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HomeMy WebLinkAbout2024-029-E-AMS-ProNet Systems-Central Recreation - Install Resideo Alarm System & SensorsRevised 04/23 1 [Departmental Use Only] TITLE Central Rec Resideo FY 2023-2024 ORANGE COUNTY CONTRACT UNDER $5,000.00 NORTH CAROLINA THIS AGREEMENT, is between Orange County, North Carolina, a body politic organized under the laws of the State of North Carolina, (the "County"), and ProNet Systems, Inc. (the "Provider"). W I T N E S S E T H: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the services set out below to the County in accordance with the terms of this Agreement, time being of the essence. The services or materials or construction (hereinafter referred to collectively as “Services”) to be furnished under this Agreement are as follows: Provide and install Resido Alarm panel with replacement sensors per quote Q121823-A dated December 18, 2023 The term of this agreement rendered shall be from January 15, 2024 to June 30, 2024. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement, without the prior written approval of the County. SPECIFIC TERMS 1.Payment: The County agrees to pay at the rates specified for Services satisfactorily (as determined by the County) performed in accord with this Agreement. The amount to be paid by the County shall not exceed Three Thousand, Three Hundred Eighteen Dollars, ($3,318.00). Payment shall be made within thirty (30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. 2.Non–waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 3.Independent Contractor: The Provider shall operate as an independent contractor, and the County shall not be responsible for any of the Provider’s acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4.Insurance: 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 DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Revised 04/23 2 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 be designated here 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. 5.Indemnity: To the extent authorized by North Carolina law the Provider agrees, without limitation, to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider in carrying out Provider’s duties and obligations related to the Services to be provided in this Agreement. It is the intent of this provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 6.Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. County may suspend this Agreement upon reasonable notice to Provider. 7.Entire Agreement and Signatures: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 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. 8.Governing Law and Priority: Both parties agree this Agreement is governed by the laws of the State of North Carolina and Orange County. 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 anti-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 this requirement 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. 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. By executing this Agreement Provider affirms Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. 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. 9.Dispute Resolution: Neither party may initiate binding arbitration. Any disputes shall be resolved by nonbinding mediation. If such mediation fails either party may initiate litigation to resolve the dispute. Should either party initiate litigation to settle any dispute involving the terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. Regardless of the outcome of said litigation each party is responsible for its own costs and fees, including attorneys’ fees. DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Revised 04/23 3 10.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. IN WITNESS WHEREOF, this Agreement is effective upon its execution by Orange County and the Provider. ORANGE COUNTY PROVIDER By: _________________________ By: _________________________ Department Director Title: ________________________ 200 S. Cameron St. ProNet Systems, Inc P.O. Box 8181 3200 Glen Royal Road, Ste 107 Hillsborough, NC 27278 Raleigh, NC 27617 DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Vice President 1/12/20241/16/2024 Revised 04/23 4 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: ProNet Systems, Inc Vendor Contact Person: Richard McClennly (RichardM@pronetsystemsnc.com) Phone: 919.277.2070 Address: 3200 Glen Royal Road, Suite 107 City Raleigh State: NC Zip: 27617 Department: AMS Amount: $3,318.00 Purpose: Central Recreation - Install Resideo Alarm System & Sensors Budget Code(s): 61370035-880000-30001 Vendor # 57979 Vendor Status with NCSOS: Current - Active Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date 01/15/2024 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: 30001) 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: DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 1/12/2024 1/16/2024 1/16/2024 1/16/2024 Revised 04/23 5 Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Q121823-A Orange County-Central Recreation Resideo Alarm Panel with Replacement Sensors ProNet Systems, Inc. 1 3200 GLEN ROYAL ROAD, SUITE 107, RALEIGH, NC 27617 www.pronetsystemsonline.com TELEPHONE 919.277.2070 FAX 919.277.2072 Q121823-A Orange County –Central Recreation Resideo Alarm Panel with Replacement Sensors December 18, 2023 Ms. Angel Barnes Orange County Asset Management Services PO Box 8181 Hillsborough, NC 27278 Dear Ms. Barnes, RE: ORANGE COUNTY-CENTRAL RECREATION RESIDEO ALARM PANEL WITH REPLACEMENT SENSORS With reference to your request to install Resideo alarm panel with replacement sensors at Orange County Central Recreation, we have pleasure in offering the following proposal for your review. Equipment Description Quantity Equipment Description Unit Price Total Price 1 Honeywell ProA7Plus Network Alarm Panel 229.49 229.49 1 Honeywell ProSixRptr Repeater 110.69 110.69 2 Honeywell ProSix Panic Wireless Panic Alarm 44.54 89.08 10 Honeywell ProSixDC Wireless Door Contact 76.94 769.40 1 First Year Monitoring 240.30 240.30 Cable and Installation Materials 46.63 Equipment Total Including Cable and Materials 1,485.59 Add Labor 1,564.94 Add Estimated Shipping 35.97 Add 7.5 % Sales Tax 231.49 Total Price Including Equipment, Labor, Sales Tax, and Shipping $3,317.99 DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Q121823-A Orange County-Central Recreation Resideo Alarm Panel with Replacement Sensors ProNet Systems, Inc. 2 Warranty All products are covered for one year, parts and labor, from date of hand over. An extended maintenance program is available. This includes parts and labor on all products for the second year after date of hand over. Service Rates Out of warranty call out is charged at $100.00 per hour and $135.00 per hour out of hours (regular business hours are 8.00 am to 5.00 pm, Monday to Friday). Response time is same day if service call is requested before 10.00 am or if the system is down due to failure. All product is covered for one year, parts and labor, from date of hand over. A Service Contract for an extended maintenance program is offered if required. This includes parts and labor on all products for the second year after date of hand over. Service Contract A maintenance program is offered below. Full Maintenance 2nd year $ 71.95 per year Terms of Payment Unless otherwise arranged, 50% of payment is due upon receipt of the order, and 50% of payment is due upon project completion. Interest will be charged at a rate of 1.5% per month on accounts 10 days past due and a 2% discount is offered for payment within 10 days of receipt of invoice. Validity These rates are valid for a period of thirty days from today’s date. We trust that in submitting this proposal we have addressed all your requirements. Should you require further clarification or additional information, please do not hesitate to contact us. Sincerely, Alan Jelley ProNet Systems, Inc. Accepted: Signed ………………………………………………. For and On Behalf of Orange County …………………………………………………..………………………… Print Name & Title Date…………………………………………………. DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Ken Lawson Jr 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 06/20/2023 Lawson Insurance Group, Inc. 6512 Six Forks Rd # 101 Raleigh NC 27615-6561 Leslie McCoy 919-846-2090 ext 202 919-846-2438 leslie.mccoy@lawsonins.com ProNet Systems, Inc. 3200 Glen Royal Rd Raleigh NC 27617-7419 Nationwide Mutual Insurance Company 23787N Nationwide Mutual Fire Insurance Company Travelers A 6 6 6 Y Y ACPGLO2252994383 02/22/2023 02/22/2024 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 B 6 6 6 6 NONE ACPCAA2252994383 02/22/2023 02/22/2024 4,000,000 4,000,000 C Y Y UB0S866703 04/28/2023 04/28/2024 6 1,000,000 1,000,000 1,000,000 Orange County is included as additional insured (CG 20 33) and Waiver of Subrogation applies per Blanket Contractors Enhancement Endorsement CG 72 88 under the general liability policy (please refer to attachments). The Umbrella/Excess Liability policy is "follow form". Blanket Waiver of Subrogation also applies to the workers compensation policy (please refer to attachments). P.O. Box 8181 Hillsborough NC 27278 Orange County DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Form_SCTNID_CTGRY.XX0316ACORD25_ACORD <docindex><index>ACORD</index></docindex> BDF_PCA CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSR LTR ADDL INSD SUBR WVDTYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY OTHER: PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY)(MM/DD/YYYY)LIMITS $ $ $ $ $ $ $ EACH OCCURRENCE DAMAGE TO RENTED MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG PREMISES (Ea occurrence) $ $ $ $ $ COMBINED SINGLE LIMIT PROPERTY DAMAGE BODILY INJURY (Per person) (Ea accident) BODILY INJURY (Per accident) $ $ $ AGGREGATE EACH OCCURRENCE E.L. EACH ACCIDENT INSURED $ $ $E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE PER STATUTE OTH- ER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. (Per accident) 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). 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. progressivecommercial@email.progressive.com 01/11/2024 1-800-444-4487 PRONET SYSTEMS INC 3200 GLEN ROYAL RD STE 107 RALEIGH, NC 27617 Orange County 300 West Tryon Street, PO Box 8181 Hillsborough, NC 27278 Progressive Commercial Lines Customer and Agent Servicing 937554208480637906D011124T151156 Brown-Phillips Insurance 401 S LIMESTONE ST, GAFFNEY, SC 29340 Progressive Southeastern Insurance Company 38784 A X X 05786709YN 01/03/2024 01/03/2025 1,000,000 A 05786709YN 01/03/2024 01/03/2025 See ACORD 101 for additional coverage details.$ DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272 Form_SCTNID_CTGRY.XX0108ACORD101_ACORD <docindex><index>ACORD</index></docindex> BDF_PCA Brown-Phillips Insurance 05786709 Progressive Southeastern Insurance Company 38784 PRONET SYSTEMS INC 3200 GLEN ROYAL RD STE 107 RALEIGH, NC 27617 01/03/2024 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY POLICY NUMBER CARRIER NAIC CODE NAMED INSURED EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:25 FORM TITLE:Certificate of Liability Insurance 1 1 Additional Coverages Insurance coverage(s) Limits…………………………………………………………………………………………………………………………………………………………………………………… Uninsured/Underinsured Motorist $1,000,000 Combined Single Limit …………………………………………………………………………………………………………………………………………………………………………………… Uninsured Motorist Property Damage (included in combined single limit w/$100 Ded) Description of Location/Vehicles/Special Items Scheduled autos only…………………………………………………………………………………………………………………………………………………………………………………… 2006 FORD 1FTRF12WX6NA28557F150 Collision $1,000 Ded Comprehensive $500 Ded …………………………………………………………………………………………………………………………………………………………………………………… 2014 JEEP 1C4RJFCG7EC272289GRAND CHEROKEE Collision $1,000 Ded Comprehensive $500 Ded …………………………………………………………………………………………………………………………………………………………………………………… 2017 FORD 1FTYR2YG3HKA41115T-250 TRANSIT V Collision $1,000 Ded Comprehensive $500 Ded …………………………………………………………………………………………………………………………………………………………………………………… 2007 FORD 1FTNE14W37DB26903ECONO/CLUB WGN Collision $1,000 Ded Comprehensive $500 Ded …………………………………………………………………………………………………………………………………………………………………………………… 2019 JEEP 1C4RJFAG2KC565077GRAND CHEROKEE Collision $1,000 Ded Comprehensive $500 Ded Liability coverage may not apply to all scheduled vehicles. Additional Information Certificate holder is listed as an Additional Insured. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. DocuSign Envelope ID: D79ABA54-35FD-4E42-BBC0-8C90F9457272