HomeMy WebLinkAbout2019-499-E Human Rights Relations - Cindy Chen translation services DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
ORANGE COUNTY
COUNTYWIDE INTERPRETER/
TRANSLATOR CONTRACT
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 1st day of July, 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"),and Chien-Chun Cindy Chen(the "Provider");
WITNESSETH:
For the purpose and subject to the following terms and conditions hereinafter set forth, the County
hereby contracts for the services of the Provider, and the Provider agrees to provide.the following
Interpretation and Translation services (hereinafter referred to collectively as "Services") to the County in
accordance with the terms of this Agreement,time being of the essence.
1. Contract. This Contract consists of this document and additional documents checked below:
a. For Health Department:
i. ❑ Health Department Additional Terms and Conditions
J, ❑ Business Associates Agreement
iii. ❑ Condition of Contract Statement
b. For Department of Social Services:
i. ❑ The General Terms and Conditions(Attachment A);
ii. ® The Scope of Work,description of services, and rate(Attachment B);
iii. ® Federal Certification Regarding Drug-Free Workplace(Attachment Q
iv. ® Conflict of Interest(Attachment D);
v. ®No Overdue Taxes(Attachment E);
vi. ❑ Outcomes and Reporting(Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior oral or
written statements or agreements.
2. Provider's Responsibilities:
a. The Provider shall be qualified to interpret between English and Chinese and translate
between English and Chinese with the County staff.
b, Professional Conduct. The Provider shall adhere to the standards of professional conduct of
an interpreter and translator while conducting the services to include the following:
i. The Provider shall relate to all County clients and staff in a respectful and professional
manner.
ii. The Provider will interpret the information being shared between clientifamily and staff
as clearly as possible, without additional personal comments or biases an the topic,being
discussed.
iii. The provider when providing translation services will translate the information as clearly
as possible without changing the meaning and the intent of the document.
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iv. The Provider will interpret and translate the information to the best of his/her ability.
c. Client Confidentiality.
i. The Provider acknowledges that she/he may have access to information that is confidential
and provided by state and federal laws and agrees to comply with all privacy policies,
regulations, and laws as well as the Health Insurance Portability and Accountability Act
(HIPAA)of 1996(P.L.104-191).
ii. The Provider agrees to protect confidential information (e.g., client name, appointment
type, telephone number, health information) that he/she may receive in doing business
with County. The Provider should ensure proper, safe storage and protection of client
information during use, and shredding/deletion of such information when it is no longer
necessary for business purposes.
iii. Breaches of client confidentiality will result in automatic termination of this Agreement.
d. Scope of Services.
i. Procedures and Guidelines Upon Acceptance of an Interpretation Assignment:
1. The Provider agrees to give at least 24 hour notice if he/she is unable to participate
in a scheduled client contact.
2. The Provider will be expected to make confirmation phone calls to clients in
advance of an assigned appointment, when feasible, and when the Provider is
provided the information by County staff. The Provider should notify County staff
as soon as possible if the client has told the Provider that he/she will not be able to
make the appointment and/or if he/she needs to reschedule. These confirmation
calls will not be paid for separately, but are considered part of the service when the
Provider accepts an assignment for an appointment.
3. The Provider shall not have contact with County clients without County staff being
present, unless specifically asked by staff to call clients to confirm or schedule
appointments. It is not acceptable for the Provider to give out his/her home
telephone number or cell phone number for later contact between the family and
Provider,
ii. Procedures and Guidelines when the Provider Accepts a Translation Assignment:
1. When asked to translate from English into the second language, the Provider will
review the original English version and request any clarification from County staff
prior to translation.
2. As needed,the Provider will discuss with County staff recommendations to improve
the utility and cultural appropriateness of material for the target audience prior to
translation. Upon consultation with Provider, County staff may choose to modify
the English version before resubmitting for a direct translation. Document
consultation may be charged as part of the translation service, but must be agreed
upon in advance.
3. All translations should match the original version in terms of content and format.
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4. The Provider will submit an electronic version of the translation. Documents must
be formatted using an MS Word software program and/or submitted as a PDF so that
County staff can open and read the document.
3. Coun 's Responsibilities. County will compensate Provider as provided in subsection 4 for
interpretation and translation services at the rate prescribed. Per hour reimbursement will begin
at the time the Provider meets with County staff for the appointment and ends at the time the
staff and interpreter contact is completed. There will be a minimum of one (1) hour of service
for an appointment. County will reimburse the Provider for one (1) hours of interpretation
service in the event of a same day cancelled appointment. That includes appointments for clients
who do not show up for an appointment, and for those who cancel an appointment with Iess than
24 hour notice.
4. Payment for Services: The County agrees to pay at the rates specified for Services satisfactorily
performed in accord with this Agreement.
a. Compensation. Compensation for Basic Services shall include all compensation due the
Provider from the County for all Services provided under this Agreement as specified below.
i) Basic Services. The amount to be paid by the County shall not exceed Four Thousand, Nine
Hundred Ninety Nine Dollars and Ninety Nine Cents Dollars ($4,999.99), to be paid at a rate
of$40/hour for Interpretation Services and $ 50/hour with one hour minimun in translating a
document for Translation Services. 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.
ii) The Provider shall complete and submit the County Invoice for Payment of Translation or
Interpretation Services form to County staff at the time the service is rendered. County staff
will verify the information, sign and forward the form for payment of services. Any
additional charges not specified herein, must be mutually agreed to in advance by County
and Provider and documented in writing with a letter signed by authorized representatives
for County and Provider and,subject to budgeted funds.
b. For interpretation services only:
i) The Provider will record the start and finish time worked to the minute. After the first hour
of service,payment will be calculated and paid per minute.
ii) The Provider shall submit one invoice per client, unless there is a block of appointments
without interruption. Without interruption means that there were no cancelled appointments
and no lunch hour included. This is appropriate for a group of clients who are served for the
same type of appointment, at the same location. For question, contact the departmental
contact.
iii) In the event of a cancelled appointment,the Provider is required to stay until relieved of duty
by the individual in charge. County staff may require other interpreter-related services in
place of the scheduled appointment. As stated above,the Provider may submit an invoice in
the event of a broken appointment(with less than 24 hour notice).
iv) If the Provider is assisting County staff with a large volume of phone calls outside of a
scheduled appointment time, the Provider should complete a Call Log to submit along with
M-vised 06/19 3
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an invoice describing the services performed. This type of service is paid by the minute,
without a one hour minute requirement for payment.
v) In the case of an unexpected closing or delayed opening (e.g., inclement weather) of the
County Offices when providing interpretation services, the Provider shall not be paid for
missed appointments. When in doubt,the Provider can call 732-8181 to see if county offices
are open or are on a delayed schedule. When possible,the Provider is also asked to help call
his/her scheduled clients to inform them of the delay or closing.
5. Term. The term of this Agreement shall be from July 1, 2019 to June 30,2020.
6. Errors and Omissions. 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.
7. Additional Terms and Conditions. The County may have additional terms and conditions that shall
be provided as an attachment(s) and is(are)hereby incorporated by reference.
8. Precedence Among Contract Documents: In the event of a conflict between or among the terms of
the Contract Documents, the terms in the Contract Document with the highest relative precedence
shall prevail. The order of precedence shall be the order of documents as listed in Paragraph 1,
above, with this contract document having the highest precedence then the first listed document and
the last-listed document having the lowest precedence. If there are multiple Contract Amendments,
the most recent amendment shall have the highest precedence and the oldest amendment shall have
the lowest precedence.
9. 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.
10. Independent Contractor: The Provider shall operate as an independent Provider, 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
shall payroll tax of any kind be withheld or paid by the County on behalf of the Provider or the
employees of the Provider.
11, Insurance: Provider shall obtain, at its sole expense, Professional Liability or Errors and Omissions
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.orangecountyn-govZdepartments/purchasing division/contracts.php). If County's
Risk Manager determines additional insurance coverage is required such additional insurance shall
consist of 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.
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12. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Grange County from all
losses, liabilities, claims, demands,suits,costs, damages or expenses(including reasonable attorney's
fees), arising from any 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 errors or omission on
the part of the Provider.
13. 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.
14. 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. This
Agreement together with any amendments or modifications may be executed electronically. All
electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and
Article 44 of North Carolina General Statute Chapter 66.
15. Governing Law. Both parties agree that this Agreement shall be governed by the laws of the State of
North Carolina. By executing this Agreement Provider affirms Provider is in compliance with
Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement
Provider certifies that Provider has not been identified, and has not utilized the services of any agent
or subcontractor, 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.
16. Non-Discrimination. Provider shall at all times remain in compliance with all applicable local, state,
and federal laws, rules, and regulations including but not limited to all state and federal non-
discrimination laws, policies, rules, and regulations and the Grange 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.
17. Dispute Resolution: Any and all suits or actions to enforce, interpret, or seek damages with respect
to any provision of, or the performance or non-performance of, this Agreement shall be brought in
the General Court of Justice of North Carolina sitting in Orange County,North Carolina. It is agreed
by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions.
Binding arbitration may not be initiated by either Party, however, the Parties may agree to
nonbinding mediation of any dispute prior to the bringing of such suit or action.
18. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of
this Agreement is based upon the availability of public funding under the authority of its statutory
mandate. In the event that public funds are unavailable and not appropriated for the performance of
County's obligations under this Agreement, then this Agreement shall automatically expire without
penalty to County immediately upon written notice to Provider of the unavailability and non-
appropriation of public funds. It is expressly agreed that County shall not activate this non-
appropriation provision for its convenience or to circumvent the requirements of this Agreement, but
only as an emergency fiscal measure during a substantial fiscal crisis.
In the event of a change in the County's statutory authority, mandate and/or mandated functions, by
state and/or federal legislative or regulatory action, which adversely affects County's authority to
Revised 06119 5
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1DB
continue its obligations under this Agreement, then this Agreement shall automatically tenninate
without penalty to County upon written notice to Provider of such limitation or change in County's
legal authority,
IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement,effective
as of the day first written above.
ORANGE COUNTY PROVIDER: Chien-Chun Cindy Chen
Docu5igned by: Docu Sig ned by:
By:
6. j°jD�n.rAk RaAW%Ult" By: L��.
0637994B755E477 027058C07CFalF.
Bo...a...a,.................,»..........., ..,.onager . ......
200 S. Cameron St, Chinese Interpreter
P.O. Box 8181 111 Tealight Lane
Hillsborough,NC 27278 Cary,NC 27513
Revised 06/19
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
ATTACHMENT B
SCOPE OF WORK
Orange County Department of Social Services
Federal Tax Id. or SSN
Contract#
A. CONTRACTOR INFORMATION
1. Contractor Agency Name:
2. 1f different from Contract Administrator Information in.General Contract:
Address
Telephone Number: Fax Number: Email:
3. Name of Program(s): Interpretation/Translation Services
4. Status: ( ) Public. ( ) Private,Not for Profit (X) Private,For Profit
5. Contractor's Financial Reporting Year July 1, 2019 through June 30, 2020
B. Explanation of Services to be provided and to whom(include SIS Service Code):
C. Rate per unit of Service (define the unit):
1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart)
2.Negotiated County Rate.
$40.00/hour---Interpretation and Translation $50 per hour with one hour
minimum in translating a document.
D.Number of units to be provided:
E. Details of Billing process and Time Frames;The CojMty will reimburse the Contractor
for services described in this contract up to the budgetary limits of the contract allotment.
The County will reimburse the Contractor at a rate of$40.00Ihour for approved services
provided and travel at the county rate. For reimbursement, the Contractor must submit the
Orange County Department of Social Services Invoice for Payment of Intemreting
Services form to the Coup staff at the time services are rendered, County staff will
verify the information, sign the form, and forward the form to the designated County
Administrator. The County will reimburse the Contractor monthly upon receipt of a
complete and correctly filed report.
Contract-Scope of Work(06/04) Page 1 of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1DB
Per hour reimbursement will begin at the time the Contractor meets with Couxtty_staff for
the appointment and ends when the County staff and Contractor contact is completed.
There will be a minimum of 1 hour of service for an appointment. Mileage
reimbursement will be for round trip from the Contractor's home or work site to the
prearranged appointment site.
F. Area to he served/Delivery site(s): —Orange County
OocuSigned by:
Oacu Sig nec[by, P.� p�
6. fV�i
— 027058007CFC41F.
0637994N 5E477
(Sign..... . _..,__., .--.--..---Person) (Signature of Contractor)
7/30/2019 7/29/2019
(Date Submitted) (Date Submitted)
Contract-Scope of Work(06/04) Page 2of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
Orange County Department.of Social Services
I. By execution of this Agreement the Contractor certifies that it will provide a drug-free
workplace by:
A. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing,possession or use of a controlled substance is prohibited in the Contractor's
workplace and specifying the actions that will be taken against employees for violation of
such prohibition;
B. Establishing a drug-free awareness program to inform employees about:
(1)The dangers of drug abuse in the workplace;
(2) The Contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
C. Making it a requirement that each employee be engaged in the performance of the
agreement be given a copy of the statement required by paragraph(A);
D. Notifying the employee in the statement required by paragraph(A)that, as a condition of
employment under the agreement, the employee will:
(1)Abide by the terms of the statement; and
(2)Notify the employer of any criminal drug statute conviction for a violation occurring
in the workplace no later than five days after such conviction;
E. Notifying the County within ten days after receiving notice under subparagraph(D)(2)
from an employee or otherwise receiving actual notice of such conviction;
F. Taking one of the following actions, within 30 days of receiving notice under
subparagraph(D)(2),with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee,up to and including
termination; or
(2)Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health,
law enforcement,or other appropriate agency; and
Making a good faith effort to continue to maintain a drug-free workplace through implementation
of paragraphs (A), (B), (C), (D), (E), and(F).
Federal Certification-Drug-Free Workplace(06/04) Page 1 of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1DB
11. The site(s) for the performance of work done in connection with the specific agreement are
listed below:
I. 113 Mao Street
(Street address)
Hillsborough, Orange,NC 27278
(City, county, state, zip code)
2. 2501 Homestead Road
(Street address)
ChM el Hill Orange,NC 27516
(City, county, state, zip code)
Contractor will inform the County of any additional sites for performance of work under this
agreement.
False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
(Section 4 CFR Part 85, Section 85,615 and 86.620).
DocuSignecl by,
V' UQAAI contractor
027058C07CFC41F.
3ignaiure Title
orange county Department of Social servUE 9/2019
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
ATTACHMENT D
CONFLICT OF INTEREST POLICY
Orange County Department of Social Services
Conflict of Interest Defined:
A conflict of interest is defined as an actual or perceived interest by a(Contractor/staff
member/Board member) in an action that results in, or has the appearance of resulting in,
personal, organizational, or professional gain. A conflict of interest occurs when an
employee/Contractor/Board member has a direct or fiduciary interest in another
relationship. A conflict of interest could include:
➢ Ownership with a member of the Board of Directors/Trustees or an employee
where one or the other has supervisory authority over the other or with a client
who receives services.
➢ Employment of or by a member of the Board of Directors/Trustees or an
employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Contractual relationship with a member of the Board of Directors/Trustees or
an employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Creditor or debtor to a member of the Board of Directors/Trustees or an
employee where one or the other has supervisory authority over the other or
with a client who receives services.
➢ Consultative or consumer relationship with a member of the Board of
Directors/Trustees or an employee where one or the other has supervisory
authority over the other or with a client who receives services.
The definition of conflict of interest includes any bias or the appearance of bias in a
decision-making process that would reflect a dual role played by a member of the
organization or group. An example, for instance, might involve a person who is an
employee and a Board member,or a person who is an employee and who hires
family members as consultants.
Employee/Contractor/Board Member Responsibilities:
It is in the interest of the organization, individual staff, and Board members to strengthen
trust and confidence in each other,to expedite resolution of problems, to mitigate the
effect and to minimize organizational and individual stress that can be caused by a
conflict of interest.
Employees are to avoid any conflict of interest, even the appearance of a conflict of
interest.' This organization serves the community as a whole rather than only serving a
special interest group. The appearance of a conflict of interest can cause embarrassment
to the organization and jeopardize the credibility of the organization. Any conflict of
interest, potential conflict of interest, or the appearance of a conflict of interest is to be
reported to your supervisor immediately. Employees are to maintain independence and
objectivity with clients, the community, and organization. Employees are called to
Conflict of Interest Policy(06144) Page 1 of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
maintain a sense of fairness,civility, ethics and personal integrity even though law,
regulation, or custom does not require them.
Acceptance of Gifts:
Employees, members of employee's immediate family, and members of the Board are
prohibited from accepting gifts, money or gratuities from the following:
a. Persons receiving benefits or services from the organization;
b. Any person or organization performing or seeking to perform services under
contract with the organization; and
c. Persons who are otherwise in a position to benefit from the actions of any
employee of the organization.
Employees may,with the prior written approval of their supervisor, receive honoraria for
lectures and other such activities while on personal days, compensatory time, annual
leave, or leave without pay. If the employee is acting in any official capacity, honoraria
received by an employee in connection with activities relating to employment with the
organization are to be paid to the organization,
NOTARIZED CONFLICT OF INTEREST POLICY
State of North Carolina
County of Orange
I, CHIEN-CHUN CINDY CHEN certify that I have read the forgoing
information, understand it, and that no conflict of interest exists in the execution of this
contract.
9&�2- -
Signature
Sworn to and subscribed bety/�,ri�e i1ne on the 1 D day of � UYY,2oi�.
��It%lotpol ,r fi
•,e�!WAJ V,q'••,.
rA 0 A a a
My Commission Expires: e�
{Notary SignatAre ind o% L1G
••�y��CQU1r► '��1��
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Conflict of interest Policy(06/04) Page 2 of 2
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1 DB
Exhibit E
Cindy Chen
l l l Tealight Lane ,
Cary,NC 27513
To; Orange County Department of Social Services
Certification:
l certify that I do not have any overdue tax debts,as defined by N.C.G.S. 1 a5-243.1,at
the federal, State, or local level. I further understand that any person who makes a false
statement in violation of N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable
as provided by N.C.G.S. 143-34(b).
Sworn Statement:
I, being duly sworn, say that I am Cindy Chen; and that the foregoing certification is true,
accurate and complete to the best of my knowledge and was made and subscribed by me.
I also acknowledge and understand that any misuse of State funds will be reported to the
appropriate authorities for further action.
Signature
Sworn to and subscrib ���ee� '1t ythe c day of a�V}'�,201
et
V
� My Commission Expires: I� -2
r
A(Notaary Signa a L&S ea $L I G
PUi�1z' ,710#'1'
DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1DB
_ 7 ® DATE(MMIODIYYYY)
CERTIFICATE OF LIABILITY INSURANCE
07/12/2019
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 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 endorsements).
PRODUCER CONTACT
NAME: _
Hiscox Inc. PHONE (888)202-3007 FAX
No):
520 Madison Avenue E-MAIL
ADDREss: confact@hisc0x.cam
32nd Floor
New York,NY 10022 IN SURER(S)AFFORDING COVERAGE NAIL#
INSURER A: Hiscox Insurance Company Inc 10200
INSURED INSURER B:
Cindy Chen
111 Tealight Ln €NSllRERt
Cary NG 27513 INSURER D;
INSURER E
INSURER F;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLTYPE OF}NSURANCE JUM SU n POLPOLICY NUMBER MMI Io�YY M
LTR MID LIMITS
GOMMERCIALGENERAL LIABILITY EACH OCCURRENCE S
DAMAGE? _11 NT O
CLAIMS-MADE - OCCUR PREMISES Ea occurrence $
ME EXP(Arty one person) $
PERSONAL&AOV INJURY $
GEN'L AGO REGATE LI M IT APPLI ES PE R: GENERAL AGGREGATE $
POLICY PRO LOC PRODUCTS-COM Plop AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO 0DOILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Peraccldent) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per a.iden!
I
MBRELLALIAB HOCCUR EAGHOCCURRENCE S
XCESS LIAB CLAIMS-MADE AGGREGATE $
ED RETENTIMiJS
WORKERS COMPENSATION PER STATUTE EMPLOYERS'LIABILITY YIN STATUTE ER
ANYPROPRIETORIPARTNEPJEXECUTIVE ❑ NIA E.L.EACH ACCIDENT S
OFFICERIM EMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION of OPERATIONS below E.L.DISEASE-POLICY LIMIT I S
A Professional Liability UDC-4212840-EO-19 07/10/2019 07110/2020 Each Claim:$250,00
Aggregate:$250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD let,Additional Remarks Schedule,may be attached it more space Is required)
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 '
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