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HomeMy WebLinkAbout2025-730-E-Emergency Svc-Caldwell VFD of Orange Co-Fire Department Services Contract Revised 01/24 1 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Caldwell VFD of Orange Co. Inc Vendor Contact Person: Buddy Hartley Phone: Address: 7020 Guess Road City Rougemont State: NC Zip: 27572 Department: Emergency Services Amount: Budgeted Annually Purpose: Fire Department Services Contract Budget Code(s): 20750620-688000 Vendor # 50744 Vendor Status with NCSOS: Inactive Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date 11/18/2025 End Date 11/18/2026 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by County Manager 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: ) 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. This agreement is approved as to technical form and content . 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: Office of the Clerk to the Board __________________________________________Date:_________ Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 12/4/2025 To maintain fire protection services in the Caldwell fire district. 12/8/2025 12/8/2025 12/8/2025 1 STATE OF NORTH CAROLINA ORANGE COUNTY FIRE PROTECTION AND EMERGENCY SERVICES AGREEMENT THIS AGREEMENT (this “Agreement”), made and entered into this day_18__ of November, 2025 by and between Orange County, hereinafter referred to as the “County” and Caldwell Fire Department, hereinafter referred to as the “Fire Department”, referred to herein as “Party” and/or collectively as the “Parties”. WITNESSETH: 1. County created the Little River Fire Protection District (the “District”) as a special tax district pursuant to Chapter 69 of the North Carolina General Statutes and desires to contract with Fire Department for fire protection and other services as set out herein. 2. Pursuant to §NCGS 69-25.4 the County agrees that it will cause to be assessed or levied a special tax of not more than Fifteen cents ($.15) per one-hundred dollar ($100) valuation of all real and personal property in the District unless otherwise limited or prohibited by law or a vote of the people, and will collect said tax as a part of the ad valorem taxes of Orange County; provided however, the amount levied annually shall be based on the needs projected in the budget estimate submitted by the Fire Department to the County as approved by the Orange County Board of Commissioners in its annual budget or as they may otherwise determine. 3. That a special or separate fund shall be maintained by the County for funds collected as a result of said special tax. 4. That from said special tax district the Board of County Commissioners will approve a Fire Protection District tax rate and Annual Budget for the Fire Department. The County agrees to remit quarterly payments, by the 15th day of the first month of each quarter. The total quarterly payments to the fire department will equal the annual budget. 5. The Fire Department shall provide and furnish adequate fire protection services and shall provide the necessary equipment, personnel, and other resources as determined by the North Carolina Department of Insurance, Fire and Rescue Service Division, and the Insurance Service Office for all persons and property located within the District. Fire Department currently has an insurance rating of Class 5/9E, and during the term of this Agreement will maintain at least a 9E insurance rating. Fire Department will furnish fire and rescue services free of charge to all persons and individuals within the District (excluding non-public commercial transportation). Fire Department shall strive to maintain the current ISO rating of 6/9E or look to achieve an ISO rating of 5 (or better). This section does not preclude the Fire Department from charging a pre- arranged nominal fee when standing by for special events. 6. The County shall continue to recognize the Fire Department as the designated fire service provider for its district. 7. That all funds paid to the Fire Department by the County shall be used exclusively by the Fire Department to provide fire protection services within the District (See Exhibit Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 2 1), and the Fire Department may also use said funds to provide Medical Responder and rescue services within the District, and to pay other legitimate fire, rescue, and Medical Responder expenses attributable to the services rendered within the District. This does not preclude mutual aid agreements. 8. The Fire Department shall provide Medical Responder Services within the District. Medical Responder Services are defined as the provision of Basic Life Support treatment as needed until such time as more highly trained personnel arrive on scene. Such Medical Responder Services may be provided through mutual aid agreements or through third party contracts 9. The Fire Department shall provide Hazardous Materials Response Services according to the North Carolina Department of Insurance North Carolina Fire Rescue Commission Haz-Mat 1 Responder level for all operational responses in the district. Hazardous Materials Response Services are defined as defensive actions necessary to protect life, property and the environment from the effects of the release. 10. The Fire Department shall provide Rescue Services to all persons and individuals within the District. Rescue Services are defined as the removal, extrication, or freeing of individuals from vehicle confinement or danger. Fire Department shall maintain any current rescue certifications through the Rescue Association. Such Rescue Services may be provided through mutual aid agreements or through third party contracts. 11. Notwithstanding Section 6 above Fire Department may provide fire protection services outside the District subject to the following terms and conditions: A. That Fire Department is authorized to extend their primary insurance fire protection services in surrounding fire insurance districts to better serve the citizens by eliminating a class 10 area in the neighboring fire district. The fire department shall provide a notarized agreement between the fire departments submitted to the fire marshal for processing to the Board of County Commissioners. B. Fire Department shall not expend any funds or resources appropriated for the use of persons and individuals in the Little River Fire District for the primary fire protection services outside the area of surrounding response districts. In the event any such expenditure occurs for primary fire protection outside of their insurance response to a neighboring district, the Fire Department shall immediately notify the County and Fire Department shall take corrective measures to rectify the expenditure and to ensure such expenditure shall not be repeated. This does not preclude fire departments in the county to expend funds toward a fire district in this county for the creation and use of a joint facility to be utilized for training in fire, rescue and other emergency services. 12. That Fire Department shall enter into an agreement with surrounding Departments in which the Fire Department provides compensation to those surrounding Departments for their availability and service providing primary fire protection services in an Orange Rural Class 10 insurance response areas. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 3 Operational Scope and Mutual Aid Participation: The Fire Department shall respond to all emergency incidents within its designated response district and may also be dispatched to incidents in other jurisdictions under approved mutual aid agreements. Upon a rrival at any incident, the Department shall operate within the scope of its certified training, personnel capabilities, and standard operating procedures. If an incident exceeds the Department's certified capabilities, such as technical rescue, hazardous materials, structural collapse, or other specialized operations, the Department shall request or defer to qualified mutual aid resources. In such cases, the Department may provide scene support, personnel assistance, or logistical aid under the direction and supervision of the authority having jurisdiction over the specialized response. Participation by the Department or its personnel in such support roles shall not be construed as assuming command of, or delivering, specialized technical services beyond the Department's contractual, certified, or insured scope. Such participation shall be limited to activities consistent with the personnel's physical capabilities, documented training, and authorized operational directives. For the purposes of eligibility under the Federal Public Safety Officers' Benefits (PSOB) Program and North Carolina Line -of-Duty Death (LODD) benefits (pursuant to G.S. 143 - 166.2 et seq.), such participation shall be deemed an official duty, provided that : A. The personnel were officially dispatched or requested through recognized mutual aid protocols; B. The personnel acted under a defined command structure and did not self -deploy; C. The activities performed were within the individual's certified training or executed under the supervision of an agency qualified to manage the incident type. 13. In providing the services contemplated herein the Fire Department shall operate in compliance with all applicable State and local laws and regulations including, but not limited to the North Carolina Fire Incident Reporting System (G.S. 58-79-45, NC Administrative Code, §.0402). The Fire Department shall submit electronic incident reports on a quarterly basis to the Office of the North Carolina State Fire Marshal. The Fire Department further agrees to notif y the Orange County Fire Marshal’s Office of the annual corporation meeting and provide a current list of its Board of Directors no later than 14 days after the by-laws declare new members take office. The Fire Department shall provide a copy of the certif ied personnel roster submitted to the N.C. State Firefighter Association to the Fire Marshal’s Office at the time of submission to the association. The fire department agrees to work with Emergency Management to resource type personnel, apparatus including pump and tank size, and specialized fire suppression equipment in Salamander or other software used by Emergency Services. The fire department shall immediately notify the Fire Marshal’s Office where there is a change in fire chief. The County shall have the right to inspect all books and accounts for the Fire Department at any time. Said inspection shall be conducted by the Orange County Fire Marshal and/or Orange County Finance Office and/or their designee. The following minimal performance standards are agreed upon by the County and the Fire Department and are a part of this contract: A. Response Time. Fire Department should have the goal of having a response time that exercises due diligence to responding to all emergencies when notified of the emergency. B. Personnel on Scene. Fire Department should have adopted standard operating guidelines that address the appropriate number of firefighters needed on all type fire calls. The National Incident Management System shall be used at all incidents to manage personnel. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 4 C. Training. Fire Department shall have the minimum standard training requirements set forth by the State of North Carolina and NC Department of Labor for providing fire and emergency services provided by the Fire Department. For purposes of this agreement emergency services includes both Medical Responder services, hazardous materials services, and rescue services. D. Fire Investigations. The Fire Department officer in charge at all fire scenes shall attempt to determine the cause and origin of every fire. When the officer in charge cannot determine the cause and origin of the fire, or if the cause is suspected to be of an incendiary nature, the officer in charge may request assistance from the Orange County Fire Marshal’s Office. E. Reports. Fire Department shall keep all records according to state law for retention. All State and county required reports and rosters shall be submitted by the applicable deadlines. F. Fire Hydrants. The Fire Department should report any malfunctions or damage to hydrants to the owner of the water distribution system. G. Emergency/Disaster Response. Fire Department shall follow the Orange County Emergency Operation Framework (EOF) Policy when responding to an emergency or disaster. H. State of Emergency. County requests that Fire Department, when available, assist with the following services, but not limited to, before, during, and following times of emergency/disaster: • Debris Clearance; • Traffic Control; • Alert and Warning; • Search and Rescue; • Evacuation Notification and Coordination ; and • life-saving and property protection measures as necessary. All operations shall be in accordance with the Orange County Orange County Emergency Operation Framework (EOF) Policy. 13. The Fire Department shall submit to an audit by a Certified Public Accountant, which will be paid for by the County up to $8,500 per year, and shall be in conformity with General Accepted Accounting Principles. If an audit has already been performed by a certified entity, the Fire Department shall present the County with a copy of that audit. Such audit to be provided on or before December 31st of each year, and to be in conformity with the most recent audit policies of the County and the North Carolina Local Government Commission. Further, the fire department agrees to comply with County budgeting procedures including a mid-year financial statement and other procedures provided for by State Law and agree to submit budget estimates to the Board of Commissioners on the standard forms used by County departments. The Fire Department also agrees to use standard line items for accounting as requested by the County Finance Department. A. In the event that the audit reveals any reportable and/or material issue(s) with regard to compliance with generally accepted accounting principles, or any material weakness or significant deficiencies, the fire department shall provide a written statement to the county that contains an explanation of each issue and an action plan (with implementation timetable) for resolving each such issue, weakness and/or deficiency, and shall provide periodic reports to the county on progress made in resolution of each issue, weakness and/or deficiency. If resolution of such issues, weakness or deficiencies requires professional advice on the part of that fire department’s (or county’s) auditor, the fire department shall bear the Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 5 cost of such advice. B. Should the fire department fail to submit its audit report to the county within the above time period, the county will suspend all funds immediately until the audit is delivered as set forth above, except that the county’s Chief Financial Officer may grant a reasonable submittal extension if the department is unable to deliver the audit for reasons beyond the control of the fire department or the auditor. C. The fire department agrees that if its financial records are judged to be un-auditable for purposes of an audit or establishment of a budget by the county’s chief financial officer or the independent audit firm, or if a regular or special audit by a certified public accountant reveals competent evidence of reckless or willful financial mismanagement practices or intentional or criminal wrongdoing, the fire department’s Board of Directors will be notified by the county. At that time, the county and Board of Directors may jointly name a trustee who will assume responsibility for management and financial decision-making for the fire department until such time as the county and fire department’s Board of Directors agree that the fire department’s finances have been stabilized to the extent required to satisfy the financial management provisions of this contract. 14. The Fire Department shall comply with the County budgeting procedures, and shall submit annual budget estimates in accordance with established County budget timetables. A supporting letter of request for the proposed tax rate shall be signed by the Fire Department’s president upon approval of its Board of Directors. The County will provide the Fire Department with standard forms for budget submission and the Fire Department shall use such standard forms. 15. The Fire Department shall comply with the State of North Carolina purchasing procedures for local governments as identified in Attachment #1, as well as other procedures provided for by state law. 16. The Fire Department shall file with the County Fire Marshal a true copy of its Articles of Incorporation, Bylaws, and shall furnish any changes made thereto not less than thirty (30) days prior to their effective dates. Further, the Fire Department agrees to amend its Articles of Incorporation and Bylaws as necessary to meet all minimum legal requirements for a North Carolina nonprofit corporation, as required by the provisions of Chapter 55A of the General Statutes of North Carolina. Should Fire Department be notified that it has failed to meet all minimum legal requirements for a North Carolina nonprofit corporation and/or failed to maintain its federal, state, or local tax-exempt status the Fire Department shall, within thirty (30) days of such notification, begin taking appropriate steps to remedy said failure. Should said failure not be appropriately remedied within ninety (90) days after such notification the County may withhold special district tax revenues until such time as the Fire Department meets all minimum legal requirements of Chapter 55A of the General Statutes of North Carolina and/or until such time as the Fire Department’s tax- exempt status is restored. 17. In the event the Fire Department dissolves then the Fire Department shall deliver, release, and convey to the County all its equipment, cash, or other assets to be used by the County exclusively for the provision of fire protection services, rescue services, or Medical Responder services within the District. Any such dissolution shall comply with applicable laws of North Carolina. If Fire Department ceases to provide either fire protection Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 6 services, rescue services, or Medical Responder services within the District Fire Department shall deliver, release, and convey to County all of its equipment, cash, or other assets used for those specific services the Fire Department has ceased to provide, to be used by the County exclusively for the provision of fire protection services, rescues services, or Medical Responder services within the District. Should the terms of this paragraph conflict with Fire Department’s Articles of Incorporation the Articles of Incorporation shall control. 18. The Fire Department agrees to hold harmless and indemnify the County from and against any and all liability and expenses including attorney fees, court costs and other costs incurred by the County caused by any act or omission of the Fire Department, its agents and employees. The Department shall purchase and maintain, during the term of this Agreement, and any extension hereof, at least the following insurance coverage: A. Comprehensive Automobile Liability Insurance with combined single limits of at least one million dollars ($1,000,000) per occurrence. Coverage shall be provided under a symbol “1”. Coverage shall apply, on an excess basis for hired, borrowed and non-owned vehicles. Coverage shall apply, on a primary basis, for commandeered vehicles. Volunteers or employees shall be considered insureds and volunteers and employees shall have coverage in excess of their personal auto liability limits when they are using their vehicles on behalf of the Fire Department. Fellow member liability shall be provided. Auto pollution liability shall be included in the coverage. B. Auto physical damage shall be provided on an agreed value basis. Coverage shall be included for hire, borrowed or commandeered vehicles without a limit of liability. Coverage shall be provided to bring replacement vehicle up to the most current national standards, such as NFPA or DOT. C. Comprehensive General Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and two million dollars ($2,000,000) aggregate. The aggregate shall apply per named insured and per insured location. The policy shall include the following coverage: Volunteers or employees as insureds, Medical Malpractice, Good Samaritan Liability Coverage, Intentional Acts Coverage for both bodily injury and or property damage, Fellow Member Liability, Non-owned Watercraft, Fire Damage Legal Liability with limits of one million dollars ($1,000,000), Pollution Liability arising out of emergency operations, training activities or equipment wash downs. D. Directors and Officers Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence with two million dollars ($2,000,000) aggregate. This policy shall include coverage for prior acts. The insureds shall include current volunteers and employees, former volunteers and employees, and any persons or organizations providing service to the Department under a mutual aid or similar agreement. Coverage shall include civil rights type suits such as discrimination and sexual harassment; liability arising out of the administration of benefit plans for employees or volunteers and employment related practice suites. Coverage shall include claims made for future compensation and benefits lost from wrongful termination of an employee. E. Umbrella Liability Insurance with limits of at least one million dollars ($1,000,000) per occurrence and one million dollars ($1,000,000) aggregate. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 7 The umbrella policy shall provide excess coverage over the Auto Liability Policy, General Liability Policy, and the Employer’s Liability Section of the Workers’ Compensation Policy. Volunteers and employees shall be included as insureds. F. The Department shall maintain Property Insurance protecting against the risk of direct physical loss or damage. The policy covering the building shall be written on a Guaranteed Replacement Cost Basis, with coverage included for Building Ordinance, Flood, and Earthquake. Coverage shall include Commandeered Property in the amount of two-hundred fifty thousand dollars ($250,000). Contents coverage shall be provided on a replacement cost basis. Coinsurance penalties shall not apply. G. Portable Equipment Coverage shall be provided protecting against the risk of direct physical loss or damage, including electrical surges. Coverage shall be provided on a Guaranteed Replacement Cost Basis. H. The Automobile Liability Policy, General Liability Policy, Umbrella Liability Policy and Management Liability Policy shall name the County as an additional insured. The Department shall furnish the County with Certificates of Insurance showing the type of policy, limits of liability, name of insurance companies, policy numbers, effective dates and expiration dates of policies. I. Workers’ Compensation Insurance covering all volunteers and salaries firefighters meeting statutory limits in compliance with applicable State and Federal Laws. J. Each policy shall also contain a ten (10) day notice to the County in the event of cancellation or modification of any stipulated insurance coverage. 19. In connection with the performance of this Agreement, the Fire Department agrees not to discriminate against any employee, member, or applicant for employment or membership because of race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam-Era or disabled veteran status. Employees, members and applicants must be competent and capable to perform the requirements of the job. The Fire Department agrees to take all reasonable measures to insure that applicants are employed, and that employees are treated appropriately, during their employment, without regard to their race, color, national origin, religion, creed, ethnicity, sex, sexual orientation, age, disability, political affiliation, and Vietnam-Era or disabled veteran status. 20. Term. This agreement is effective as of November ____, 2025 and shall continue for one years, until November ____, 2026. Either party may terminate this agreement effective at the end of any fiscal year by giving the other party notice at least (1) year in advance of the end of the fiscal year that the agreement is to terminate. If, before the expiration of this agreement, the parties have come to a new agreement, this agreement shall become void upon the effective date of the new agreement. 21. This Agreement sets forth the entire understanding of the parties and supersedes any and all prior agreements, arrangements, and understandings related to the subject matter hereto. This Agreement may not be changed or terminated except in writing and as Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 18 18 8 provided herein, and no notice shall be effective unless evidenced by a written instrument duly executed by the Party or Parties, hereto. 22. Any notice required under this Agreement will be in writing, addressed to the appropriate party at its address identified on the signature page of this Agreement and delivered either in person, by email, by facsimile, by registered or certified mail, or by commercial courier service. All notices shall be effective upon the date of receipt. 23. Any provision or part of this Agreement held to be void or unenforceable under any Laws or Regulations shall be deemed stricken and all remaining provisions shall continue to be valid and binding upon the Parties. The Parties agree that the Agreement shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 24. That this Agreement shall be binding upon and inure to the benefit of the parties and their respective successors, legal representatives and assigns, but this Agreement may not be assigned by either party without prior written consent of the other party, which may be withheld in the sole discretion of a party. 25. No act or failure to act by the County or the Fire Department shall constitute a waiver of any right or duty granted to the Parties by the terms of this Agreement. Nor shall any act or failure to act constitute any approval except as specifically agreed to in writing. 26. 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 Fire Department affirms that Fire Department is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Fire Department certifies that Fire Department 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 Fire Department certifies that they have 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. 27. Fire Department 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. 28. 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 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 9 either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. IN WITNESS WHEREOF, the County has caused this instrument to be executed by the Chairperson of the Board of County Commissioners and attested by the Clerk to the Board of County Commissioners, and the Fire Department has caused this instrument to be signed in its corporate name by its President, attested by its Secretary, and its corporate seal hereto affixed, all by order of its Board of Directors. Acknowledged and agreed to the day and date first above recorded. ORANGE COUNTY FIRE DEPARTMENT BY: BY: County Manager President Address: 300 W. Tryon St. Address: 7020 Guess Road Hillsborough, NC Rougemont, NC 27572 Contact Person: Kirby Saunders Contact Person: Brad Allison Emerg. Services Director Fire Chief ATTEST: ATTEST: Clerk Board of Commissioners Secretary Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 10 Attachment 1 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 11 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF 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 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. (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSR 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 AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED 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-TORY LIMITSWC STATU- LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 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) GENERAL LIABILITY 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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD 11/25/2025 Herring & Bickers 2344 Operations Dr., Ste. 101 Durham NC 27705 Lee Hammond 919-479-9900 lee@herringbickers.com Caldwell Fire Department Inc. 7020 Guess Rd. Rougemont NC 27572 Key Risk Management Services A B0166PC2025-1 7/1/2025 7/1/2026 100,000 100,000 500,000 Orange County PO Box 8181 Hillsborough NC 27278 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF County: ORANGE State: NC Tuesday, March 11, 2025 Page 1 Insured:C04008 CALDWELL FIRE DEPARTMENT, INC Broker:A17868 Please complete and return to no later than .All pre-filled information should be verified for accuracy,and all questions not pre-filled should be answered. Are additional lines of insurance needed to broaden your client’s protection?We encourage you to request them by completing the appropriate sections of a VFIS application. Dear VFIS Representative: We hope you will use this Renewal Questionnaire as an efficient and effective means of reviewing and updating renewal data.This is an opportune time for you and your Property & Casualty (P&C)client to evaluate the benefits of our program and will help you to provide professional service to your client while protecting your agency's E&O exposure. Our goal is to continue to maintain our renewal processing standards.In order to ensure a timely renewal,it is critical that this questionnaire be completed and submitted to VFIS at least days prior to renewal.If you have any questions regarding this questionnaire,please feel free to contact your Regional Director,Marketing Office or VFIS P&C Underwriting. Thank you for your continued confidence in VFIS,America's Leading Insurance Provider for Emergency Organizations. Sincerely, Troy Markel President, VFIS Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 2 Insured’s Name: Insured’s Mailing Address: Notice: As changes are made throughout this document, a system-generated ""pdate indicator will appear in the left margin. Contact Name/Title:# Full-Time Employees:1 # Part-Time Employees:2 Contact Phone:# Active Volunteers:3 Contact Mobile: Contact Email: # Publicly Elected Trustees/ Commissioners/Directors: Web Site: Federal I.D. #: 1 A full-time employee is one who is regularly scheduled to work 35 or more hours a week. These hours may be in a set rotation or in varying shifts from week to week. 2 A part-time employee is one who on average works less than 35 hours a week, or has no set number of hours a week, or receives an hourly rate per call. 3 A volunteer performs services without expectation of any compensation. Type of Organization:Fire Department Relief Association Fire Department w/Ambulance County/State Association Ambulance Corps Search & Rescue Team Rescue Squad (no ambulances)*911 Emergency Dispatch First Responder Training School Hospital EMS Haz Mat Team Other (describe): * If the insured has ambulances they should be classified as an Ambulance Corps even though their entity name may include "Rescue Squad". Population of area served on a first call basis: Number of Responses per Year: Fire and other non-medical runs. Emergency medical or first responder medical runs. Include number of runs involving medical treatment at the scene of an emergency or while in transport (or both). Non-emergency transports. Are all volunteers covered by Workers' Compensation? Yes No N/A Are all paid employees covered by Workers' Compensation? Yes No N/A If no to either of the above, is there an Accident & Sickness policy in force with primary medical benefits of at least $10,000? Yes No BRAD ALLISON - CHIEF 0 2 U 919.451.9074 35 U 56-1194798 U 5,000 U 160 241 0 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 3 Property In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Crime In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Portable Equipment In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Auto In-Force 04/03/2024 04/03/2025 VFNU-CM-0008399-04 General Liability In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Management Liability In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Excess Liability In-Force 04/03/2024 04/03/2025 VFNU-TR-0008398-04 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 4 CALDWELL FIRE DEPARTMENT, INC LOCAL RELIEF FUND BOARD Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 5 Do you wish to insure all structures at each location described below? Yes No If no, describe any structures not to be covered: 1 1 7020 GUESS RD ROUGEMONT NC 27572 FIRE STATION 1 2 7020 GUESS RD ROUGEMONT NC 27572 TOWER/ANTENNA 2 1 3726 HUNT RD HILLSBOROUGH NC 27278 FIRE STATION Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 6 (show 100% replacement cost values) Property Deductible: For the Earthquake, Flood and Named Storms deductibles listed below, if a deductible percentage is listed, that percentage applies to the sum of the Building and Contents limits. 5%$1,000 N/A 5%$1,000 N/A 5%$1,000 N/A Note: In order for coverage to apply to a building or structure, it must be specifically described in the declarations as having "real property" coverage. Do not assume that smaller structures at a described premises will be covered automatically. $250 U 1 1 $678,962 $229,740 3 04 1 2 $10,955 Not Covered 04 2 1 $562,432 $5,624 3 04 1 1 No 1 2 No 2 1 No Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 7 Metal sheathing with exposed fasteners Built-up roof or single-ply membrane WITH gutters Concrete/clay tiles Shingle - 55 mph wind rating Shingle - 110 mph wind rating Metal sheathing with CONCEALED fasteners Built-up roof or single-ply membrane WITHOUT gutters Wood shakes Shingle - 55 mph wind rating/Secondary Water Resistance (SWR) Shingle - 110 mph wind rating/Secondary Water Resistance (SWR) Flat Roof WITH Parapets Hip Roof with Slope <= 6:12 (26.5º) Gable Roof with Slope <= 6:12 (26.5º) Braced Gable Roof with Slope <= 6:12 (26.5º) Flat Roof WITHOUT Parapets Hip Roof with Slope > 6:12 (26.5º) Gable Roof with Slope > 6:12 (26.5º) Braced Gable Roof with Slope > 6:12 (26.5º) Toe Nailing/No Anchorage Clips Single Wraps Double Wraps Structural Does the property coverage include a Special Property Floater? Yes No If yes, have you verified that the following schedule is complete and the values are adequate? Yes No Please indicate any other additions, changes or deletions as applicable. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 8 Do checks require at least two signatures? Yes, in excess of $ No Do purchases require the signed approval of two or more people? Yes, in excess of $ No Are bank accounts, credit card statements and vendor payments reconciled at least monthly? Yes No Are bank accounts and credit card statements reconciled by someone not authorized to deposit, withdraw or use the card? Yes No Are criminal background checks done on persons who regularly handle money? Yes No Are you aware of, or do you have knowledge of, any dishonest or criminal act committed by any of your members prior to the date of this questionnaire, whether committed during the course of their membership with you or otherwise? Yes No If yes, explain: Are financial records audited by outside parties? Yes No If yes, how often? Does your organization run bingo nights or other games of chance? Yes No If yes, how often? Annually Monthly Weekly or more often If yes, approximate annual revenues raised by such gaming? $ CALDWELL FIRE DEPARTMENT, INC $25,000 None No $10,000 None $10,000 None $25,000 None All Annually Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 9 Please indicate any other additions, changes or deletions as applicable. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 10 Blanket:Guaranteed Replacement Cost Deductible: Does the insured own any boats powered by motors over 100 horsepower? Yes No If yes, and the insured wants hull coverage, please provide the following: Length of boat: Hull construction: Use of boat: Water navigated: Year/make/model: Serial Number: Value of boat: Horsepower of motor: Year/make/model of motor: Serial number of motor: Value of motor: Value of misc. equipment: Does your organization own or operate drones? Yes No Unless previously provided, please complete the schedule below. Are all operations being conducted in accordance with FAA rules? Yes No How many personnel are authorized to operate the drones? How many hours of training are required prior to personnel being authorized to operate the drones? Does your organization loan, rent or lease the drones to others? Yes No If yes,a. Describe to whom: b. Will you loan, rent or lease: with your authorized operator without your operator $100 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 11 Please indicate any other additions, changes or deletions as applicable. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 12 Combined Single Limit for Bodily Injury & Property Damage:$300,000 $500,000 $1,000,000 Auto Liability Symbol "No Fault" or Statutory Personal Injury Protection:Included Not Included Auto Medical Payments: Uninsured Motorists: Underinsured Motorists: Are there any Garage Liability or Garagekeeper's exposures (for example, repairing the vehicles of others)? Yes No Primary liability coverage for members' personally owned and hired vehicles? Yes No Air Cascade Unit Hazardous Materials Vehicle Heavy Rescue Truck Aerial Device Mini-Pumper Light Rescue Truck 1 Not Included $1,000,000 $1,000,000 U 1 1994 FREIGHTLINER PUMPER TANKER 1FV6JLCB9RL719799 PT $850,000 $100 $500 U 2 2003 INTERNATIONAL PUMPER TANKER 1HTWCADR83J070881 PT $850,000 $100 $500 U 3 2008 FORD BRUSH VEH 1FDWF37Y48EC20984 BV $125,000 $100 $500 U 4 2010 INTERNATIONAL PUMPER TANKER 1HTWCAZRXAJ177632 PT $475,000 $100 $500 U 5 2013 CHEVROLET TAHOE 1GNSK2E02DR135349 OTH $60,000 $100 $500 U 6 2014 INTERNATIONAL PUMPER 3HAMKAZR4EL790606 PR $575,000 $100 $500 7 2019 FORD CHIEFS VEH 1FTEW1E57KKF08908 OTH $55,000 $100 $500 U 8 2021 SPARTAN PUMPER TANKER 4S9CU2D94MC560197 PT $975,000 $100 $500 U 9 2021 CHEVROLET FIRST RESPONDER 3GCUYEED6MG101645 FR $60,000 $100 $500 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 13 Advanced Life Support Ambulance Other Salvage Truck Antique Pumper with large diameter hose Service Vehicle Basic Life Support Ambulance Private Passenger Snowmobile Bus Pumper (regular)Tanker Brush Vehicle Pumper/Tanker Tournament Vehicle Chemical and Form Unit Quint with large diameter hose Trailer First Responder Vehicle Quint (regular) Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 14 Please identify all Chief Vehicles in the Insured Identifier Section below. Chiefs Vehicles will be insured on an Agreed Value basis. 1 1994 FREIGHTLINER PUMPER TANKER 1FV6JLCB9RL719799 2 2003 INTERNATIONAL PUMPER TANKER 1HTWCADR83J070881 3 2008 FORD BRUSH VEH 1FDWF37Y48EC20984 4 2010 INTERNATIONAL PUMPER TANKER 1HTWCAZRXAJ177632 5 2013 CHEVROLET TAHOE 1GNSK2E02DR135349 6 2014 INTERNATIONAL PUMPER 3HAMKAZR4EL790606 7 2019 FORD CHIEFS VEH 1FTEW1E57KKF08908 8 2021 SPARTAN PUMPER TANKER 4S9CU2D94MC560197 9 2021 CHEVROLET FIRST RESPONDER 3GCUYEED6MG101645 732 733 755 743 781 736 782 U 731 U 783 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 15 Please indicate additions, changes or deletions in the Auto Comments section below. 6 Loss Payee CIVIC FEDERAL CREDIT UNION ISAOA ATIMA 3600 WAKE FOREST RD RALEIGH, NC 27609 8 Loss Payee PIEDMONT ELECTRIC MEMBERSHIP CORPORATION PO DRAWER 1179 HILLSBOROUGH, NC 27278 Please indicate any other additions, changes or deletions as applicable. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 16 Each Occurrence or Medical Incident:$300,000 $500,000 $1,000,000 General Aggregate:$1,000,000 $2,000,000 $3,000,000 $10,000,000 Medical Expense:$5,000 $10,000 Line of Duty Accidental Death Benefit:$10,000 Not Included Employer's (Stop Gap) Liability: Yes No If yes, provide current payroll: Pollution Liability – Above Ground Storage Tanks: Yes No If yes, do you routinely monitor the tank(s) to ensure they are not leaking? Yes No If Yes, how frequently Do employees know and follow release reporting, investigation and confirmation procedures? Yes No Pollution Liability Exclusion – Class B Firefighting Foam: In your inventory, do you have any Class B foam? Yes No If yes, how many gallons? Is the foam labeled "Fluorine Free"? Yes No If no, have these foam containers been isolated within a leak containment enclosure and removed from use (fire ground, training, etc.)? Yes No Do you have a plan to properly dispose of this foam? Yes No If yes, when and how? Liquor Liability: Which of the following best describes the organization’s use of alcoholic beverages? The organization sells alcohol year-round (bar or club). Total Receipts: License/Permit required by state: Yes No License/Permit obtained: Yes No U U Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 17 The organization sells alcohol at special events. Describe events(s): Total Receipts: License/Permit required by state: Yes No License/Permit obtained: Yes No The organization permits alcohol on the premises or at sponsored functions, but does not sell it. The organization provides bartenders to serve alcohol provided by others at functions. The organization prohibits alcohol on the premises and at sponsored functions. Fundraising or other special events: If yes, indicate all that apply: Carnivals or field days with mechanical amusement rides # days held annually: Are rides operated by an amusement ride contractor? Yes No If yes, does the contractor carry at least $1 million in liability limits? Yes No If yes, does the contractor name this client as an Additional Insured and provide them with a COI? Yes No Conventions # days held annually: Fireworks # days held annually: Fireworks detonated by: Qualified outside contractor Applicant If detonated by outside contractor, does the contractor carry at least $1 million in liability limits? Yes No If yes, does the contractor name this client as an Additional Insured and provide them with a COI? Yes No Bingo # of days held annually: Motorized event # days held annually: Hall rentals # days rented annually: Written agreement signed by renter? Yes No COI obtained from renter if other than an individual? Yes No Any boats greater than 100hp? Yes No If yes, how many? If physical damage is desired, please be sure to schedule coverage under Portable Equipment. Any grandstands or bleachers? Yes No If yes, how many? U U U Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 18 Any vacant land? Yes No If yes, how many acres? Other? Yes No If yes, describe: Do all areas of public assembly have emergency lighting? Yes No N/A Do you participate in any sports activities on a league basis? Yes No If yes, do you have an A&S policy with a league sports rider (or similar first-party medical coverage for sports activities)? Yes No Do you sponsor a Junior Firefighter program (or explorer post), youth camp, or events involving minors? Yes No If yes, please identify the written policy and procedure items you have in place. Formal abuse and prevention and control program Yes No Zero Tolerance Statement Yes No Annual Employee training and communication Yes No Response to an allegation procedure Yes No Criminal Background checks Yes No Supervision of Youth Yes No Anti-retaliation and False Allegations Yes No Validation of compliance – oversight, supervision and validation Yes No Emergency medical services provided? Yes No If Yes, please provide the following Professional Health Care Liability questions: Level of state certification/licensing: Not state certified/licensed First responder Basic life support Advanced life support If 'not state certified/licensed' or 'first responder' was checked above, describe the highest level of service provided: Non-medical only Basic life support Advanced life support Does the insured provide pre-arrival medical instructions to callers? Yes No Estimate the number of annual dispatches made: Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 19 Please indicate any other additions, changes or deletions as applicable. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 20 Each Offense or Wrongful Act: Annual Aggregate: Coverage is to be renewed on a: Claims Made Basis Occurrence Basis Note: If switching from Claims Made to Occurrence, contact your Underwriter to determine the cost of the Supplemental Extended Reporting Period endorsement. Each Event Limit:Each Electronic Information Security Event Retroactive Date: Each Event Limit:Each Privacy Event Retroactive Date: Deductible:$0 Each Privacy Event Each Event Limit:$20,000 Each Cyber Extortion Threat Deductible:$0 Each Cyber Extortion Threat Aggregate Limit:$50,000 Aggregate Please indicate any other additions, changes or deletions as applicable. $1,000,000 $10,000,000 $1,000,000 $50,000 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 21 Each Occurrence: Annual Aggregate: �Unmanned aircraft (drones) $1,000,000 sublimit applies and cannot be increased. Abuse or Molestation Each Occurrence............................................................................$1,000,000 Abuse or Molestation Aggregate.......................................................................................$1,000,000 Cyber Liability Each Occurrence.......................................................................................$1,000,000 Cyber Liability Aggregate...................................................................................................$2,000,000 Excess over the following underlying coverages: Auto ☒ General Liability and Professional Liability ☒ Management Liability ☒ Please indicate any other additions, changes or deletions as applicable. $1,000,000 $2,000,000 Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 22 Installment plan:Annual Premium Payment Semi-Annual ($2,500 P&C account minimum) Quarterly ($3,500 P&C account minimum) Ten Pay ($10,000 P&C account minimum and 25% down payment) ® Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 23 Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime, and may subject such person to criminal and civil penalties. This document is provided to assist in the review and updating of the insured’s exposures. It must not be construed as a coverage document. Actual coverage is provided only by the policy. By signing, you agree that the information contained in this Renewal Questionnaire is true and accurate to the best of your knowledge. Prepared by (Print): Signature:Date: Title: Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 24 Deciding on an appropriate agreed value for each of your emergency vehicles is not an easy task,but it is an important one.Below are some tips you may find useful.But first,let’s briefly review the coverage provided by VFIS’agreed value endorsement (AU1002). In the event of a loss to a covered vehicle,we’ll pay the least of the following: 1.the cost to repair the damaged property; 2.the cost to replace a part or parts of the damaged property with a part or parts of like kind and quality, without deduction for depreciation; 3.the cost to replace the entire covered auto and its permanently attached equipment with a comparable new auto and permanently attached equipment manufactured to current standards;or 4.the agreed value stated in your policy declarations as applicable to the damaged or stolen property. As you can see,you will never receive more than the agreed value you have chosen. Your first step is to estimate,for each vehicle,both its actual cash value (market value)and what it would cost today to replace it with a new vehicle designed,as closely as possible,with the same specifications. (Keep in mind that you should include permanently attached equipment in these values.)The agreed value you eventually select should be somewhere within this range.Why? If the agreed value is less than the actual cash value of the vehicle,our agreed value coverage could actually penalize you in the event of a loss.You may be better off with the actual cash value coverage that’s common in the insurance industry.On the other hand,if the agreed value you select is more than the replacement value of the vehicle,you would be paying premium for an amount of coverage you would never be able to collect.As stated above,the policy will never pay more than the replacement cost or the agreed value, whichever is less. Some considerations you should make when determining a lower boundary include age of vehicle,general condition,how it is equipped,and how easy it would be to replace. So you’ve set the lower and upper boundaries.Within that range,what agreed value is right for your organization?The answer depends on what you would likely do if the vehicle was damaged beyond repair. � If so,you should choose an agreed value close to the low end of the range. � If so,you should choose an agreed value at the estimated current cost of the vehicle you have in mind. � If so,you should set the agreed value at the high end of the range. � If that’s the case,consider deleting physical damage coverage from the vehicle. The discussion above involves payment of the agreed value limit when a vehicle is damaged beyond repair. Be aware of another consideration in choosing an agreed value limit –in the majority of accidents,the vehicle is repairable.When a high agreed value is chosen,damages from even a severe accident may not involve an agreed value limit payment.The policy provides that a vehicle is repairable if it can be repaired for up to 60%of the agreed value.High agreed value limits allow for extensive repairs,even on older vehicles with low market values. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF Insured Name: CALDWELL FIRE DEPARTMENT, INC Tuesday, March 11, 2025 Page 25 Remember that your plans may change over time,as will the values of emergency vehicles.VFIS recommends that you and your agent go through the above thought process periodically so your agreed values will meet your needs in the event of a loss. Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF WORKERS' COMPENSATION CERTIFICATE OF COVERAGE ISSUED BY OR ON BEHALF OF THE VOLUNTEER SAFETY WORKERS' COMPENSATION FUND NAME AND ADDRESS OF FUND PARTICIPANT Caldwell Fire Department lnc 7020 Guess Rd Rougemont, NC 27572 This company is a qualified self-insured in the state of North Carolina for its Workers' Compensation liabilities pursuant to all statutory requirements under section 97-93 of the North Carolina Workers' Compensation Act. CLTENT NUMBER: 0'166 COVERAGE PERIOD FROM: 7 l1 l?025 TO 7 t1 t2026 EMPLOYER LIABILITY LIMITS: AUTHORIZED AGENT: DATE:81712025 $100,000 $500,000 $100.000 Each Accident Disease-Policy Limit Disease-Each Employee 0,2 l<b--z-7_. Volunteer Safety Worker's Compensation Fund 3OO GALLERIA OFFICE CENTRE, SUITE 2OO SOUTHFIELD, MI 48034 AGENCY: Herring & Bickers lnsurance Agency PO Box 1559 Hillsborough, NC 272780000 Ilt(t%* Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF