HomeMy WebLinkAbout2018-304-E Housing - Housing Choice voucher programDocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
[Departmental Use Only]
TITLE Shelton J. Haynes
FY 2018 -2019
NORTH CAROLINA
CONSULTING SERVICES AGREEMENT
UNDER $90,000
ORANGE COUNTY
This Agreement, made and entered into this 2Wh day of July, 2018, ( "Effective Date ") by
and between Orange County, North Carolina a body politic and corporate of the State of North
Carolina (hereinafter, the "County ") and Shelton J. Haynes, (hereinafter, the "Consultant ").
WITNESSETH:
That the County and Consultant, for the consideration herein named, do hereby agree as
follows:
ARTICLE 1 SCOPE OF WORK
1.1 Scope of Work
1.1.1 This Services Agreement ( "Agreement ") is for professional consulting services to
be rendered by Consultant to County with respect to (insert type of project) Orange County
Housing Authority Financial Assessment.
1.1.2 By executing this Agreement, the Consultant represents and agrees that Consultant
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.
1.1.3 Time is of the essence with respect to this Agreement.
1.1.4 The services to be performed under this Agreement consist of Basic Services, as
described and designated in Article 3 hereof. Compensation to the Consultant for Basic Services
under this Agreement shall be as set forth herein.
ARTICLE 2 RESPONSIBILITIES OF THE CONSULTANT
2.1 Services to be Provided. The Consultant shall provide the County with all services
required in Article 3 to satisfactorily complete the Project within the time limitations set forth
herein and in accordance with the highest professional standards.
2.2. Standard of Care
2.2.1 The Consultant shall exercise reasonable care and diligence in performing services
under this Agreement in accordance with the highest generally accepted standards of this type of
Consultant practice throughout the United States and in accordance with applicable federal, state
and local laws and regulations applicable to the performance of these services. Consultant is
solely responsible for the professional quality, accuracy and timely completion and submission
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of all reports, drawings, specifications, plans, documents and services (hereinafter
"Deliverables ") related to the Basic Services.
2.2.2 The Consultant shall be responsible for all errors or omissions, in the deliverables
prepared by the Consultant.
2.2.3 The Consultant shall correct at no additional cost to the County any and all errors,
omissions, discrepancies, ambiguities, mistakes or conflicts in any Deliverables prepared by the
Consultant.
2.2.4 The Consultant shall assure that all Deliverables prepared by it hereunder are in
accordance with applicable laws, statutes, and that any necessary or appropriate applications for
approvals are submitted to federal, state and local governments or agencies in a timely manner so
as not to delay the Project.
2.2.5 The Consultant 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.
2.2.6 Any and all employees of the Consultant engaged by the Consultant in the
performance of any work or services required of the Consultant under this Agreement, shall be
considered employees or agents of the Consultant 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
Consultant.
2.2.7 If activities related to the performance of this agreement require specific licenses,
certifications, or related credentials Consultant 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.
ARTICLE 3 BASIC SERVICES
3.1 Basic Services
3.1.1 The Consultant shall perform as Basic Services the work and services described
herein and as described in Exhibit 1.
ARTICLE 4 DURATION OF SERVICES
4.1 Scheduling of Services
4.1.1 The Consultant shall schedule and perform its activities in a timely manner.
4.1.2 Should the County determine that the Consultant is behind the agreed upon
schedule, it may require the Consultant to expedite and accelerate his efforts, including providing
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additional resources and working overtime, as necessary, to perform his services in accordance
with the approved project schedule at no additional cost to the County.
4.1.3 The Commencement Date for the Consultant's Basic Services shall be July 20,
2018.
ARTICLE 5 COMPENSATION
5.1 Compensation for Basic Services
5.1.1 Compensation for Basic Services shall include all compensation due the
Consultant from the County for all services under this Agreement except for any authorized
Reimbursable Expenses which are defined herein. The maximum amount payable for Basic
Services is Six Thousand Three Hundred Eighty Seven/84 Dollars ($6,387.84). Payment for
Basic Services shall become due and payable in direct proportion to satisfactory services
performed and work accomplished.
ARTICLE 6 RESPONSIBILITIES OF THE COUNTY
6.1 Cooperation and Coordination
6.1.1 The County has designated Sherrill Hampton, Housing and Community
Development Director 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
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.
6.1.2 The County shall be solely responsible for determining whether Consultant as
satisfactorily completed Tasks. It is agreed that County shall not unreasonably withhold its
determination of satisfactory completion of any Task. In the event the amount of an invoice is
disputed County may withhold payment until the dispute is resolved by the parties. County may
also withhold payment on an invoice until the satisfactory completion of a Task by Consultant.
ARTICLE 7 INSURANCE AND INDEMNITY
7.1 General Requirements
7.1.1 Consultant shall obtain, at its sole expense, Commercial General Liability
Insurance, Automobile Insurance, Workers' Compensation Insurance, Professional Liability
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). Consultant shall not commence work until such insurance is in effect and
certification thereof has been received by the Owner's Risk Manager.
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7.2 Indemnity
7.2.1 The Consultant agrees, without limitation, to 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 Consultant
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 Consultant to indemnify the County to the fullest extent
permitted under North Carolina law.
ARTICLE 8 AMENDMENTS TO THE AGREEMENT
8.1 Changes in Basic Services
8.1.1 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 Consultant. The Consultant shall proceed to perform the
Services required by the Amendment only after receiving a fully executed Amendment from the
County.
ARTICLE 9 TERMINATION
9.1 Termination for Convenience of the County
9.1.1 This Agreement may be terminated without cause by the County and for its
convenience upon seven (7) days prior written notice to the Consultant.
9.2 Other Termination
9.2.1 The Consultant 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 Consultant shall give the County seven (7) days' prior written notice of its intent
to terminate this Agreement for cause.
9.3 Compensation After Termination
9.3.1 In the event of termination, the Consultant 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 Consultant.
9.3.2 Should this Agreement be terminated, the Consultant 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.
9.4 Waiver
9.4.1 The payment of any sums by the County under this Agreement or the failure of
the County to require compliance by the Consultant 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
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for damages by the County for any breach of this Agreement or a waiver of any other required
compliance with this Agreement.
9.5 Suspension
9.5.1 County may suspend the work at any time for County's convenience and
without penalty to County upon three (3) days' notice to Consultant. Upon any suspension by
County, Consultant shall discontinue the work and shall not resume the work until notified to
proceed by County.
ARTICLE 10 ADDITIONAL PROVISIONS
10.1 Relationship of Parties
10.1.1 Consultant is an independent contractor of the County. Neither Consultant nor
any employee of the Consultant shall be deemed an officer, employee or agent of the County.
Consultant's personnel shall not be employees of, or have any contractual relationship with, the
County.
10.2 Limitation and Assignment
10.2.1 The County and the Consultant each bind themselves, their successors, assigns,
and legal representatives to the terms of this Agreement. Neither the County nor the Consultant
shall assign or transfer its interest in this Agreement without the written consent of the other.
10.3 Governing Law
10.3.1 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.
Consultant 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 Non - Discrimination Policy and
Orange County Living Wage Policy (each policy is incorporated herein by reference and may be
viewed at http: / /www.orangecountyne.gov /departments /purchasing division /contracts.php).
Any violation of this requirement is a breach of this Agreement and County may immediately
terminate this Agreement without further obligation on the part of the County. This paragraph is
not intended to limit the definition of breach to discrimination. By executing this Agreement
Consultant affirms that Consultant and any subcontractors of Consultant are and shall remain in
compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. Where
applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the
General Statutes constitutes Consultant's breach of this Agreement. By executing this
Agreement Consultant affirms Consultant is in compliance with Article 2 of Chapter 64 of the
North Carolina General Statutes. By executing this Agreement, Consultant certifies that
Consultant has not been identified, and has not utilized the services of any agent or
subcontractor, on the Iran divestment list created by the State Treasurer pursuant to G.S. 147-
86.58 and the Israel boycott list created pursuant to G.S. 147 - 86.81.
10.4 Dispute Resolution
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10.4.1 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 and it is
agreed by the parties that no other court shall have jurisdiction or venue with respect to such
suits or actions. The Parties may agree to nonbinding mediation of any dispute prior to the
bringing of such suit or action. Under no circumstances shall any dispute be addressed through
binding arbitration.
10.5 Extent of Agreement
10.5.1 This Agreement, together with the Request for Proposals together with
attachments distributed by the County and the Consultant's submitted Proposal, all of which
constitute the Contract Documents, represents the entire and integrated agreement between the
County and the Consultant and supersedes all prior negotiations, representations or agreements,
either written or oral. In the event of a conflict among the terms of the Contract Documents, the
priority of documents shall be This Agreement, the County's Request for Proposals, attachments
to the County's Request for Proposals, the Consultant's Proposal. This Agreement may be
amended only by written instrument signed by both parties. Modifications may be evidenced by
facsimile signatures.
10.6 Severability
10.6.1 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.
10.7 Ownership of Deliverables
10.7.1 All Deliverables, together with all supporting materials, source documentation,
data collected, field notes, and working drafts, developed in the performance of this Agreement
shall become the property of the County and may be used on any other project without additional
compensation to the Consultant. The use of the Deliverables 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.
10.8 Non - Appropriation
10.8.1 Consultant 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 Consultant 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
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authority to continue its obligations under this Agreement, then this Agreement shall
automatically terminate without penalty to County upon written notice to Consultant of such
limitation or change in County's legal authority.
10.9 Notices and Signatures
10.9.1 This Agreement together with any amendments or modifications may be executed
electronically. All electronic signatures affixed hereto evidence the consent of the Parties to
utilize electronic signatures and the intent of the Parties to comply with Article 11A and Article
40 of North Carolina General Statute Chapter 66.
10.9.2 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
Attention: Housing & C/D
P.O. Box 8181
Hillsborough, NC 27278
[SIGNATURE PAGE TO FOLLOW]
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Consultant's Name & Address
Shelton J. Haynes
555 E. 78th Street, 6B
New York, NY 10075
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
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.
COUNTY: Orange County CONSULTANT: Shelton J. Haynes
BceuSigned by:cu5igned
IE0637994B755E477... 6ln Al (' R%wtt.#''it,t i7'�' '
AHAM'EOA24F5...
County Manager Shelton J. Haynes, Owner and Principal
Printed Name and Title
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DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
Request for Proposal: Orange County Government,
Department of Housing and Community Development,
Housing Choice Voucher Program
Purpose: Orange County Housing Authority Financial
Assessment
Shelton J. Haynes
July 10, 2018
I
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
TABLE OF CONTENTS
Scope of Work ............................................................................................... ............................... 3 -4
Milestone Schedule .............................................................................................. ..............................5
Fee Schedule ....................................................................................................... ............................... b
FeeSchedule Contingency .................................................................................. ..............................7
Acceptance Criteria ........................................................................................... ............................... 8
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
SCOPE OF WORK
I ntro ducti on f Backa ro u nd
The Orange County Government, Department of Housing and Community Development (OCHA), Housing Choice Voucher
Program (HCVP) was listed as a "standard" housing authority by the U.S. Department of Housing and Urban Development
in 2018. The housing authority received a score of 70 percent on the Section 8 Management Assessment Program
(SEMAP), which included fourteen SEMAP indicators. Also, the housing authority Is operating at a significant financial
deficit; therefore, this project consists of providing a detailed analysis of the overall fiscal sustainability and solvency,
which includes financial associated items of the OCHA HCV Program.
Statement of Work (SCOW
The scope of work Includes a thorough assessment of the overall financial vitality of the Housing Choice Voucher Program.
The evaluation will include but is not limited to the restructuring the department operational budget, operating without a
deficit, closing the monthly budget gaps. Each stage of the project requires approval from Orange County's Director of
Housing before moving on to the next step. Specific deliverables and milestones listed in the Work Requirements and
Schedules and Milestones sections of this SOW.
Period of Performance
The period of performance for the Orange County Government, Department of Housing and Community Development,
HCV Program Project is approximately thirty (30) working days August 159 to September 301h, 2018. All work must be
scheduled to complete.
Place of Performance
Shelton Haynes will work onsite at the Department of Housing and Community Development, HCV Program central office
two days, and work remotely for the remaining of the project, which equates to two (2) working days and eight to twenty
hours a week. In addition, Shelton Haynes will meet with the Orange County Finance Department while onsite at the
Orange County Housing Authority.
Work Requirements
As part of the HCVP Project, Shelton Haynes will be responsible for performing tasks throughout various stages of this
project, The following is a list of these functions, which will result in the successful completion of this project:
Observation Phase:
• Consultant will review all financial budgets related to the HCV Program
• Consultant will assess the financial deficit gaps within the HCV Program monthly budgets
• Consultant will define the department working accessible capital
• Consultant will determine the department fiscal sustainability, solvency financial and any financial associated items of
the OCHA HCV Program
Assessment Review Phase:
• Consultant will prepare a detail recommendation analysis of the findings from the observation phase
Closure Phase:
• Consultant will provide Department of Housing and Community Development, HCV Program with all documentation by
the approved project plan
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
• Consultant will conclude on/off-site support at 11.59 pm on the final day of the period of performance
Reports:
Shelton Haynes agrees to make all reports and recommendations to OCHA in writing within thirty (34) days
after completion of its services upon any assigned subject if so requested by OCHA. Also, Shelton Haynes shall
also submit from time to time reports of the progress being made upon any assigned subject upon request from
OCHA, within thirty (30) days of such request.
4
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MILESTONE SCHEDULE
The below list consists of the initial milestones identified for the Housing Choice Voucher Program Financial
Assessment:
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
FEE SCHEDULE
Shelton Haynes' fee is }used on the time required and will be a flat rate of $5,000 for the financial assessment of the
Change County Housing Authority (OCHA). Any additional services outside of the scope of work will be on an hourly fee
schedule.
Shelton Haynes shall submit to the Orange County Housing Authority an invoice detailing the services performed during
the preceding month and the amount due. All such invoices shall be due and payable within thirty (30) calendar days
after receipt thereof by the OCHA.
Shelton Haynes provides the following estimate based on the project summary provided: Expenses for travel, meals, and
lodging are not included as part of the flat rate above and will be reimbursed by Orange County Housing Authority. All
travel expenses will be reimbursed based on the appropriate documentation being submitted i.e. invoice and receipts.
Description'
Cost
Total
Flight Expense
$368.40 x 2
$736.80
Transportation Expense
$65.00 /day
$260.00
Jodging Expense
$136.52 night
$273.04
Food Expense
$59.00 day
$118.00
Total
$1,387.84
Total estimated project cost including all expenses is $6,387,84
1 Fee Schedule - Based on the average cost of two (2) visits to Durham, NC.
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
FEE SCHEDULE CONTINGENCY
In the event that OCHA fails to pay Shelton Haynes the entire fee within thirty (30) days of the due date, OCHA shall, in
addition to said payment, be liable for a late fee of ton percent (10 %) of the late payment, as well as court costs, and
reasonable attorney's fees and costs, if applicable
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
ACCEPTANCE CRITERIA
For the OCHA Project, the acceptance of all deliverables will reside with the Department of Housing and Community
Development, HCV Program Housing Director. The Housing Director will consult with Shelton Haynes to ensure the
completeness of each stage of the project and the scope of work has been completed. Once a project phase is completed,
and Shelton Haynes provides their analysis for review and approval, the Housing Director will either sign off on approval
for the next step to begin or reply to the consultant, in writing, advising what tasks requires completion.
Once all project tasks are completed, the project will enter the handoff/ciosure stage. During this phase of the project,
Shelton Haynes will provide their project closure report or project task checklist to Department of Housing and Community
Development, HCV Program Housing Director. The acceptance of this documentation will acknowledge receipt of all
project deliverables and that the consultant has met all assigned tasks. Any discrepancies Involving completion of project
tasks or disagreement between Orange County Government, Department of Housing and Community Development, HCV
Program and Shelton Haynes will meet to determine the best options for all parties involved.
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
DATE tMMfDDIYYYY}
AtCCORDO CERTIFICATE OF LIABILITY INSURANCE
_ _ _ 07/09/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIST
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(Sj, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Hiscox Inc A%c °NEE 888 202 -3007 FAX
520 Madison Avenue ADDRIESS. contact@hiscox.com
32nd Floor INSURER(S) AFFORDING COVERAGE NAIC #
New York, NY 10022 INSURERA: Hiscox Insurance Company Inc 10200
INSURED iucliaFa w
SHELTON HAYNES
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERNS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INSURERC:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
555 E 78TH ST
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CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBES] HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSI3 � - -- - -- ADDL SUHR POLICY E POLICY E %P LIMITS
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UDC- 2303886 -EO -18
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ACORD 25 (2014101) 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..
AUTHORIZED REPRESENTATIVE
W IUUt1 -ZU14 AIL; UKU i;SAKVUKA I IUN. All rig nis reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6
"a'
AC`CW?L CERTIFICATE OF LIABILITY INSURANCE DATE (MMdDDdYYYY)
�� 0710912018
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME;
- .
Hiscox Inc 888 202 -3007 -- FAX
fC No.
520 Madison Avenue A DRESS: contact@hiscox.com
32nd Floor INSURER (S) AFFORDING COVERAGE NAIC #
New York, NY 10022 INSURER A: Hiscox Insurance Company Inc 10200
INSURED INSUx1 =R e :
SHELTON HAYNES INSURER C:
. . . .. .... ....... .
555 E 78TH ST INSURERo
6B INSURER E
NEW YORK NY 10075 INSURER F:
PnVIFRAnPR f`FI7TIF1r`AT1- RIIIMRFR• RFvl -ql m fJIIMRPR.
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 RESPE=CT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMiDDI EFF (MMIDDNYYYI EI(P LIMITS
IT. Rim Wyo
ACCORDANCE WITH THE POLICY PROVISIONS.
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
_ CLAIMS,MADE OCCUR
$
DA AG O R h
E ISES_ Eac urrence
$ .......
MED EXP (Any one person)
_ ............._.. _.. ..........._. —
PERSONAL a ADV INJURY
$
GEWL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRO'
..__ POLICY n JECT [A LOC
- -- .........
$
PRODUCTS
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accldent
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
BODILY INJURY (Per acctdant)
I
$
AUTOS AUTOS
- - ---
PROPERTY DAMAGE
Per awldent
$
- -... ......_.
_
NON -OWNED
HIRED AUTOS AUTOS
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE. _
$
$
EXCESS LIAR CLAIMS -MADE
AGGREGATE
DED RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIEfOWPARTNERIEKECUTIVE
OTH
STATUTE ER
.- .......
3
E.L. EACH ACCIDENT
-
$
OFFICEWMEMBEREXCLUDED? ❑
(Mandatory In NH)
NIA
NIA
--
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
If es, desMbe under
DESCRIPTION OF OPERATIONS below
$
Professional Liability
Each Claim: $ 1 ,000,000
A
UDC- 2303886 -EO -18
07/0912018
0710912019
Aggregate: $ 1,000,000
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
nra rrrrr me unr M=M I Alkirt =1 1 ATInM
(511VUtf -ZU14 AS.:UKU L;UKVUKAI IUN. All rlgnis reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(511VUtf -ZU14 AS.:UKU L;UKVUKAI IUN. All rlgnis reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD