ 5 : * 5 2 0 0 ( 7 ' ; : 3 *5 2 0 0 ( 7 & 2 / 2 5 3 ( % % / ( * 5 / +, * + 3 5 ( 6 6 8 5 ( / $ 0 , 1 $ 7 ( 6 * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 : , / 6 2 1 $ 5 7 7 , * 5 , 6 / $ 0 , 1 $ 7 ( 6 - 0 :, / 6 2 1 $ 5 7 7 , * 5 , 6 & 2 / 2 5 6 ( 9 ( 1 , 1 * 7 , * 5 , 6 )6 ( ' * ( 7 < 3 ( 9 , 1 < / ( ' * ( 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : (1 3 &+ 2 , & ( 6 ( 1 ' 3 $ 1 ( / : 2 5 . 7 2 3 ' ; + 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( * 5 / :6 ( 1 ' 3 $ 1 ( / 6 8 5 ) $ & ( 7 < 3 ( * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 1 ( 9 $ 0 $ 5 / $ 0 , 1 $ 7 ( 6 ( ; 7 / ( $ ' 7 , 0 ( - ) 1( 9 $ 0 $ 5 & 2 / 2 5 6 1 ( 9 $ 0 $ 5 & 2 5 ' , $ / * 5 $ < 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( 75 : && 1 ' % ' ( * 5 ( ( & 2 9 ( 5 + * ) )$ % 5 , & * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 // 5 // 5 &+ $ , 5 7 5 $ , 1 0 ( 6 + & 7 75 : && 1 ' % ' ( * 5 ( ( & 2 9 ( 5 + * ) )$ % 5 , & * 5 $ ' ( 3 $ 7 7 ( 5 1 * 5 ' 0 2 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( % * 02 0 ( 1 7 8 0 8 1 , 9 ( 5 6 ( & 2 / 2 5 6 & 2 6 0 , & 7 75 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 6 7 3 7( ; 7 8 5 ( ' 7 5 , 0 & 2 / 2 5 7 ( ; 7 8 5 ( ' 3 ( % % / ( 72 3 & $ 3 2 3 7 , 2 1 : , / / 0 $ 7 & + 7 5 , 0 & 2 / 2 5 75 : (1 3 &+ 2 , & ( 6 ( 1 ' 3 $ 1 ( / : 2 5 . 7 2 3 ' ; + 3 %$ 6 ( 7 5 , 0 & 2 / 2 5 3 ( % % / ( * 5 / :6 ( 1 ' 3 $ 1 ( / 6 8 5 ) $ & ( 7 < 3 ( * 5 $ ' ( / $ 0 , 1 $ 7 ( 6 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ? * , = $ ? & ' % ? 2 & 7 5 $ 1 6 3 Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 ,W H P 4 W \ 3 U R G X F W *5 $ ' ( / $ 0 , 1 $ 7 ( 6 3 $ 7 7 ( 5 1 6 1 ( 9 $ 0 $ 5 / $ 0 , 1 $ 7 ( 6 ( ; 7 / ( $ ' 7 , 0 ( - ) 1( 9 $ 0 $ 5 & 2 / 2 5 6 1 ( 9 $ 0 $ 5 & 2 5 ' , $ / * 5 $ < 3 9, 1 < / ( ' * ( & 2 / 2 5 3 ( % % / ( // 5 // 5 &+ $ , 5 + , % $ & . 6 / , ' ( 6 < 1 & 5 + ,Q V W D O O D W L R Q ,Q V W D O O D W L R Q D Q G 5 H P R Y D O R I ( [ V W : D O O 7 I U W R & H G D U * U R Y H 7K H D W W D F K H G T X R W D W L R Q L V J R R G I R U G D \ V $ Q \ G U D Z L Q J R U V S H F L I L F D W L R Q U H Y L V L R Q V D U H V X E M H F W W R U H T X R W H D W W K H F X U U H Q W S U L F L Q J L Q H I I H F W D W W K H W L P H R I R U G H U 7K H D E R Y H T X R W H G U D Z L Q J D Q G V S H F L I L F D W L R Q V V K R X O G E H U H Y L H Z H G F D U H I X O O \ E H I R U H R U G H U L Q J $ O O R U G H U V D U H F X V W R P D Q G F D Q Q R W E H U H W X U Q H G X Q O H V V D UH V W R F N L Q J I H H L V D S S O L H G 7U L D Q J O H 2 I I L F H V G H V L J Q D Q G V D O H V W H D P K D Y H P D G H H Y H U \ H I I R U W WR F R P S O H W H D F F X U D W H S O D Q V D Q G V S H F L I L F D W L R Q V ( Q G 8 V H U D S S U R Y D O D Q G V L J Q D W X U H L V U H T X L U H G EH I R U H R U G H U V D U H S O D F H G &/ , ( 1 7 6 , * 1 $ 7 8 5 ( B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B ' $ 7 ( BB B B B B B B B BB B B B B B B B B B 'H O L Y H U \ & R Q W D F W 3 H UV R Q B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B ' H O L Y H U \ 3K R Q H BB B B B B B B BB B B B B B B B B B B B B 'H O L Y H U \ $ G G U HV V B BB B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B B B B B B BB B B B B B B B B B B B B B B B B B B B B B B B B %L O O L Q J $ G G U H V V B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B B B B B B B B B B B B B B B B B B B B B BB B B B B B B B B B B 3DJHRI & ? 8 6 ( 5 6 ? 7 5 ( < ? 2 1 ( ' 5 , 9 ( ? ' 2 & 8 0 ( 1 7 6 ? * , = $ ? & ' % ? 2 & 7 5 $ 1 6 3 Y L V X D O V S Do c u S i g n E n v e l o p e I D : C 2 B 6 6 1 4 7 - 2 0 2 2 - 4 F 7 C - 8 3 9 F - 4 E 0 5 D 4 A C A 8 0 0 12/07/2017 Business Insurers of Carolinas 800 Eastowne Drive, Suite 208 PO Box 2536 Chapel Hill NC 27515-2536 Patty Miller (919)968-4611 (919)968-8991 pmiller@business-insurers.com Triangle Office Equipment, Inc. PO Box 2372 Chapel Hill NC 27515 Tri-State Ins Co of Minnesota 31003 Acadia Insurance Company 31325 17-18 A ADV4359170 11/01/2017 11/01/2018 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 Employee Benefits 1,000,000 B CNA-4359171-41 11/01/2017 11/01/2018 1,000,000 Underinsured motorist BI split limit 1,000,000 B WCA-4359172-41 11/01/2017 11/01/2018 1,000,000 1,000,000 1,000,000 Orange County PO Box 8181 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DEDRETENTION$ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: C2B66147-2022-4F7C-839F-4E05D4ACA800