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HomeMy WebLinkAbout2018-384-E Aging - A Helping Hand in-home aide servicesRevised 10/17 1 [Departmental Use Only] TITLE FY NORTH CAROLINA SERVICES AGREEMENT UNDER $90,000.00 NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter “Agreement”), made and entered into this 25th 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 A Helping Hand, (hereinafter, the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Agreement is for services to be rendered by Provider to County with respect to (insert type of project): In HomeServices 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 DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 2 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): Perfom In Home Services as specified in Attachment A. 4. Duration of Services a. Term. The term of this Agreement shall be from July 1, 2018 to June 30, 2019. b. Scheduling of Services. i) The Provider shall schedule and perform its activities in a timely manner. 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 DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 3 resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be July 1, 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 $10,000.00 Dollars ($22.74 per hour). Payment for Basic Services shall become due and payable within thirty (30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). b. Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. c. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Annie Deaver) 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 General Liability Insurance and Workers Compensation Insurance (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the County's Risk Manager. DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 4 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. e. Suspension. County may suspend the Basic Services and this Agreement at any time for County’s convenience and without penalty to County upon three (3) days’ notice to DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 5 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. c. Non-Discrimination. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal non-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Any violation of the Orange County Non-Discrimination Policy is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. e. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 6 g. Ownership of Work Product. Should Provider’s performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h. Non-Appropriation. Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County’s obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County’s statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County’s authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County’s legal authority. i. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider’s Name Attention:Department on Aging A Helping Hand P.O. Box 8181 1502 W Hwy 54, Ste 405 Hillsborough, NC 27278 Durham, NC 27707 [SIGNATURE PAGE TO FOLLOW] DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 Revised 10/17 7 IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: By: _________________________________ County Manager By: __________________________________ Jennifer Ashley, Executive Director Printed Name and Title DocuSign Envelope ID: 5E364E15-E7CE-4D90-8F1B-84B8CD2A29F3 DocuSign Envelope ID: 5E364E15- E7CE- 4D90- 8F1B- 84B8CD2A29F3 ATTACHMENT A SCOPE OF WORK- A Helping Hand 1. Explanation of Services to be provided: Contractor will provide employees to perform in -home services for the Department on Aging's clients at the level, amount and frequency specified by the Aging Transitions Staff. Questions should be directed to that staff person. The Contractor will provide Level I Home Management. In -Home Aide Services at this level are intended to provide support to those needing assistance with basic home Management tasks, such as companionship, transportation, housekeeping, cooking Shopping, and bill paying, as needed. Persons /families to be served include those who are Self - directing, medically stable, and have at least one instrumental activity of daily living (IADL) impairment or require assistance with basic home management tasks. Personal care tasks may not be performed at this level. 2. Rate per unit of Service: A maximum allowable rate of $22.74/hour, of which the Contractor must pay the In -Home Aide at least the County's Living Wage (currently $14.25 per hour). The County has increased the standard fixed rate to compensate the Contractor for any amount above Federal Minimum Wage. Note: The Contractor will not be reimbursed for its initial assessment visit to the client's home. 3. Details of Billing process and time frames: Orange County will reimburse the Contractor for services described. The County will reimburse at a rate of $22.74/hour for approved services as stated in the Purchase of Service Authorizations approved by Department on Aging staff. For reimbursement the Contractor must submit the invoice and Aide notes to the Aging Transitions Data Manager within 90 days of the date of service. Any invoice submitted after this period will not be processed. The Contractor must designate one staff person to direct any billing questions from the Data Manager. For Fiscal year end the OCDOA will send out information and cutoff date for invoices. Once that date is past, no invoices will be processed for the closed out year. DocuSign Envelope ID: 5E364E15- E7CE- 4D90 -8F1 13- 84B8CD2A29F3 .4CORUR OP ID: HK �-- CERTIFICATE OF LIABILITY INSURANCE =DATE YYY) 05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 High & Rubish Insurance Agency NAME: Laura Pope P.O BOX 3040 PHGNE 6015 Farrington Rd. Ste 101 A/c No Ext : 919- 913 -1144 a/c No 919- 913 -1155 Chapel Hill, NC 27517 ADDRESS: laura hi handrubish.com CUSTOMER ID #: HELPI-1 INSURED A Helping Hand INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Companies 10677 1502 W Hwy 54 Ste 405 Durham, NC 27707 INSURER B: U.S. Liability Insurance Co. 25895 INSURER C: INSURER D: INSURER E: vV YCRHV CJ CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDS AIM D ABOVEB OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR BR LTR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY POLICY EFF POLICY EXP MM /DD /YYYY MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY HHC0005888 EAACAOCCURR�NCE $ 1,000,0 03/01/2017 03/01/2018 CLAIMS -MADE � OCCUR PREMISES Ea occurrence $ 100,0 HHA0005888 MED EXP (Any one person) $ 10,0 03/01/2018 03/01/2019 PERSONAL & ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,01 POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,01 AUTOMOBILE LIABILITY $ ANY AUTO HHC000688 COMBINED SINGLE LIMIT 03/01/2017 03/01/2018 (Ea accident) $ 1,000,0I ALL OWNED AUTOS HHA0006888 03/01/2018 03/01/2019 BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ A X HIRED AUTOS PROPERTY DAMAGE X NON -OWNED AUTOS (PER ACCIDENT) $ UMBRELLA LIAB OCCUR $ EXCESS JAB CLAIMS -MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE $ RETENTION $ $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ N/A IQBY LIMITS (Mandatory in NH) E.L. EACH ACCIDENT $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ B Professional Liab ND010541771 E.L. DISEASE - POLICY LIMIT $ 09/09/2017 09/09/2018 1,000,001 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ORANG -3 Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 200 S. Cameron St NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 8181 Hillsborough, NC 27278 -8181 AUTHORIZED REPRESENTATIVE -2009 ACORD 25 (2009/09) © 1998_8 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 5E364E15- E7CE- 4D90 -8F1 B- 84B8CD2A29F3 mTMa • T ACOR'D ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 07/10/2018 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, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 773- 754 -0849 S. Wolf and Associates, Inc. 2338 W. Morse CONTACT NAME;_ _-- __ -_, -- ___ PHONE 773 - 754 -0848 FAX (A/C, No, Ext): (Arc, No): -- -- -- -- -- -.... Chicago, IL 60645 Polly Kosyla E-MAIL - -- - -- .-. .....-------------------- -- ---- ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Wesco Insurance Company DAMAGE TO RENTED PREMISES (Ea occurrence ) -------- WED EXP (Any one person ) - _$ ---------------- -__ $ INSURED A Helping Hand NC Jennifer Ashley INSURER B: PERSONAL & ADV INJURY $_- AGGREGATE LIMIT APPLIES PER: POLICY n JE LOC OTHER: 1502 W NC Hwy 54 - #405 Durham, NC 27707 INSURER c : ---- -- - - -- PRODUCTS - COMP /OP AGG - __-- __-- ,_------ INSURER D: INSURER E AUTOMOBILE INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS AUTHORIZED REPRESENTATIVE 1��- 'a,-, � COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence ) -------- WED EXP (Any one person ) - _$ ---------------- -__ $ GEN'L PERSONAL & ADV INJURY $_- AGGREGATE LIMIT APPLIES PER: POLICY n JE LOC OTHER: GENERAL AGGREGATE $_^ ---- -- - - -- PRODUCTS - COMP /OP AGG - -- $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON rNED AUTOS ONLY AUTOS ONLY L COMBINED SINGLE LIMIT Ea i i n $ BODILY INJURY Per ersonl $ BODILY INJURY. Per accident $ PROPERTY DAMAGE (Per accident ) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WWC3356988 07/30/2018 07/30/2019 x PER OTH- AT TE R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 0 11000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER rONrFI I OTInN ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government THE THEREOF, THDTHE POLICY PROVISIONS. WILL BE DELIVERED IN ACCORDANCE EXPIRATION 200 South Cameron Street PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 1��- 'a,-, � ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD