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HomeMy WebLinkAbout2021-033-E Social Svc-Haven House Cardinal Managed Care performance agreement DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E CARDINAL MANAGED CARE FUNDS PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2020, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, Post Office Box 8181, Hillsborough,North Carolina,27278, ("County")and Haven House,Inc.DBA Haven House Services,a not- for-profit corporation, located at 600 West Cabarrus Street,Raleigh,North Carolina 27603 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Haven House, Inc. DBA Haven House Services agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2020 to June 30,2021. 2. Scope of Services. a. Provider will provide services to the residents of Orange County, as outlined in the attached Cardinal Managed Care Funds and Program Budget and any amendments or revision thereto which is attached as Exhibit "A", which are incorporated by reference. The Scope of Services and the Program Budget may be different based on County appropriation;however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement. b. The Provider shall be solely responsible for the means,methods,techniques,sequence,safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. Cardinal Managed Care Funding. i. Cardinal Managed Care Funding. The County agrees to appropriate funds for the provision of services described the"Program Services"section of Exhibit A,and may be more particularly outlined in the"Expense Description"section of Exhibit A,the maximum sum of$19,000.00 in Cardinal Managed Care Funds. ii. The Provider shall be paid Cardinal Managed Care Funds in twelve equal monthly installments in the amount of$1,583.33,The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Work Statement, at the discretion of the County the Provider may be required to repay the funds to the County. («Agencys Name») Orange County Cardinal Managed Care Fund Performance Agreement Revised 112021 Page I of 9 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E c. The County's obligation to make the payments is contingent upon receipt of Progress Reports and requests for reimbursements as provided in Section 4 below, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Work Statement. d. Once Provider has satisfied its obligations as provided in Sections 3 and/or 4 payment will be made within 21 days after receipt of the Progress Report and Request for Reimbursement. e. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Cardinal Managed Funds Reporting. Provider will provide Orange County a Monthly Progress Report for Cardinal Managed Care funds that includes a fiscal report and updates on performance measures as outlined in the Work Statement. Progress Reports are due by the 151 of the next month following the month being reported. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below(hereinafter referred to as"default"), the County may immediately terminate this Agreement,in whole or in part,and from time to time.Notice of termination must be in writing,state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings,be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above,the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance,incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider,the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County shall pay Provider that portion of the fees and (;�Age�.cys ,1Vame�j) Orange County Cardinal Managed Care Fund Performance Agreement Page 2 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. The County may(but shall not be required to)grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing,either parry may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. e. Should this Agreement be terminated,the Provider shall deliver to the County within seven (7)days, at no additional cost, all deliverables including any electronic data or files relating to the Project. f. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents,consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A- Statutory State NC & Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee (uAgencys Name)>) Orange County Cardinal Managed Care Fund Performance Agreement Page 3 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies(with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager . Post Office Box 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. S. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Limitation and Assignment. The County and the Provider each bind themselves,their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement or the rights to payment to any other parry without the written consent of the other. 11. Indemnification. Provider agrees to defend,indemnify,and hold harmless the County,for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender,national origin, age, handicap, (�c�gencys �ar�ze�� Orange County Cardinal Managed Care Fund Performance Agreement Page 4 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E religion,sexual orientation,familial status or veterans status with reference to any activities carried out by the grantee,no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. 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. 15. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 15.00 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. 16. Notice. The Parties hereto agree and understand that written notice,mailed or delivered,to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance &Administrative Services Provider: Michelle Zechmann Orange County Haven House,Inc.DBA Haven Post Office Box 8181 House Services Hillsborough,NC 27278 600 West Cabarrus Street Raleigh,NC 27603 17. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede,replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms,and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 18. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States,the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part,term or provision held to be invalid. («Agencys Name� Orange County Cardinal Managed Care Fund Performance Agreement Page 5 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified,and has not utilized the services of any agent or subcontractor,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. 19. Signatures. 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 40 of North Carolina General Statute Chapter 66. IN WITNESS WBEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. ,a"a b, ehalf of the Provider �ld( �Zt,(,U,WIOUAIA, 1/19/2021 Michelle Zechmann,Haven House,Inc. DBA Haven House Services Date b,aau&aazb,kehalf of Orange County Government bbin.IMt, Rmmtysb-� 1/25/2021 Bonnie Hammersley, County Manager Date (t�Ag-Qncy_s Name»): Orange County Cardinal Managed Care Fund Performance Agreement Page 6 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Haven House Inc. DBA Haven House Services Party/Vendor Contact Person: Michelle Zechmann Contact Phone: 919-833-3312 Party/Vendor Address: 600 West Cabarrus Street City Ralei State: NC Zip: 27603 Department: Social Services Amount: $19,000 Purpose: Cardinal Innovations MOE Budget Code(s): 10420020-710050 Vendor#801445 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date 7/l/2020 Approved by Board Yes®No ❑ Agenda Date: 6/16/2020 This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: ocuSigned by: Department Director's Signature[;_.,,,,1 C,bSfbin. Date:1/19/2021 Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficienc � rgiag(Bystandards, specifications, and requirements: / / 2021 Office of the Risk Management Officer QUSa vvullb 1 Date: 19 Financial Services This instrument has been pre-audited' f 4vquired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Date: 1/21/2021 Legal Services This agreement is approved as t €14 ",Wd sufficiency: Office of the County Attorney '\ Date:1/25/2021 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: («Agencys Name» Orange County Cardinal Managed Care Fund Performance Agreement Page 7 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E Exhibit A Cardinal Managed Care Funds Scope of Services And Program Budget ��cAgei?cys 1Vamea) Orange County Cardinal Managed Care Fund Performance Agreement Page 8 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E ATTACHMENT "A" Orange County Certifications—FY 2021 Cardinal Managed Care Fund Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address; phone and email address and if possible,fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: Certified by: Title: CEO Date: 1/19/2021 (Provider's Signature) (tcAgencys_Namq, Orange County Cardinal Managed Care Fund Performance Agreement Page 9 of 9 Rev. 112021 DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E EXHIBIT"B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Haven House(MOE Funds) Program Name: Wrenn House Funding Award: $19 000 Outline how the agency will spend Change County's funding award. Expense Description Amount Prorated salaries for shelter staff, All positions provide direct service andtor case management to 10 Orange County youth. 15,707 Prorated fringe benefits to include: FICA,SUTA,401K matah up to 6%,health,disability and Worker's Camp insurance. 3,293 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Shelter stay-Provide safe,supervised short-term shelter to Orange County youth who are in crisis • Counseling services-Provide counseling services to youth in the shelter(individual,family counseling) • Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of'riumber of persons/units served within Change County,only(all Towns and municipalities), If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results %/#of youth actively participating in shelter care activities as determined 75% (7,8 by the service plan out of 10 youth) %/#of youth receiving crisis interventions/strategies as intended by the 85% of program design/service plan youth (8.5 of 10 youth) 80% of %/#of youth successfully or satisfactorily completing services as intended youth (8 of by the program design/service plan 10 youth) r( � Certified by: Title: t ed_'Get Date: (Pr vider's Electroni Sign ure) **You will sign this document elec a ly with your performance agreement. DocuSign Envelope ID:D76EOBB3-1E71-4C6C-B396-A64E9777B70E A�� ® DATE(MMIDDIYYYY) l`�+ViR" CERTIFICATE OF LIABILITY INSURANCE 8/14/2020 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: Christina Luckey,CISR,CLCS Marsh&McLennan Agency LLC PHONE FAX 5605 Carnegie Blvd. (A/C.No Ext:704-556-3329 A/c No):212-607-6514 Suite 300 ADDRESS: christina.luckeyamarshmma.rom Charlotte NC 28209 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alliance of Nonprofits forinsurance RRG 10023 INSURED HAVEN-2 INSURER B: Eastern Alliance Insurance Company 10724 Haven House, Inc. Juli Kirby INSURER C: 600 W Cabarrus Street INSURER D: Raleigh NC 27603 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1687872021 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 p POLICY NUMBER MM/DD MMIDD A X COMMERCIAL GENERAL LIABILITY 202025015 2/1/2020 211/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence1 $500,000 MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 JECT POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $3,000,000 X OTHER: Liquor Liability $*SEE BELOW A AUTOMOBILE LIABILITY 202025015 2/1/2020 2/1/2021 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accid entt $ A X UMBRELLA LIAB X OCCUR 201925015UMB 2/1/2020 2/1/2021 EACH OCCURRENCE $2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $2,000,000 DIED I X I RETENTION$in nnn $ B WORKERS COMPENSATION 030000050295 2/1/2020 2/1/2021 XPER AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liability 202025015 2/1/2020 211/2021 LIMIT/DED **SEE BELOW Sexual Conduct/Abuse Liability LIMIT/DED ***SEE BELOW Employee Benefits Liability LIMITIDED ****SEE BELOW DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) . *LIQUOR LIABILITY--- Generai Aggregate Limit$1,000,000 Each Common Cause Limit$1,000,000 **PROFESSIONAL LIABILITY-- Aggregate Limit$3,000,000 Each Event Limit$1,000,000 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Goverment ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Manager PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27287 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E AGENCY CUSTOMER ID: HAVEN-2 LOC#: ACO® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Marsh&McLennan Agency LLC Haven House,Inc. Juli Kirby POLICY NUMBER 600 W Cabarrus Street Raleigh NC 27603 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ***SEXUAL CONDUCT&PHYSICAL ABUSE--- General Aggregate Limit$1,000,000 Each Claim Limit$1,000,000 ****EMPLOYEE BENEFITS LIABILITY--- Each Employee$1,000,000 Aggregate$3,000,000 Retroactive Date:5/15/2006 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD