HomeMy WebLinkAbout2021-095-E CJRD - Reentry House Plus Inc. outside agency agreement DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
OUTSIDE AGENCY 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, 200 South Cameron Street,
Hillsborough,North Carolina, 27278, ("County") and Reentry House Plus, Inc., a not-for-profit corporation
located at P.O. Box 361,Hillsborough,NC 27278 ("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 Reentry House Plus,Inc. 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, as outlined in the attached Outside Agency Funding
Application and any amendments or revision thereto which is attached as Exhibit "A" and
incorporated by reference, to the residents of Orange County. The Scope of Services and
the Program Budget may be different from the original application 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 as Exhibit"B".
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. The County agrees to appropriate for the provision of services described in Exhibit B,
Scope of Services,the maximum sum of$20,000.
b. All funds appropriated shall be used for purposes described in Exhibit B. 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 Scope of Services, at the
discretion of the County the Provider may be required to repay the funds to the County.
c. The Provider shall be paid in four equal installments in the amount of $5,000. 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.
d. The County's obligation to make the quarterly payments is contingent upon receipt of
Progress Reports, which show satisfactory progress toward completion of performance
measures and an accounting of expenditures as detailed in the attached Scope of Services.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21
days after receipt of the Progress Report and Request for Reimbursement or 21 days after
due date of Progress Report whichever is later.
f. The County is not obligated to provide any other support to Provider in this or in
succeeding fiscal years.
4. Agency Reporting.
a. Provider will provide Orange County a Progress Report that includes a fiscal report and
updates on performance measures as outlined in the Scope of Services. Progress Report
dates are: July 1 —December 31; January 1 —March 31 and April 1 -June 30. Reports are
due on January 11,April 12, and July 12 of the program fiscal year.
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. hi 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 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.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
c. Notwithstanding the foregoing, either party 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.
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
• 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.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
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.
8. 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. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to
any other party without the prior written consent of the County.
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,
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. 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 $ 14.25 per
hour. To the extent possible, Orange County recommends that Reentry House Plus, Inc. provide
a living wage to its employees.
15. 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:
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
County: Finance&Administrative Services Provider: Reentry House Plus,Inc.
Orange County P.O. Box 361
Post Office Box 8181 Hillsborough,NC 27278
Hillsborough,NC 27278
16. 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.
17. 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.
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.
18. 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 WHEREOF,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.
For and on the Provider
2/1/2021
Doug Peterson,Board President Date
For and on beh �0 y"ge CCounty Government
�bVt lndt, (�Awtw,t VS�f t1 2/9/2021
Bonnie Hammersley, County Manager Date
r
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Reentry House Plus, Inc. Party/Vendor Contact Person: Doug Peterson Contact Phone: 919-
260-6685 Party/Vendor Address: P.O. Box 361 City: Hillsborough State: NC Zip: 27278 Department: Finance &
Administrative Services Amount: $20,000 Purpose: FY 2020-21 Outside Agency/Human Services Performance
Agreeement Budget Code(s): 10495050-710015 Vendor # 66581 (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®Nor-1 Agenda Date: 6/19/2020
This agreement is approved as to technical for TUB e���
{('t 2/1/2021
Department Director's Signature 27n7RFRFFf:51AQ'A Date:
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 sufficiency of insura tandadapspecifications,and requirements:
&A. rbvvutib
Office of the Risk Management Officer sP:Q1 6990498 Date:2/3/2021
Financial Services
This instrument has been pre-audited in the manner re uwr@ff"TffLM-ocal Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 2/3/2021
7naF51a1vnrlanQ
Legal Services
This agreement is approved as to legal form an 1�ijCr by:
2/8/2021
Office of the County Attorney 1� Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ singersoll&oran e�ync.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:
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
Exhibit A
Provider's Outside Agency Application
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
Exhibit B
Provider's Revised Scope of Services and Program Budget
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
ATTACHMENT "A"
Orange County Certifications—FY 2020-21
Outside Agency 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.
Certified by: Title: Date:
(Provider's Signature)
r
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
EXHIBIT"B"
Scope of Services—FY 2020-21
Outside Agency Performance Agreement
Agency Name:
Selec �0 USZ (�Gt
����
Program Name: Housing and Reentry Services
Funding Award: $20,000.00
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
The money is being held in escrow to be used towards opening a transition house near 20,000.00
Hillsborough in June 2021.
Program Services
Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021.
• Housing for 5 formerly incarcerated men who are transitioning from prison
• Other services include assistance with employment & like skills education.
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange
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
Housing 5
formerly
The performance measure for this grant is the opening of the house. incarcerate
d men.
,—DocuSigned by: /�!
Certified by. UAA' �)yL Title: awu,Date:
(FrovMWsrrT&tronic Signature)
"You will sign this document electronically with your performance agreement.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
EXHIBIT `B"
Scope of Services—FY 2020-21
Outside Agency Performance Agreement
Agency Name: Reentry House Plus
Program Name: Reentry House Purchase
Funding Award: $20,000
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
The Outside Agency funding will contribute to the purchase of the house that will be $20,000
used as a home for individuals re-entering in Orange County from incarceration
Program Services
Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021.
• Purchase the home
Provide residence to re-entering individuals
• Provide case management and supportive services to the residents
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange
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
Certified by: Title: Date:
(Provider's Electronic Signature)
"You will sign this document electronically with your performance agreement.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
EXHIBIT"B"
Scope of Services—FY 2020-21
Outside Agency Performance Agreement
Agency Name: Reentry House Plus O
Program Name: Housing and Programs for Post-incarcerated
Funding Award: $20,000.00
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
House rental $20.000
Other Program services(not included here)[from other sources of grants and income] [76,000.00]
Program Services
Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021.
Education and training for employment
• Preparation for and assistance with independent housing
Transportation to and mentoring for employment and essential life skills.
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange
County,only(all Towns and municipalities).
If-you use Rercentagm you must also rovide the total number of Participants within that measure's description or for an
earlier performance measure.
Performance Measures Anticipated
Results
80%
10 residents to indepence or return to families (8 of 10)
90%
20 participants in life/skill training for post-incarcerated 18
complete
program)
80%
10 residents will be assisted with employmentleducational opportunities to (8 0f 10)
secure employment and independent living
Certified by: Title: Date:
(Provider's Electronic Signature)
"You will sign this document electronically with your performance agreement.
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
011
ANGE COUNTY
NORTH CAROLINA
FY 2020-21 Outside Agency
Contact Information
Congratulations on being awarded Outside Agency Funding for FY 2020-21!
Please provide the below information regarding your agencies' contacts for fiscal year 21.
Please complete and sign this form electronically and submit to Allen Coleman at
outsideajtencies@oraneecountync.eov by Friday,August 14 2020.
Section A-. Agency Information:
Agency Legal Name Reentry House Plus, Inc.
Agency DBA (IfApplicahle)
Physical Address Not disclosed (privacy)
Mailing Address PO Box 361 , Hillsborough, 27278
Agency's Telephone Number 773-671 -6887
Agency Website www.reentryhouseplus.wildapricot.org
Section B. Executive Director's Information
Executive Director's Name David Stanford, Secretary
Executive Director's Telephone Number 773_671 -6887
Executive Director's Email Address reentryhouseplus@yahoo.com
Will the Executive Director Sign the YES ® NO
Performance Agreement?
If no, please tell us who?—Name:
Email Address dstanford4900@yahoo.com
2] Application Orientation &
What type of Communications should this Training Opportunities
individual receive? II Financial Reporting
Please select check all that apply: El Performance Reporting
ED Performance Agreement Execution
1
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
O11 A
rVANGE COUNTY
NORTH�I CAS OLINA
FY 2020-21 Outside Agency
Contact Information
Section C: Program Contact Information
Program Director's Name Tommy Green
Program Director's Telephone Number 91 9-339-2410
Program Director's Email Address anotherchancefoudationl8@gmail.com
F;71 Application Orientation&
What type of Communications should this Training Opportunities
individual receive? []✓ Financial Reporting
Please select check all that apply: r-71 Performance Reporting
Performance Agreement Execution
Section D: Financial Contact information
Finance Director's Name Paul Triulzi, Treasurer
Finance Director's Telephone Number 919-321 -2664
Finance Director's Email Address paul.triulzi@yahoo.com
0 Application Orientation &
What type of Communications should this Training Opportunities
individual receive? ✓[� Financial Reporting
Please select check all that apply. Performance Reporting
Performance Agreement Execution
Section E: Administrative/Office Manager Contact Information
Administrative Contact Name David Stanford
Administrative Telephone Number 773-671 -6887
Administrative Email Address reentryhousepius@yahoo.com
Q Application Orientation &
What type of communications should this Training Opportunities
individual receive? 0 Financial Reporting
Please select check all that apply: Performance Reporting
0 Performance Agreement Execution
2
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
ORANGE COUNTY
NORTH CAROLINA
FY 2020-21 Outside Agency
Contact Information
Existing Agencies:
Has your agencies banking information changed? YES N
Has your federal ID number changed? D YES OrNo
New Agencies:
Please submit a W9 and EFT Authorization Form. Both documents are required.
Signature D e
3
DocuSign Envelope ID: 1BE60CB8-ODEB-4A6C-BF4E-E85200702589
ACORGI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
aB/2o12D20
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($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the poiicy(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 NAME:C Steven Viola
ONE (336)945-3713 FAX,Underwriters Inc. PAH! Ent- Ac No (33fi)9454719
6380 Shallowtord Road E-MAIL steve@securityunderwriters.com
ADDRESS:
P O Box 369 INSURER(S)AFFORDING COVERAGE NAIC#
Lewisville NC 27023 INSUMRA: Alliance of Nonprofits for Insurance
INSURED INSURER B:
ReEntry House Plus,Inc. INSURER C:
- P.O.BOX 361 INSURER D:
INSURER E:
Hillsborough NC 27278 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL2082003476 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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_
ILTR TYPE OF INSURANCE INSD WVD POLICYNUMBER NiWO EFF PWDD LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE ® OCCUR PREMISES Ea occurrence $ 500,000
MED EXP(Anyone Person) $ 20,000
A 2020-65458 10/0112020 10/01/2021 PERSONAL&ADV INJURY $ 1,000,000
GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY ❑PRO- LOC PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER: JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 2020-65458 10101/2020 10/01/2021 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACHOCCURR"CF $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$_ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNERIEXECUTNE ❑ N f A E.L.EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
(Mandatary in NH) El.DISEASE-EA EMPLOYEE S
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Each Wrongful Act $1,000,000
Directors&Officers Liability
A 2020-65458-ad 1010112020 10/01/2021 Annual Aggregate $1,000,000
DESCRIP MN OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Addirkmal Remarks Schedule,may be attached if 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
Orange County North Carolina Finance&Administrative Services ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 8181
AUTHORIZED REPRESENTATIVE
Hillsborough NC 27278
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