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HomeMy WebLinkAbout2021-598-E-AMS-Pine Shore Energy-To install L2 Pedestal Mounted EVSE at the ERPDRevised 07/20 1 [Departmental Use Only] TITLE Charging Stations FY 2021/2022 NORTH CAROLINA SERVICES AGREEMENT NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter “Agreement”), made and entered into this 1st day of October, 2021, (“Effective Date”) by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and Pine Shore Energy, LLC, (hereinafter, the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1.Services a.Scope of Work. i)This Agreement is for services to be rendered by Provider to County with respect to (insert type of project): Provide two Clipper Creek L2 Pedestal mounted EVSE (#5 & #6) at Parking Spot #160 & 162 of Orange County Parking Deck. These locations are noted on drawings attached for reference only. New units shall include smart charging components and individual remote monitoring for detailed reporting on energy utilization and user interactions. Each EVSE shall have capability for connection into new county wide system. . Please See Attached Proposal dated 10/04/2021. ii)By executing this Agreement, the 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. iii)Time is of the essence with respect to this Agreement. DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 2 iv)The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2.Responsibilities of the Provider a.Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b.Standard of Care. i)The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. Provider is solely responsible for the professional quality, accuracy and timely completion and submission of all work related to the Basic Services. ii)Provider shall be responsible for all errors or omissions of its agents, contractors, employees, or assigns 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. iii)The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv)Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v)If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. vi)In determining the Basic Services to be provided, should any documents be referenced in this Agreement, the terms of this Agreement shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 3 vii)Should this Agreement involve project designs, the construction or creation of which is to be bid out or fulfilled by other contractors, and bidding or negotiation with contractors produce prices which, when added to the other elements of the approved total project cost, produce a cost that is in excess of the approved total project cost, the Provider shall participate with the County in negotiation and design adjustments to the extent such are necessary to obtain prices within the approved total project cost. All activity of the Provider with respect to these matters shall constitute Basic Services and shall be performed by the Provider without additional compensation. If negotiation and design adjustments fail to bring costs within the total project cost the County may reject all bids and Provider will redesign or reduce portions of the project in an effort to reduce the bid prices to within the total project cost and rebid the project. One such redesign is included within Basic Services. If this second letting for bids does not produce bids that are within the approved total project cost initially or after negotiations with the contractor the cost is not reduced to an amount within the total project cost, the Provider is not obligated to engage in further redesign. 3.Basic Services a.Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): To install two Clipper Creek L2 Pedestal mounted EVSE at Eno River Parking Deck in Hillsborough NC. Please See Attached Proposal dated 10/04/2021. 4.Duration of Services a.Term. The term of this Agreement shall be from 10/04/2021 to 04/04/2022. b.Scheduling of Services. i)The Provider shall schedule and perform its activities in a timely manner. ii)Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii)The Commencement Date for the Provider's Basic Services shall be 10/04/2021. 5.Compensation a.Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services satisfactorily (as determined by the County) performed pursuant to this Agreement. The maximum amount payable for Basic Services shall not exceed Fourteen Thousand Forty Dollars and Thirty One Cents ($14,041.31). Payment for satisfactorily performed Basic Services shall become due and payable within thirty (30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 4 b.Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. 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. c.Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6.Responsibilities of the County a.Cooperation and Coordination. The County has designated (Brennan Bouma) to act as the County's representative with respect to the Project who shall have the authority to render decisions within guidelines established by the County Manager or the County Board of Commissioners and who shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7.Insurance a.General Requirements. 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 consist of NA (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. 8.Indemnity a.Indemnity. To the extent authorized by North Carolina law the Provider agrees, without limitation, to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from property damage or bodily injury including death to any person or persons caused in whole or in part by the negligence or 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 provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 9.Amendments to the Agreement a.Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 5 Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 10.Termination a.Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days’ prior written notice to the Provider. b.Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. Either party may terminate this Agreement upon notice to the other party that obligations pursuant to this Agreement are made impractical due to declarations of emergency by Orange County or by North Carolina due to events directly impacting Orange County. Both parties shall remain responsible for all payment and performance due up to the receipt of such notice, but shall have no further obligation or responsibility beyond that date provided the terminating party has taken all reasonable steps to complete the performance of its obligations. c.Compensation After Termination. i)In the event of termination, the Provider shall be paid that portion of the fees and 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. Upon request of the County, the Provider shall submit to County all relevant documentation, including but not limited to, job cost records, to support its claims for final compensation. ii)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. d.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. e.Suspension. County may suspend the Basic Services and this Agreement at any time for County’s convenience and without penalty to County upon three (3) days’ notice to Provider. Upon any suspension by County, Provider shall discontinue work on the Basic Services and shall not resume the Basic Services until notified to proceed by County. 11.Additional Provisions DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 6 a.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 without the written consent of the other. b.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 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. c.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 Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Any violation of the Orange County Non-Discrimination Policy is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. d.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. e.Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f.Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g.Ownership of Work Product. Should Provider’s performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 7 things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h.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 or mandated functions, by state or federal legislative or regulatory action, which adversely affects County’s authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County’s legal authority. i.Signatures. 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 11A and Article 40 of North Carolina General Statute Chapter 66. j.Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider’s Name Attention:Alan Dorman Pine Shore Energy LLC P.O. Box 8181 PO Box 443 Hillsborough, NC 27278 Brevard, NC 28712 [SIGNATURE PAGE TO FOLLOW] DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Revised 07/20 8 IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: By: _________________________________ Bonnie Hammersley By: __________________________________ David Thompson Printed Name and Title DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 10/20/2021 10/21/2021 Revised 07/20 9 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: Pine Shore Energy LLC Party/Vendor Contact Person: David Thompson Contact Phone: 1- 828-553-6257 Party/Vendor Address: PO Box 443 City Brevard State: NC Zip: 28712 Department: AMS Amount: $14041.31 Purpose: To install L2 Pedestal Mounted EVSE at the ERPD Budget Code(s): 61370035-803050-30051 Vendor # 65135 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: 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: Department Director’s Signature ________________________________________ Date: ________ 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 sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ 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:_________ DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 10/20/2021 10/21/2021 10/21/2021 10/21/2021 Pine Shore Energy LLC PO Box 443 Brevard, NC 28712 US 828-553-6257 dave@pineshoreenergy.com www.pineshoreenergy.com Quote ADDRESS Brennan - Bouma Orange County - Asset Management Services 131 W. Margaret Lane Hillsborough, NC 27278 Orange SHIP TO Brennan - Bouma Orange County - Asset Management Services 131 W. Margaret Lane Hillsborough, NC 27278 Orange QUOTE #1045 DATE 10/04/2021 PROJECT EVSE#5 & #6-O.C. Parking Garage DATE ACTIVITY QTY RATE AMOUNT L2 - Item #2A Single Station Ruggedized with AppCTRL® Pedestal Mount Pedestal AppCTRL_Ped + 1 HCS-40R with COSMOS 2 4,338.06 8,676.12 Item #NAEAS-4 | Networking - AppCtrl UPC w/ Control Logic and Graphics AppCtrl-UPC w/ logic & graphics. PDM-10-0300-06-000 Smart Top + 120V RCPT 1.50 2,339.00 3,508.50 NC-691A:Level 2 EV Supply Equipment:Item # 15 L2 - Bollards (Includes material and installation 2 bollards; price is per unit) - copy BOL-36-4.5, 36 in x 4.5 in. Yellow Steel Pipe Safety Bollard w/ 4 pack anchors Model # 3512298 (or equal to meet spec) 1 877.06 877.06T Scope of Work: Provide two Clipper Creek L2 Pedestal mounted EVSE (#5 & #6) at Parking Spot #160 & 162 of Orange County Parking Deck. These locations are noted on drawings attached for reference only. New units shall include smart charging components and individual remote monitoring for detailed reporting on energy utilization and user interactions. Each EVSE shall have capability for connection into new county wide system. Pine Shore Energy LLC is Vendor for NC-State Contract 691A - Electric Vehicle Charging Station Equipment, Accessories, Installation & SUBTOTAL 13,061.68 TAX 979.63 TOTAL $14,041.31 DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 Infrastructure. All work shall be performed in accordance with this contract. Payment Terms:50% Project Mobilization 90% Substantial Completion 100% Final Inspections Accepted By Accepted Date DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 1. Provide and/or prepare mounting surface for new electrical service equipment in accordance with MFG recomendations and NEC. 2. Provide meterbase to accomodate 400A 120/240V meter and outdoor panel. Provide conduit from meter base to 400A 240/120vAC Single Phase panelboard. Coordinate all requirements with Duke Energy. 3. Borehole thru concrete deck as required for running conduit from meter to panelboard. 4. Provide Paneloard EV1N located adjacent to EV Charging Cluster on parking deck Levels 1 to 2. Provide ten (10) 40A-2P and four (4) 20A-1P circuit breakers, 5. Borehole thru concrete deck as required for running conduit from panelboard to existing EVSE #1 thru #4 and future EVSE #4 thru #10 6. Existing conduit and feeder circuits enter EVSE #1 thru #4 thru concrete deck to bottom of units from existing panelboard in West Campus Office Building. Disconnect, abandon in place and tag existing conduit and wiring from Panelboard to JB near EVSE. 7. Provide new conduit and conductors as required from new panel board EV1N to existing EVSE #1 thru #4. Pathways shall be sized to accomodate 6 future EVSE. 8. Connect existing 120vAC EVSE control circuit to new control circuit in new panelboard. 9. Terminate and test all wiring for power and controls. Scope of Work Area of Work (EVSE on Levels One to Two) Sheet Title: Date Designed by: Checked by: Pine Shore Energy LLC 131 Fayette St NW Winston-Salem, NC 27101 ©2021 828-553-6257 Dave@pineshoreenergy.com www.pineshoreenergy.com THIS DRAWING IS NOT TO BE SCALED FOR CONSTRUCTION PURPOSES. THE SCALE WHEN INDICATED IS FOR GENERAL REFERENCE ONLY. Project #: STATEWIDE TERM CONTRACT 691A ELECTRIC VEHICLE CHARGING STATION EQUIPMENT, ACCESSORIES, INSTALLATION & INFRASTRUCTURE Planning Phase: C:\Users\dave\Documents\Pineshore\Projects\4. projects_con\Orange_County_NC\OC_Parking_Deck\dwg\OC_Gateway_Center_Parking_Deck_EVSE_Upgrades.rvt 9/24/2021 12:12:56 PM E0 E-092421Orange County, SustainabiltyEV Charging ElectricalUpgradesDT Planning - Site & Scope of WorkNash & Kollock StreetHillsboro, NC 27278Sept 24, 2021 Estimate 1" = 100'-0"2 Site Work Area NOT TO SCALE1Site Location DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 EVSE #4 EVSE #3 EVSE #2 EVSE #1 EVSE #5 EVSE #6 EVSE #7 EVSE #8 EXISTINGFUTURE EVSE #7 EVSE #8 NEW 400A 120/240V 1Ph PNL EV1N 170168166164162160158156154152 Sheet Title: Date Designed by: Checked by: Pine Shore Energy LLC 131 Fayette St NW Winston-Salem, NC 27101 ©2021 828-553-6257 Dave@pineshoreenergy.com www.pineshoreenergy.com THIS DRAWING IS NOT TO BE SCALED FOR CONSTRUCTION PURPOSES. THE SCALE WHEN INDICATED IS FOR GENERAL REFERENCE ONLY. Project #: STATEWIDE TERM CONTRACT 691A ELECTRIC VEHICLE CHARGING STATION EQUIPMENT, ACCESSORIES, INSTALLATION & INFRASTRUCTURE Planning Phase: C:\Users\dave\Documents\Pineshore\Projects\4. projects_con\Orange_County_NC\OC_Parking_Deck\dwg\OC_Gateway_Center_Parking_Deck_EVSE_Upgrades.rvt 9/24/2021 12:12:57 PM E0.1 E-092421Orange County, SustainabiltyEV Charging ElectricalUpgradesDT Planning - EVSE Level 1N LayoutNash & Kollock StreetHillsboro, NC 27278Sept 24, 2021 Estimate 1" = 40'-0"1 Parking Deck - Level 1 1/16" = 1'-0"2 EVSE Level1 North Layout DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11 01/19/2021 Arnold Mlay Ins Agency Inc 110A Oakdale Street Brevard NC 28712 Kathryn L Mlay (828) 884-3670 (828) 966-9684 brightowlinsurance @gmail.com Pine Shore Energy PO Box 443 Brevard NC 28712 Evanston Insurance Company Evanston Insurance Company Evanston Insurance Company Integon Indemnity A x x x MKLV7PEO001207 01/13/2021 01/13/2022 1,000,000 100,000 10,000 1,000,000 1,000,000 Included Electronic Media Lia 1,000,000 D x 2010838663 12/08/2020 12/08/2021 750,000 B MKLV7PEO001207 01/13/2021 01/13/2022 Professional Liability 1,000,000 C MKLV7PEO001207 01/13/2021 01/13/2022 DataBreach 1,000,000 engineering software and hardware for electronic vehicle stations Orange County P.O. Box 8181 Hillsborough, NC 27278 <DA> ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: BC65C531-1F9F-4A99-B7A9-5A90267E0C11