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HomeMy WebLinkAbout2023-469-E-AMS-Tri Solutions-Southern Human Services - Floor FinishesRevised 04/23 1 [Departmental Use Only] TITLE SHSC Flooring FY 2023-2024 NORTH CAROLINA SERVICES AGREEMENT NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter “Agreement”), made and entered into this 5th day of September, 2023, (“Effective Date”) by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and Tri Solutions, Inc., (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): Southern Human Services Corridor and Lobby VCT Surfaces - 460 Ultra Durable Epic Urethane 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. 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 DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 2 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) Should any documents, exhibits, or addenda be attached to this Agreement, the terms of this Agreement shall have priority in any conflict with or among the terms of such referenced documents, exhibits. 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 DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 3 a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): All labor, materials, and equipment necessary to apply Upic Urethane coating to Clinic Lobby 120, Corridor/Hallway 133, Corridor 002, Corridor 003, Vending 028, Waiting 013, Corridor 034 and Breakroom 039 which includes strip of existing finish, prep for application of Epic finish and application of Epic Finish. 4. Duration of Services a. Term. The term of this Agreement shall be from September 15, 2023, to June 30, 2024. 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 September 15, 2023, or as scheduled with Asset Management Services. 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 Fifteen Thousand Seven Hundred Fifty Dollars ($15,750.00). 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). 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 DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 4 a. Cooperation and Coordination. The County has designated (Freddy Brooks) 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 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. 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 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 DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 5 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 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. DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 6 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 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 or 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 or 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. In the event of a change in the County’s statutory authority, mandate or mandated DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 7 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:A. Barnes Tri Solutions, Inc P.O. Box 8181 712 Summit Ave Hillsborough, NC 27278 Kinston, NC 28501 [SIGNATURE PAGE TO FOLLOW] DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D Revised 04/23 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, County Manager By: __________________________________ Brad Albritton, President Printed Name and Title DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D 8/25/20238/28/2023 Revised 04/23 9 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Tri Solutions, Inc Vendor Contact Person: Brad Albritton (brada@tilerestorationinc.com) Phone: 252.916.2045 Address: 215 Summit Ave City Kinston State: NC Zip: 28501 Department: AMS Amount: $15,750.00 Purpose: Southern Human Services - Floor Finishes Budget Code(s): 61370035-880002-10065 Vendor # 61702 Vendor Status with NCSOS: Active Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: 9/5/2023) (Most Recent Amendment ) Effective Date 09/05/2023 End Date 06/30/2024 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by AMS Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: 10065) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) Department Affirmation 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. Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services 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 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: Received for record retention: DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D 8/26/2023 8/28/2023 8/28/2023 8/28/2023 Revised 04/23 10 Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D    Corporate Office: 712 Summit Ave, Kinston, NC 28501 South Carolina Office: 7001 St Andrews Road, #370, Columbia, SC 29212   Phone: 1-866-327-4600 Fax: 1-252-376-1452  Freddy Brooks  Orange County Public Works   600 Highway 86 North  Hillsborough  NC  27278  Phone:919-245-2636  Fax: 919-644-3043  Email: fbrooks@orangecountync.gov  Date: 06/23/2023  Rep: Brad Albritton  Cell: 252-916-2045  Email:  brada@tilerestorationinc.com  Southern Human Services -Corridor and Lobby VCT Surfaces - 460 Ultra Durable Epic Urethane  Units  Process  Description of Area  Price Per Unit  Price 1 460 Ultra Durable  Epic Urethane  Labor and Materials to apply Epic Urethane  Coating to Clinic Lobby 120,  Corridor/Hallway 133     Pricing Includes:  Strip of existing finish   Prep for application of Epic Finish   Application of Epic Finish  $4,450.00 $4,450.00  1 460 Ultra Durable  Epic Urethane  Labor and Materials to apply Epic Urethane  Coating to SHS Area Corridor 002, Corridor  003, Vending 028, Waiting 013, Corridor 034  and Break Room 039.    Pricing Includes:  Strip of existing finish   Prep for application of Epic Finish   Application of Epic Finish  $11,300.00 $11,300.00     ** Sales Tax Will be applied to Approved Scope**    50 % o f  Pr opo sa l  D ue B ef or e  W or k is  Sc he d u led Deposit Due:  Sales and Use Tax:$0.00  Te r m s: N e t  20 Da y s Total:$0.00  A f e e  of 3 % wi l l  be added f o r  a l l  al l C r e d it C a r d  transac t ions     Please Remit All Contracts, PO's and Payments To:  TRI Solutions, Inc. 712 Summit Avenue, Kinston, NC 28501  B y  s ig n i ng th is pr o po s a l; I  a c k n owled g e  t h a t  I  h a v e  r e a d a nd  accep t e d t he t e rm s  a n d con di t i o ns c on t a in e d her e in .    Nam e _________________________________________________DAT E___________________   Proposal Valid for 30 Days Delivery to Job and Installation is included.   You have three (3) days from the date of our agreement to cancel this order. If you wish to cancel after the 3 days you will be responsible to pay some or all of the  total price.      DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D   2    Materials are specific to each job application. A deposit is required prior to the scheduling of each project.    Standard warranty offers a full (1) year warranty on materials and labor from date of purchase according to Terms and Conditions. Warranty will provide  replacement of material and needed labor in the event that TRI Solutions Inc materials prove defective and provided materials are installed in strict compliance by  Certified TRI Solutions Inc installation technicians. Samples are only representative of what will be installed in your project.  Improperly cured or prepared subfloor  which is specified in your new construction along with the subfloor being level, structurally sound, free of residual solvent(s), moisture free and fully cured is the  responsibility of the General Contractor, Construction Company or the Project Superintendent.  All services guaranteed as specified. All work to be completed in a  workmanlike manner according to standard practices. Any alteration or deviation from this proposal involving extra costs will be executed only upon written orders  and will become an extra charge over and above the proposal. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,  tornado and other necessary insurance. Our workers are fully covered by Workman’s Compensation Insurance. Evidence of Insurance will be provided upon  request. Any special requirements or endorsements may incur additional charges. We do not waive any rights of subrogation against the contractor or owner for  any loss covered by insurance of any type. Notwithstanding the foregoing, in no event will TRI Solutions Inc be responsible for damages due to delays beyond TRI  Solutions Inc’s reasonable control.  TRI Solutions Inc warrants and guarantees that all materials and equipment furnished shall be new unless otherwise specified, and that all Work will be of the  specified quality, free from faults or defects in materials or workmanship, and in accordance with requirements.  All TRI Solutions Inc services require a minimum of 72 hours of cure time before they can be exposed to moisture. If this timeline is not adhered to the customer  takes full responsibility for any damage or performance issues that may result. Epoxies chalk and yellow with age extended exposure to UV and artificial lighting.  Lack of ventilation, incomplete mixing, miscatalyzation or the use of heaters that emit carbon dioxide and carbon monoxide during application and initial stages of  curing may cause amine blush, possibly affecting the adhesion of subsequent topcoats.  TRI Solutions Inc will take all precautions to protect adjoining flooring, walls, materials etcetera from exposure to water and/or chemicals. Any damage that may  occur from contact from water and/or chemical is not the responsibility of TRI Solutions Inc. or its staff.   Pricing subject to change when additional cost and/or requirements need to be met on behalf of TRI Solutions for vendor approvals and/or project award.    TRI Solutions Inc marketing will send periodic email communication informing you of various service offerings. At any time you wish to stop receiving this  information you may opt-out from within the email received or contact our office.   I hereby give TRI Solutions Inc. authorization to do the work specified and payment will be made as outlined above.    Suspending Services for Non Payment.  If the client, other than as allowed by the Contract or other than due to the fault of TRI Solutions Inc, fails to pay TRI  Solutions Inc undisputed amounts due within thirty (30) days after the time that such amounts are due to be paid, TRI Solutions Inc may, upon seven (7) additional  days’ written notice to the client, stop the Work until payment of such undisputed amount is paid. The Contract Time and Contract Sum shall be extended  appropriately to reflect TRI Solutions Inc reasonable costs of shut-down, delay, and start-up.    Standard of Care. It is agreed that TRI Solutions Inc expressly disclaims all express or implied warranties and guarantees with respect to the performance of  professional services, and it is agreed that the quality of such services shall be judged solely as to whether TRI Solutions Inc performed its services consistent with  the professional skill and care ordinarily provided by firms practicing in the same or similar locality under the same or similar circumstances (hereinafter the  “Standard of Care”)    Limitation of Damages. Neither party shall be liable to the other party for lost revenues, lost profits or other incidental, indirect, special, consequential, or exemplary  damages in connection with this Agreement or performance hereunder, whether or not a party has been advised by the other party of the probability of such  damage or loss, whether such damage or loss arises in contract, tort, including negligence, strict liability or otherwise. The Contractor, Owner, or End-users sole  remedy under this Agreement for any Products, Services, or Labor that fail to conform to the applicable Specifications or otherwise for TRI Solutions breach of this  Agreement shall be the repair or replacement of the Products, Services or a refund of the amount actually paid to TRI Solutions by Contractor, Owner, or End User  for specific Product or Services provided. Claims for damages of any nature whatsoever pursued under this Agreement shall be limited to direct damages only up  to the aggregate amount of contract disbursed as of the time the dispute arises.            DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D 08/25/2023 Jake A Parrott Insurance Agency Inc 2508 N HERRITAGE STREET PO BOX 3547 KINSTON NC 28502 Dallas T. Williams (252) 523-1041 (252) 523-0145 dtwilliams@parrottins.com TRI SOLUTIONS INC DBA TILE RESTORATION 712 SUMMIT AVE KINSTON NC 28501-3134 EMPLOYERS MUTUAL CASUALTY CO 21415 ACCIDENT FUND INSURANCE CO OF AMERICA 10166 EMC INSURANCE COMPANIES 2023-2024 MASTER A Y Y 5D86997 01/01/2023 01/01/2024 1,000,000 500,000 10,000 1,000,000 2,000,000 2,000,000 A Y Y 5E86997 01/01/2023 01/01/2024 1,000,000 Medical payments 5,000 A 5J86997 01/01/2023 01/01/2024 5,000,000 5,000,000 B N Y 100074826 01/01/2023 01/01/2024 1,000,000 1,000,000 1,000,000 C INLAND MARINE/INSTALLATION FLOATER 5C86997-24 01/01/2023 01/01/2024 CATASPHE- JOB LT 57,000 DEDUCTIBLE 500 ORANGE COUNTY, IT'S OFFICERS, OFFICIAL AGENTS & EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WITH RESPECT TO GENERAL & AUTO LIABILITY, VIA WRITTEN CONTRACT IN FORCE WITH THIS REQUIREMENT INCLUDED. WAIVER OF SUBROGATION APPLIES IN FAVOR OF ADDITIONAL INSURED WITH RESPECT TO GENERAL & AUTO LIABILITY & WORKER’S COMPENSATION, VIA WRITTEN CONTRACT IN FORCE WITH THIS REQUIREMENT INCLUDED. UMBRELLA IS FORM FOLLOWING. 30 DAY NOTICE OF CANCELLATION APPLIES, EXCEPT FOR NON-PAYMENT, WHICH IS 10 DAYS. ORANGE COUNTY RISK MANAGEMENT PO BOX 8181 HILLSBOROUGH NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: BA62595E-F8A7-475F-A373-BB9E0B94B92D