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HomeMy WebLinkAbout2019-325 Health - Bonitz Flooring Services SHSC carpet DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 [Departmental Use Only] TITLE BONITZ FLOOR- SHSC FY 18/19 ORANGE COUNTY CONTRACT UNDER$5,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 31"day of May, 2019, ("Effective Date")by and between Orange County, North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the "County"), party of the first part; and Bonitz Flooring, Inc. (the "Provider"), party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement,time being of the essence: The services and/or materials and/or construction (hereinafter referred to collectively as "Services") to be furnished under this Agreement are as follows: Demo existing carpet in medical records and scarify old adhesive. Furnish and install EF Contract Rush Tile RSH54 Silver Spot Light carpet tiles (over existing floor in Sheriff office and office next door). Carpet to be installed during regular business hours at Health's Southern Human Services Center in Chapel Hill,NC. The term of this agreement rendered shall be from 6-5-19 to 7-31-19. 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 to the satisfaction of the County. Provider shall be responsible for all errors or omissions, 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. Provider agrees that Provider shall not sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement,without the prior written approval of the County. SPECIFIC TERMS 1. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed Four Thousand Eight Hundred Five Dollars, ($4,805.00). Payment shall be made within thirty (30) days of an invoice properly submitted to County. 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. 2. Non—waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same,nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent contractor, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. Revised 12/18 1 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 4. Insurance: 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 be designated here N/A (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. 5. Indemnity: The Provider agrees, without limitation, to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death,to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider in carrying out Provider's duties and obligations related to the Services to be provided in this Agreement. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. County may suspend this Agreement upon reasonable notice to Provider. 7. Entire Agreement and Signatures: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 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 I IA and Article 40 of North Carolina General Statute Chapter 66. 8. Governing Law and Priority: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina and Orange County. 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 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.oran ec�ountync. og v/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 and does not limit the definition of breach to discrimination. 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. By executing this Agreement Provider affirms Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. 9. Dispute Resolution: Neither party may initiate binding arbitration. Any disputes shall be resolved by nonbinding mediation. If such mediation fails either party may initiate litigation to resolve the dispute. Should either party initiate litigation to settle any dispute involving the terms of this Agreement Revised 12/18 2 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. 10. 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. IN WITNESS WHEREOF, Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORA AT/�T !",r%TTXTT'%7 PR�t 7T7lTil O"uSigned by, DocuSigned by: qu a a S�_Wo rG�ut� � o By. 3C16F2�09E3445F. By. 673CE9EEC8FA4E2 impartment t)irector Title: �< 200 S. Cameron St. Bonitz Flooring Group P.O. Box 8181 10701 World Trade Blvd. Hillsborough,NC 27278 Raleigh,NC 27617 Revised 12/18 3 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Page 1 of 2 A��0 DATE(MM/ Y) CERTIFICATE OF LIABILITY INSURANCE 03/22/201/2019 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 CONTACT NAME: Willis of Tennessee, inc. DBA Willis of South Carolina PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century BlvdWC, C No Ext: A/C No): E-MAIL P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Zurich American Insurance Company 16535 INSURED INSURER B: American Guarantee and Liability Insurance 26247 Bonitz Flooring Group, inc. 10701 World Trade Blvd INSURERC: AIG Specialty Insurance Company 26883 Raleigh, NC 27617 INSURERD: Columbia Casualty Company 31127 INSURERE: Travelers Property Casualty Company of Ame 25674 INSURER F: COVERAGES CERTIFICATE NUMBER:W10560886 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR IN SD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 RENTED CLAIMS-MADE � OCCUR PREMISES(DAMAGE ToEa occurrence) ccurrrence) $ 1,000,000 A X XCU Included MED EXP(Any one person) $ 10,000 Y Y GLO 8343873-23 04/01/2019 04/01/2020 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY� PRO- � LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y BAP-8343872-23 04/01/2019 04/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB I X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE Y Y AUC 2791382-22 04/01/2019 04/01/2020 AGGREGATE $ 10,000,000 DIED X RETENTION$0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NO N/A Y WC 8343871-23 04/01/2019 04/01/2020 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Contractor's Pollution CPO 9528327 04/01/2019 04/01/2021 Each Loss $2,000,000 Aggregate Limit $2,000,000 Deductible/SIR Amoun $ 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder and all other parties are named as additional insureds under the General Liability for ongoing and completed operations, the Auto Liability and Umbrella Policies when required by written contract. The General Liability, Auto Liability and Umbrella policies are Primary and Non-Contributory in favor of the Additional Insureds when required by written contract. Waiver of subrogation is included with regards to General Liability, Auto Liability, Workers Compensation and Umbrella Policies when required by written contract and permitted by law. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION 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 Evidence of Coverage A-- L]71 �J ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17675254 13ATcx: 1122573 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 AGENCY CUSTOMER ID: LOC#: ,n`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of Tennessee, Inc. DBA Willis of South Carolina Bonitz Flooring Group, Inc. 10701 World Trade Blvd POLICY NUMBER Raleigh, NC 27617 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: Columbia Casualty Company NAIC#: 31127 POLICY NUMBER: CEO 1014136604 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Per Claim $2,000,000 Aggregate $2,000,000 Retention $ 50,000 INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: Y-630-OD492820-TIL-19 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Blk Bldg, BPP, Stock, Inv Total Values $32,035,000 Special Form Replacement Cost INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: QT-660-819OA917-TIL-19 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Contractors Equipment Owned Equipment $662,707 Boom & Jib Coverage Included Leased & Rented Equip $300,000 Overload excluded $5,000 Deductible ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 17675254 BATCH: 1122573 CERT: W10560886 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Additional Insured — Automatic — Owners, Lessees Or Z U RI C H Contractors THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GLO 8343873-23 04/01/2019 d r d r r d d d r Commercial General Liability Coverage Part A. II —Who Is An Insured d d d dd r d r r r r r r d dd dd r d d r r r r r r d r r " d r " r r d r " r d d r r " d 1. r r r r r r r r d r r r d dd rd dr r dr a. r r C 2010 10/01 d r b. C 2037 10/01 d r r r dd r d r d r " d r " r r d r" r d d r r " r (1) r r r r r 1.a. r (2) r r " r r r 1.b. r r r r r r r r r 1. r rd d dd r d (a) d r " " r r d r " r d d r r " r d r r d d r r r r r r d (b) d r " r " r r d d r r " d d d " r d - d r rd" r r r r r r r r d r dd r d 2. r r r r r r r r d r r r d dd r d d r r d r a. r r C 20 10 07/04 d r b. C 2037 07/04 d r r r dd r d r d r " d r " r r d r" r d d r r " d r r (1) r r r (2) r r - -21 2- CW 11/18 1 4 d r d r r r r DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 r r (a) r r r r r 2.a. r (b) r r " d d d r d - d r rd" r r r 2.b. r r r r r r r r r 2. r rd d dd r d (i) d r " r r d r " r d d r r " r d r r d d r r r r r r d (ii) d r " r " r r d d r r " d d d " r d - d r rd" r r r r r r r r d r dd r d 3. r r r 1. r r r 2. d r r r r r r r r d r r r d dd r d a. d r C 2010 04/13 d d r d d d r b. W r r r d r r r dd rd d r " r r d " r" r d d r r " d r r (1) r r r (2) r r r r r r r r r r r r r r r 3. r rdd dd rd (a) r d (b) W r d r r r r d r r r r r r d r dd r d d (C) d r " r r d r " r d d r r " r d r r d d r r r r r r 4. r r r 1. r r r 2. d r r r r r r r r d r r r d dd r d a. d r C 20 37 04/13 d d r d d d r b. W r r d - d r rd" r d r r r dd r d d r " r " r r d d r r r r " d d d r d - d r rd" r r r r r r r r r 4. r rd d dd r d (1) r d (2) W r d r r r r d r r r r r r d r dd r d (3) d r " r " r r d r d r r d d r r r r r r d - -21 2- CW 11/18 2 4 d r d r r r r DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 (4) " d r " r " r r d d r r " d d d " r d - d r rd" r r r r r r r r d r dd r d B. r r rd d dd r d r r d A. d r dd r d d r " r r d r " r d d r r " r r d r r r r d r r r r r r r r d 1. r r r r r r r r dr r r r d rd r rd r r d r d r 2. r r r r r r r d r r r d r r r r r r r d rr d " d r " r " r r d r d r d d r r " d r d r r r r d r r r r r r r r C. r r r d d d r dd d r r 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit IV—Commercial General Liability Conditions dd r d (1) W r d r rr r r (2) W r r r" r d (3) r r d d d r " r r d r rr d r dd rd rd r d r dd rd d rd r r r r r r r r r r d - r r D. r r r d d d r 1. dd d Other Insurance C d IV — Commercial General Liability Conditions Primary and Noncontributory insurance r r r d r r r r dd r d r d d a. dd rd d rd d r r r d b. r r r d r r r r r r r r d r r r r dd r d 2. r r dd d r r 4.b. Other Insurance C d d r IV — Commercial General Liability Conditions r r r r r r r r r dd rd dd rd r rd dd rd r r d r r rr r" r d dd rd d rd r d r r r rd r r r r r r d r dd rd r r d - r r E. d r d dd r d dd d C r r d r dd r d d dd r d d d r d d dd r d - -21 2- CW 11/18 3 4 d r d r r r r DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 F. r r rd d dd r d d r r r A.3. r r r A.4. d r dd d III — Limits Of Insurance Additional Insured —Automatic—Owners, Lessees Or Contractors Limit dd r d r 1. r d r r r r r r r d A. d r r 2. d r r r r d r r r r r r d r d r - -21 2- CW 11/18 4 4 d r d r r r r DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff.Date of Pol. Exp.Date of Pol. Eff.Date of End. I Producer I Add'1 Prem. Return Prem. 8343873-23 04/01/2019 04/01/2020 04/01/2019 80062000 $ INCL $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement,which is executed before a loss,to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B Cw(12/01) Page 1 of 1 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Coverage Extension Endorsement ZURICH Policy No. Eff.Date of Pol. Exp.Date of Pol. Eff.Date of End. Producer No. AWL Prem Return Prem. 8343872-23 04/01/2019 04/01/2020 04/01/2019 80062000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II —Covered Autos Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any "employee" of yours is also an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s)where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. U-CA-424-F CW(04-14) Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Covered Autos Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II—Covered Autos Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. 2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and b. Any: (1) Overdue lease or loan payments at the time of the 'loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: U-CA-424-F CW(04-14) Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of$3000. I. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to$750 for"loss"to personal effects which are: (1) Personal property owned by an "insured"; and (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for"loss" to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for 'loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same 'loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph 13.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph 13.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for 'loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such 'loss". U-CA-424-F CW(04-14) Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 K. Airbag Coverage The Exclusion in Paragraph 13.3.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you by us, the following applies for each covered "auto" on a per vehicle basis: 1. If the deductible on this policy or Coverage Form is the smaller(or smallest) deductible, it will be waived; or 2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest) deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss"from any one cause is $5,000 or the deductible shown in the Declarations, whichever is greater. N. Temporary Substitute Autos— Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos— Physical Damage If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following types of vehicles are also covered "autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss"; or 5. Destruction. 2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos— Physical Damage We will pay the owner for "loss"to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. O. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner(if you are a partnership), a member(if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any U-CA-424-F CW(04-14) Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 agent, servant or employee of the "insured"to notify us of any"accident", claim, "suit" or"loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or"suit" including, but not limited to, the date and details of such claim or "suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos—Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official's duties as respect their obligations to you. However, any "auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of"autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, T. Bodily Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. U-CA-424-F CW(04-14) Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 U. Expected Or Intended Injury The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II—Covered Auto Liability Coverage is replaced by the following: Expected Or Intended Injury "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. V. Physical Damage—Additional Temporary Transportation Expense Coverage Paragraph AA.a. of Section III — Physical Damage Coverage is replaced by the following: 4. Coverage Extensions a. Transportation Expenses We will pay up to $50 per day to a maximum of$1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section: In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease agreement. To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas, either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source. X. Return of Stolen Automobile The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section: If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay only for those covered "autos"for which you carry either Comprehensive or Specified Causes of Loss Coverage. All other terms, conditions, provisions and exclusions of this policy remain the same. U-CA-424-F CW(04-14) Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Zurich Policy#AUC2791382-22(Policy Term 4/1/2019-4/1/2020) 2. Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, Ca-RAMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 3. Loss means those sums actually paid that the insured is legally obligated to pay as damages for the settlement or satisfaction of a claim because of injury or offense, after making proper deductions for all recoveries and salvage. However: a. Under Coverage A: (1) Loss also includes defense expenses and supplementary payments if underlying insurance includes defense expenses and supplementary payments in the Limits of Insurance; and (2) Loss does not include defense expenses and supplementary payments if underlying insurance does not include defense expenses and supplementary payments in the Limits of Insurance. b. Under Coverage B., loss does not include defense expenses and supplementary payments. 4. Other insurance means a policy of insurance providing coverage that this policy also provides. Other insurance includes any type of self-insurance or other mechanisms by which an insured arranges for funding of legal liabilities. Other insurance does not include underlying insurance or a policy of insurance specifically purchased to be excess of this policy providing coverage that this policy also provides. 5. Pollutants mean any man-made or naturally occurring solid, liquid, gaseous or thermal irritant or contaminant, including but not limited to: smoke; vapor; soot; fumes; acids; alkalis; chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 6. Suit means a civil proceeding in which injuries or damages to which this insurance applies are alleged. Suit includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit pursuant to law or contract or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 7. Underlying insurance means the policy or policies of insurance listed in the Schedule of Underlying Insurance forming a part of this policy. We will only be liable for amounts in excess of the Limits of Insurance shown in the Schedule of Underlying Insurance for any underlying insurance. B. The following definitions are applicable to Coverage A only: 1. Hostile fire means one which becomes uncontrollable or breaks out from where it was intended to be. 2. Insured means: a. You; b. Any person or organization included as an insured in underlying insurance; and c. Any person or organization qualifying as an additional insured in underlying insurance but only to the same extent that such person or organization is an additional insured under such underlying insurance. 3. Non-Admitted Jurisdiction means: a. Any country or political subdivision in which we are not licensed or permitted to insure risks and where doing so would violate the insurance laws and regulations of such jurisdiction; or b. Any country or political subdivision where we are prevented by law from investigating,defending or settling an occurrence or suit. 4. Occurrence means a covered event as defined in underlying insurance. 5. Qualified Entity means any entity, person or organization that is not an insured under this policy and would qualify as an insured under this policy, but for the fact that the entity is registered, domiciled or has ongoing operations in a non-admitted jurisdiction. U-UMB-103-C CW(03/10) Page 10 of 19 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 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 ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION 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 04/01/2019 Policy No. WC 8343871-23 Endorsement No. Insured Premium$ Insurance Company C r r r Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Notification to Others of Cancellation, Nonrenewal ZURICH or Reduction of Insurance Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AWL Prem Return Prem. BAP 8343872-23 04/01/2019 04/01/2020 04/01/2019 80062000 $- $- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): Cert Holder 30 At the address provided by the cert holder on Accord 25 Ed. 05/10 All other terms and conditions of this policy remain unchanged. U-CA-811-A CW(05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Notification to Others of Cancellation, Nonrenewal ZURICH or Reduction of Insurance Policy No. I Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. I Producer No. AWL Prem Return Prem. GLO 8343873-23 04/01/2019 1 04/01/2020 1 04/01/2019 1 80062000 $- $- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A. If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): Cert Holder 30 At the address provided by the cert holder on Accord 25 Ed. 05/10 All other terms and conditions of this policy remain unchanged. U-GL-1447-A CW(05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 Endorsement# 09 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance Z U R I C H Policy No. Eff.Date of Pol. Exp.Date of Pol. Eff.Date of End. Producer Add'I Prem. Return Prem. U C 2791382-22 04/01/2019 04/01/2020 04/01/2019 80062000 Named Insured and Mailing Address: Producer: BONITZ, INC. WILLIS OF TN DBA WILLIS OF SC 645 ROSEWOOD DR PO BOX 2827 P.O. Box 82 COLUMBIA, SC 29202-2827 COLUMBIA, SC 29201-4603 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. The following is added to SECTION VI. CONDITIONS: Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance a. If we cancel or non-renew this policy by written notice to the first named insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: (1) To the name and address corresponding to each person or organization shown in the SCHEDULE below; and (2) At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first named insured, or the longer number of days notice if indicated in the SCHEDULE below. b. If we cancel this policy by written notice to the first named insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the SCHEDULE below at least 10 days prior to the effective date of such cancellation. c. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: (1) To the name and address corresponding to each person or organization shown in the Schedule below; and (2) At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. d. If notice as described in Paragraphs a., b. or c. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Organization(s): Number of Days Notice: Cert Holder 30 At the address provided by the cert holder on Accord 25 Ed. 05-10 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. U-UMB-697-A(05/10) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 DocuSign Envelope ID: F772F57D-CDB6-49D8-AED6-68B334B4C6C6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel or non-renew this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non- renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): ert Holder 30 At the address provided by the cert holder on Accord 25 Ed. 05-10 All other terms and conditions of this policy remain unchanged. 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 04/01/2019 Policy No. WC 8343871-23 Endorsement No. Insured: Bonitz, Inc.(et al) Premium $ Insurance Company: Zurich American Insurance Company WC 99 06 34 (Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc.with its permission. Page 1 of 1