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HomeMy WebLinkAbout2018-537-E AMS - Triangle Office Equipment Seymour officeRevised 10/17 1 NORTH CAROLINA CONSTRUCTION SERVICES AGREEMENT UNDER $50,000 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter “Agreement”), is made and entered into this 27th day of August, 2018 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: August 27, 2018 through December 31, 2018. The Project Commencement Date shall be August 27, 2018. Dollar Amount Not to Exceed: Six Thousand Four Hundred Seventy One Dollars and Eighty-Four Cents ($6,471.84) 2. SERVICES Contractor agrees to provide the following construction services (the “Work”): Provide and install demountable wall system per quote dated June 21, 2018 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 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 DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 Revised 10/17 2 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 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 DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 Revised 10/17 3 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 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 DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 Revised 10/17 4 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: C96E815A-2DFE-4846-8BDE-E3315B5EF516 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 Elliot Road P.O. Box 8181 Chapel Hill Hillsborough, NC 27278 NC 27514 DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516   DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Triangle ice Equipment 300B South Elliott Rd Prepared For: Chapel Hill, NC 27514 Angel Barnes P:919- 929 -4203 F:919- 929 -7647 www.triangleofficeequipment.com Orange County F: Item Qty. Product Hillsborough P: 919 -245 -2628 ROUND TRAINING TABLE, STD HEIGHT, W /GLIDES, 30" DIA 1 1 TRW RDTT30.GL Prepared By: Madison Dail I- PRESSURE LAMINATES GR1L GRADE 1 LAMINATES LAMINATES /PATTERNS .1 LAMINATES W /MATCHING VINYL EDGE JG VINYL EDGE COLORS .325 FUSION MAPLE TRIM COLOR T2 TEXTURED TRIM COLORS FEXTURED TRIM COLOR TK TEXTURED CHARCOAL (L EDGE COLOR TABLES W5 FUSION MAPLE T51 TASK W /BLACK TRIM, UPHOLSTERED 2 1 TRW SID100 FABRIC COLOR T36 BLACK CASTER OPTION NB STANDARD HARD CASTERS PETITE CYLINDER NCP NO PETITE CYLINDER Corner Base Trim 3 1 TRW TCB Trim Color J Stucco Corner Crown 4 1 TRW TCC $ 271.44 $ 271.44 $ 462.00 $ 462.00 $ 25.52 $ 25.52 $ 21.56 $ 21.56 C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 1 of 7 6/21/2018 Prepared By: Madison Dail Rep: Trey Jones Rep Phone: 919 -291 -1998 $ 271.44 $ 271.44 $ 462.00 $ 462.00 $ 25.52 $ 25.52 $ 21.56 $ 21.56 C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 1 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Straight Crown, 12' 5 1 TRW TCS $ 51.92 $ 51.92 C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 2 of 7 Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Floor Plate, 12' 6 1 TRW TFP $ 33.88 $ 33.88 Trim Color .J Stucco Straight Base Trim, 12' Length 7 2 TRW TSB $ 23.76 $ 47.52 Trim Color .J Stucco LIVE 2 STACK CHAIR W/ CASTERS AND ARMS 8 2 TRW TV275 $ 242.40 $ 484.80 FRAME COLOR S1 BLACK CASTER OPTION NB NO SOFT BRAKING CASTERS !E, CALL CUST SERVICE) NC NO CAL 133 ABRIC GRADE /PATTERN .1 STANDARD SEATING FABRICS )ARD SEATING FABRICS C GRD C HIGHEST OF DIFF. FABRICS SEAT FABRIC ... Skipped Option ABRIC GRADE /PATTERN .1 STANDARD SEATING FABRICS )ARD SEATING FABRICS ... Skipped Option ARM COLOR OPTION BR BLACK ARMS Wall Channel Condition Kit, 9' and less 9 2 TRW TWCO9 $ 63.80 $ 127.60 Trim Color T2 Textured Trim Colors Textured Trim Color .TJ Textured Stucco C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 2 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product Corner Condition, Standard, 9' and less 10 1 TRW WCSCO9 $ 77.00 $ 77.00 Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection Outside P02 Textured Paint Colors Textured Paint Colors TJ Textured Stucco Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Base Trim Color 31 Smooth Trim Colors Smooth Trim Color .J Stucco Straight Condition, Standard, 9' and less 11 3 TRW WCSSO9 $ 70.40 $ 211.20 Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection .OS Vinyl Same Vinyl All Sides All Sides - Grade /Pattern GOB Textured Vinyls -All Textured Vinyl Colors V49 Textured Stucco Punchouts .1 Punchouts Punchouts Side 1 CN No Punchout Punchouts Side 2 CN No Punchout - omponent Mounting Kit .1 Mounting Kit Mounting Kit Side 1 NK1 No Kit Mounting Kit Side 2 NK2 No Kit Base Trim Color —.Ti Smooth Trim Colors Smooth Trim Color _.J Stucco 40.875 cntrline Minimum Door Section, RH Swing, 8ft1/4 h to 9ft h 1.2 1 TRW WDSR4OO9 $ 1,483.68 $ 1,483.68 Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection V Vinyl /Corn Both Sides Side 1 - Grade /Pattern GOB Textured Vinyls -Sdi C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 3 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product Textured Vinyl Colors .V49 Textured Stucco Side 2 - Grade /Pattern GOB Textured Vinyls -Sd2 Textured Vinyl Colors .V49 Textured Stucco Transom Opening TG Glass Glazing Options G2 TW Tempered Glass Option ered Glass Color Options T03 Tempered Glass Door Height .7H 7 Foot 0 Inch Door Door Lite FL Full Light Door Type SC Solid Core Door Surface Color .V Vinyl Covered Door Vinyl Color .2 Textured Vinyl Colors Textured Vinyl Colors .V49 Textured Stucco Door Glazing Options G2 TW Tempered Door Glass Option ered Glass Color Options T03 Tempered Glass Door Hardware LL Lever Lockset Key Set RK Random Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Base Trim Color T1 Smooth Trim Colors Smooth Trim Color .J Stucco Filler Panel, 12" centerline width 13 1 TRW WPF12O9 $ 99.44 $ 99.44 Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection .V Vinyl /Com Both Sides Side 1 - Grade /Pattern GOB Textured Vinyls -Shc Textured Vinyl Colors .V49 Textured Stucco Side 2 - Grade /Pattern GOB Textured Vinyls -Sd2 Textured Vinyl Colors .V49 Textured Stucco Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Filler Panel, 18" centerline width 14 1 TRW WPF18O9 $ 148.28 $ 148.28 C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 4 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection V Vinyl /Corn Both Sides Side 1 - Grade /Pattern GOB Textured Vinyls -Sdi Textured Vinyl Colors V49 Textured Stucco Side 2 - Grade /Pattern GOB Textured Vinyls -Sd2 Textured Vinyl Colors V49 Textured Stucco Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco Glazed Panel, Full Light, 42" centerline width 15 2 TRW WPGF4209 Tempered Glass $ 673.20 $ 1,346.40 Ceiling Height .103 103 inches plus Fraction .0 none Grade Selection V Vinyl /Corn Both Sides Side 1 - Grade /Pattern GOB Textured Vinyls -Sdi Textured Vinyl Colors V49 Textured Stucco Side 2 - Grade /Pattern GOB Textured Vinyls -Sd2 Textured Vinyl Colors V49 Textured Stucco Glazed Segments S1 1 Opening Glazing Options G2 TW Tempered Glass Option Bred Glass Color Options T03 Tempered Glass Trim Color T2 Textured Trim Colors Textured Trim Color TJ Textured Stucco INT EXT RECT DESK W/ FULL MOD & GMT, RGHT HAND, 36WX66W 16 1 TRW ZFERDR366624.1 X24D $ 372.40 $ 372.40 LAMINATE SELECTION .1 GRADE 1 HIGHEST GRADE THERMOFUSED LAMINATE TOP COLOR AA TOP GRD1 SOLID THERMOFUSED LAMINATES FUSED - SOLID COLORS XZ4 BLACK ' SURFACE EDGE COLOR AA GRD1 SOLID VINYL EDGE COLOR ID VINYL EDGE COLORS .XZ4 BLACK BASE COLOR AB BASE GRD1 WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 5 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product INT LAMINATE MODULAR PEDESTAL, 12/12 17 1 TRW ZFP1212 $ 325.20 $ 325.20 PULL STYLE L CLASSIC APPLIED PULL LAMINATE SELECTION .1 GRADE 1 HIGHEST GRADE THERMOFUSED LAMINATE UNIT COLOR AB UNIT GRDI WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE DOOR /DRAWER COLOR AB DRAWER GRD1 WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE OPTION - SILVER LOCK R RANDOM INT LAMINATE MODULAR PEDESTAL, 6/6/12 18 1 TRW ZFP6612 $ 344.40 $ 344.40 PULL STYLE L CLASSIC APPLIED PULL LAMINATE SELECTION .1 GRADE 1 HIGHEST GRADE THERMOFUSED LAMINATE UNIT COLOR AB UNIT GRDI WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE DOOR /DRAWER COLOR AB DRAWER GRD1 WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE OPTION - SILVER LOCK .R RANDOM INT RETURN W/ FULL MOD & GMT, FULL END PNL, 24D X 36W 19 1 TRW ZFSR2436.F.EP $ 237.60 $ 237.60 LAMINATE SELECTION .1 GRADE 1 HIGHEST GRADE THERMOFUSED LAMINATE TOP COLOR AA TOP GRD1 SOLID THERMOFUSED LAMINATES FUSED - SOLID COLORS XZ4 BLACK 'SURFACE EDGE COLOR AA GRD1 SOLID VINYL EDGE COLOR [D VINYL EDGE COLORS XZ4 BLACK BASE COLOR AB BASE GRDI WOOD GRAIN THERMOFUSED LAMINATES :AIN LAMINATE COLORS XZ2 FUSION MAPLE Installation Installation $ 300.00 $ 300.00 C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 6 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 Item Qty. Product $ 6,471.84 The attached quotation is good for 60 days. Any drawing or specification revisions are subject to re -quote at the current pricing in effect at the time of order. The above quote, drawing, and specifications should be reviewed carefully before ordering. All orders are custom and can not be returned unless a 40% restocking fee is applied. Triangle Office's design and sales team have made every effort to complete accurate plans and specifications. End User approval and signature is required before orders are placed. CLIENT SIGNATURE: DATE: Delivery Contact Person: Delivery Phone #: Delivery Billing Address: C:\ USERS \MADIS \DOCUMENTS \TREY \ORANGE COUNTY \SEYMOUR CENTER \OC- SEYMOUR CENTER- 2- 28- 18.visual.sp4 Page 7 of 7 DocuSign Envelope ID: C96E815A -2DFE- 4846- 8BDE- E3315B5EF516 O 1� 0� ZFSR 436.F.EP ZFP1212 O RDI rj0GL N O O 0 T 00` A Oj O S A m rn OO T N T 4 A � T N G3F42 E 09F42(R VVFI 61 098 600SOM 60SSOM 60SSOM TFPTCS TCCTCB 00 00 TSBTSB 00 APPROVED BY: Triangle Office Equipment DATE: 05 -04 -18 DRAWN BY: MWD SHEET: 1 OF 1 CUSTOMER: PROJECT: PROJECT NUMBER: ANGELBARNES ORANGE COUNTY SEYMOUR CENTER '225 Do c u S i g n E n v e l o p e I D : C 9 6 E 8 1 5 A - 2 D F E - 4 8 4 6 - 8 B D E - E 3 3 1 5 B 5 E F 5 1 6 08/21/2018 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 Y 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 N WCA-4359172-41 11/01/2017 11/01/2018 1,000,000 1,000,000 1,000,000 B Hired Auto Physical Damage CNA-4359171-41 11/01/2017 11/01/2018 Limit/ACV $65,000 Deductible $1,000 Certificate holder is included as additional insured in reference to the General Liability policy per written contract. Orange County PO Box 8181 131 West 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: 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 ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR 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: C96E815A-2DFE-4846-8BDE-E3315B5EF516 COMMERCIAL GENERAL LIABILITY CL CG 04 92 09 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.  CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1of 7  GENERAL LIABILITY ULTRA PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGE EXTENSIONS Provision Name Of Coverage Extension Included or Limit of Insurance A.Miscellaneous Additional Insureds Included B.Expected Or Intended Injury Or Damage Included C.Knowledge Of Occurrence Included D.Legal Liability – Damage To Premises Rented To You (Fire, Lightning, Explosion, Smoke, Or Leakage From Automatic Fire Protective Systems) $300,000 E.Medical Payments $10,000 F.Mobile Equipment Redefined Included G.Newly Formed Or Acquired Organization, Partnership Or Limited Liability Company And Extended Period Of Coverage Included H.Who Is An Insured – Amendment Included I.Non-Owned Watercraft (Increased to maximum length of less than 51 feet) Included J.Supplementary Payments – Increased Limits 1. Bail Bonds $ 3,000 2.Loss Of Earnings $ 1,000 K.Unintentional Omission Or Unintentional Error In Disclosure Included L.Waiver Of Transfer Of Rights Of Recovery Against Others Included M.Liberalization Clause Included N.Incidental Medical Malpractice Included The above is a summary only. Please consult the specific provisions that follow for complete information on the extensions provided. The provisions of the Commercial General Liability Coverage Part apply except as otherwise provided in this endorsement. This endorsement applies only if such Coverage Part is included in this policy. A. MISCELLANEOUS ADDITIONAL INSUREDS 1. Section II – Who Is An Insured is amended to include as an insured any person or organization (referred to as an additional insured below) described in Paragraphs A.1.c.(1) through A.1.c.(8) below when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, provided that: a. The written contract or written agreement is: (1) Currently in effect or becoming effective during the term of this policy; and (2) Fully executed by you and the additional insured prior to the "bodily injury", "property damage" or "per- sonal and advertising injury". DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2of 7  b.The insurance afforded by this provision does not apply to any person or organization included as an additional insured by a separate endorsement issued by us and made a part of this policy or coverage part. c. Only the following persons or organi- zations are additional insureds under this provision, with coverage for such additional insureds limited as provided herein: (1) Managers Or Lessors Of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new con- struction or demolition operations performed by or on behalf of such additional insured. (2) Mortgagee, Assignee Or Receiver A mortgagee, assignee, or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a covered premises by you. This insurance does not apply to structural alterations, new con- struction or demolition operations performed by or on behalf of such additional insured. (3) Owners Or Other Interests From Whom Land Has Been Leased An owner or other interest from whom land has been leased to you but only with respect to liability arising out of the ownership, mainte- nance or use of that part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to lease that land. (b) Structural alterations, new con- struction or demolition operations performed by or on behalf of such additional insured. (4) Lessor Of Leased Equipment Any person(s) or organization(s) from whom you lease equipment but only with respect to liability for "bodily injury", "property damage" or "per- sonal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). A person’s or organization’s status as an additional insured under this endorsement ends when their written contract or written agreement with you for such leased equipment ends. This insurance does not apply to any "occurrence" which takes place after the equipment lease expires. (5) State, Municipality, Governmental Agency Or Subdivision Or Other Political Subdivision – Permits Or Authorizations Relating To Premises Any state, municipality, govern- mental agency or subdivision or other political subdivision subject to the following additional provisions: (a) This insurance applies only with respect to: (i) The following hazards for which the state, municipality, governmental agency or subdivision or other political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (1.1) The existence, maintenance, repair, construction, erection or removal of adver- tising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3of 7  (1.2) The construction, erec- tion or removal of elevators; or (1.3) The ownership, main- tenance or use of any elevators covered by this insurance. (ii) Operations performed by you or on your behalf for which the state, municipality, governmental agency or subdivision or other political subdivision has issued a permit or authorization. (b) This insurance does not apply to "bodily injury", "property dam- age" or "personal and advertising injury" arising out of operations performed for the state, munici- pality, governmental agency or subdivision or other political subdivision. (6) Controlling Interest Any person(s) or organization(s) with a controlling interest in the Named Insured but only with respect to their liability arising out of: (a) Their financial control of you; or (b) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new con- struction or demolition operations performed by or for such person(s) or organization(s). (7) Co-Owner Of Insured Premises A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owner’s liability as co-owner of such premises. (8) Vendors (a) Any person(s) or organization(s) (referred to as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor’s business. The insurance afforded the vendor does not apply to: (i) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a written contract or written agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the written contract or written agreement; (ii) Any express warranty unau- thorized by you; (iii) Any physical or chemical change in the product made intentionally by the vendor; (iv) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manu- facturer, and then repackaged in the original container; (v) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (vi) Demonstration, installation, servicing or repair opera- tions, except such operations performed at the vendor's premises in connection with the sale of the product; (vii) Products which, after distri- bution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 4of 7  (viii) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. How- ever, this exclusion does not apply to: (1.1) The exceptions contained in Sub- paragraphs (iv) or (vi); or (1.2) Such inspections, ad- justments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in con- nection with the distribution or sale of the products. (b) This insurance does not apply to any insured person or organi- zation, from whom you have acquired products, or any ingredient, part or container, entering into, accompanying or containing such products. 2. With respect to coverage provided by this Provision A. Miscellaneous Additional Insureds, the following additional provisions apply: a. Any insurance provided to an additional insured designated under Paragraphs A.1.c.(1) through A.1.c.(8) above does not apply: (1) To "bodily injury" or "property damage" included within the "products-completed operations hazard"; or (2) To "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence of such additional insured. b. The insurance afforded to such additional insured only applies to the extent permitted by law. c. The insurance afforded to such additional insured will not be broader than that which you are required to provide by the written contract or written agreement. 3. With respect to the insurance afforded to the additional insureds within this Provision A. Miscellaneous Additional Insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. B. EXPECTED OR INTENDED INJURY OR DAMAGE Exclusion 2.a. Expected Or Intended Injury of Section I – Coverage A – Bodily Injury And Property Damage Liability is deleted and replaced by the following: a. Expected Or Intended Injury Or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. C. KNOWLEDGE OF OCCURRENCE Paragraph 2.a. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions is deleted and replaced by the following: a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim only when the "occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A manager, if you are a limited liability company; or (4) An "executive officer" or the "employee" designated by you to give such notice, if you are an organization other than a partnership or a limited liability company. To the extent possible, notice should include: (i) How, when and where the "occurrence" or offense took place; DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 5of 7  (ii) The names and addresses of any injured persons and witnesses; and (iii) The nature and location of any injury or damage arising out of the "occurrence" or offense. D. LEGAL LIABILITY – DAMAGE TO PREMISES RENTED TO YOU (Fire, Lightning, Explosion, Smoke, Or Leakage From Automatic Fire Protective Systems) If damage to premises rented to you is not otherwise excluded from this policy or coverage part, then the following provisions apply: 1. Under Section I – Coverage A – Bodily Injury And Property Damage Liability, the last paragraph (after the exclusions) is deleted and replaced by the following: Exclusions c. through n. do not apply to dam- age by fire, lightning, explosion, "smoke", or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in Section III – Limits Of Insurance. 2. The paragraph immediately after Sub- paragraph j.(6) of Paragraph 2. Exclusions of Section I – Coverage A – Bodily Injury And Property Damage Liability is deleted and replaced by the following: Paragraphs (1),(3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, "smoke", or leakage from automatic fire protective systems) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III – Limits Of Insurance. 3. Paragraph 6.of Section III – Limits Of Insurance is deleted and replaced by the following: 6. Subject to Paragraph 5. above, the greater of: a. $300,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations, is the most we will pay under Coverage A for damages because of "property damage" to premises while rented to you, or in the case of damage by fire, lightning, explosion, "smoke", or leakage from automatic fire protective systems, while rented to you or temporarily occupied by you with permission of the owner. This limit will apply to all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, "smoke", leakage from automatic fire protective systems, or other covered causes of loss or any combination thereof. 4. Subparagraph b.(1)(a)(ii) of Paragraph 4. Other Insurance of Section IV – Commercial General Liability Conditions is deleted and replaced by the following: (ii) That is fire, lightning, explosion, "smoke" or leakage from automatic fire protective systems insurance for premises rented to you or temporarily occupied by you with permission of the owner; 5. Subparagraph a. of Definition 9. "Insured contract" of Section V – Definitions is deleted and replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, "smoke" or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract". 6. As used in this Provision D. Legal Liability – Damage To Premises Rented To You: "Smoke" does not include smoke from agricultural smudging, industrial operations or "hostile fire". E. MEDICAL PAYMENTS If Coverage C – Medical Payments is not otherwise excluded from this policy or coverage part, the Medical Expense Limit is changed, subject to the terms of Section III – Limits Of Insurance, to the greater of: a. $10,000; or b. The Medical Expense Limit shown in the Declarations. F. MOBILE EQUIPMENT REDEFINED Subparagraph f.(1) of Definition 12. "Mobile equipment" of Section V – Definitions is deleted and replaced by the following: DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6of 7  (1) Equipment with a gross vehicle weight of 1,000 pounds or more and designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; G. NEWLY FORMED OR ACQUIRED ORGANIZA- TION, PARTNERSHIP OR LIMITED LIABILITY COMPANY AND EXTENDED PERIOD OF COVERAGE Paragraph 3. of Section II – Who Is An Insured is deleted and replaced by the following: 3. Any organization you newly acquire or form, other than a joint venture, and over which you maintain ownership or: a. Majority interest of more than 50% if you are a corporation; b. Majority interest of more than 50% as a general partner of a newly acquired or formed partnership; and/or c. Majority interest of more than 50% as an owner of a newly acquired or formed limited liability company; will qualify as a Named Insured if there is no other similar insurance available to that organization. However, for these organiza- tions: (i) Coverage under this provision is afforded only until the next anniversary date of this policy’s effective date after you acquire or form the organization, partnership or limited liability company, or the end of the policy period, whichever is earlier; (ii)Section I – Coverage A – Bodily Injury And Property Damage Liability does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization, partnership or limited liability company; (iii)Section I – Coverage B – Personal And Advertising Injury Liability does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization, partnership or limited liability company; (iv) Coverage applies only when operations of the newly acquired organization, partnership or limited liability company are the same or similar to the operations of insureds already covered under this insurance; (v) Coverage only applies for those limited liability companies who have established a date of formation as recorded within the filed state articles of organization, certificates of formation or certificates of organization; and (vi) Coverage only applies for those part- nerships who have established a date of formation as recorded within a written partnership agreement or partnership certificate. H. WHO IS AN INSURED – AMENDMENT The last paragraph of Section II – Who Is An Insured is deleted and replaced by the following: No person or organization is an insured with respect to the conduct of any: a. Current partnership or limited liability company, unless otherwise provided for under Paragraph 3. of Section II – Who Is An Insured; b.Current joint venture; or c. Past partnership, joint venture or limited liability company; that is not shown as a Named Insured in the Declarations. I. NON-OWNED WATERCRAFT Subparagraph (2) of Exclusion 2.g. Aircraft, Auto Or Watercraft of Section I – Coverage A – Bodily Injury And Property Damage Liability is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge. J. SUPPLEMENTARY PAYMENTS – INCREASED LIMITS Section I – Supplementary Payments – Coverages A And B is changed as follows: 1. The limit shown in Paragraph 1.b. for the cost of bail bonds is changed from $250 to $3,000; and 2. The limit shown in Paragraph 1.d. for loss of earnings because of time off from work is changed from $250 a day to $1,000 a day. DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 CL CG 04 92 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7of 7  K. UNINTENTIONAL OMISSION OR UNINTEN- TIONAL ERROR IN DISCLOSURE The following provision is added to Paragraph 6. Representations of Section IV – Commercial General Liability Conditions: However, the unintentional omission of, or unintentional error in, any information given or provided by you shall not prejudice your rights under this insurance. This provision does not affect our right to collect additional premium or to exercise our right of cancellation or non-renewal. L. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" and included in the "products-completed operations hazard" when you have agreed in a written contract or written agreement that any right of recovery is waived for such person or organization. This waiver applies only to the person(s) or organization(s) agreed to in the written contract or written agreement and is subject to those provisions. This waiver does not apply unless the written contract or written agreement has been executed prior to the "bodily injury" or "property damage". However, if any person or organization is separately scheduled on a separate waiver of transfer of rights of recovery which is attached to this policy, then this waiver does not apply. M. LIBERALIZATION CLAUSE The following is added to Section IV – Commercial General Liability Conditions: If we adopt a mandatory attachment form change which broadens coverage under this edition of the Commercial General Liability CG0001 for no additional charge, and those changes are intended to apply to all insureds under this edition of CG0001, that change will automatically apply to your insurance as of the date we implement the change in your state. This liberalization clause does not apply to changes implemented through introduction of a subsequent edition of the Commercial General Liability form CG0001. N. INCIDENTAL MEDICAL MALPRACTICE 1. Paragraph 2.a.(1)(d) of Section II – Who Is An Insured does not apply to a physician, nurse practitioner, physician assistant, nurse, emergency medical technician or paramedic employed by you if you are not in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services. 2. This provision is excess over any other valid and collectible insurance whether such insurance is primary, excess, contingent or on any other basis. Any payments by us will follow Paragraph 4.b. of Section IV – Commercial General Liability Conditions. DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516 ¤ 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by ___________________________________________ WC 00 03 13 (Ed. 4-84) #MBOLFU8BJWFSPGTVCSPHBUJPOQFSXSJUUFODPOUSBDU 5SJBOHMF0GGJDF&RVJQNFOU *OD  "DBEJB*OTVSBODF$PNQBOZ 8$" DocuSign Envelope ID: C96E815A-2DFE-4846-8BDE-E3315B5EF516