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HomeMy WebLinkAboutSEASONAL SOUPS & COMMON LINK - CONTRACT - RFP - 7632 OUTDOOR CONCESSIONAIRE - DOWNTOWN TRANSIT CENConcession Agreement Page 1 of 10 7632 Outdoor Concessionaires – Downtown Transit Center CONCESSION AGREEMENT THIS AGREEMENT is made and entered into this day of May 29, 2014, by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation (City), and COMMON-LINK, LLC (Concessionaire). WITNESSETH WHEREAS, the City agrees to grant to the Concessionaire and the Concessionaire accepts from the City a concession for outdoor vending at the Downtown Transit Center (DTC) located at 250 N. Mason Street, Fort Collins, CO 80524. NOW THEREFORE, in consideration of the mutual covenants and obligations herein expressed, the parties agree as follows: Section 1. Contract Documents The contract documents consist of this Agreement and Exhibits A, B and C, a t t ached hereto and incorporated herein by this reference. Section 2. Terms of the Agreement A. This Agreement shall be effective from June 1, 2014 until May 31, 2015, unless sooner terminated as herein provided. The City may, at its option, renew the Agreement for additional one (1) year terms, to a maximum of four (4) additional one (1) year terms. B. In the event that the concession location can not be used because of improvements being made at the concession location, this Agreement may be suspended on t h i r t y ( 30) days’ notice to the Concessionaire. The suspension shall continue until the improvements are completed or it is determined that the location can no longer be used as a concession site. Section 3. Concession Operations The City hereby grants Concessionaire a concession for the use of the Downtown Transit Center concession area as defined in Exhibit "A", consisting of one (1) page, attached and incorporated herein by reference, for outdoor vending. The Concessionaire shall have the right to operate an outdoor food vending concession within this area in accordance with the Agreement. A. Independent Contractor: The services to be performed by the Concessionaire are those of an independent contractor and not as an employee of the City. The City shall not be responsible for withholding any portion of Concessionaire's compensation hereunder for the payment of FICA, Worker's Compensation or otherwise. B. Records: The Concessionaire shall keep adequate and proper business records of all expenses and receipts of the concession operations. At the request of the City, all such business records shall be made open and available for inspection and audit by the City of Fort Collins Treasury Division. C. Licenses: The Concessionaire shall obtain and pay for all licenses needed for the operation of the concession including, but not necessarily limited to, a County Health DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 2 of 10 7632 Outdoor Concessionaires – Downtown Transit Center Department Food Services establishment inspection and City and State sales tax licenses. Any such licenses held specifically by the Concessionaire in connection with this Agreement shall be surrendered by the Concessionaire at the time of termination of this Agreement. D. Laws, Rules & Regulations : The operation of the concession granted under this Agreement shall, at all times, conform with all applicable Federal, State, and local laws and with all applicable rules and regulations adopted by the City or any of its Boards or Departments . E. Insurance/Indemnity: The Concessionaire shall indemnify, save and hold harmless the City from all claims and losses, including costs and reasonable attorney's fees arising directly or indirectly out of the Concessionaire's use of the concession area or operation of the concession. The Service Provider shall maintain, during the life of this Agreement, such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage, naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit "B", consisting of one (1) page, attached and incorporated herein by reference. The Concessionaire, before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, P.O. Box 580, Fort Collins, CO 80522, one (1) copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. F. Signage: All signs on the concession cart or truck must be approved by the City. Signs may be displayed in or on the cart or truck only unless additional signage is approved by City staff. G. Mobile Food Truck: The mobile food truck may not exceed the size of eleven (11) foot wide and thirty-five (35) foot long. Truck width shall not extend beyond one (1) foot of the forward and side curbs. The design and appearance of the mobile food truck must conform to the specifications described in Concessionaire's proposal, unless otherwise agreed to in writing by the parties before the mobile food truck may be used at the concession area. The City reserves the right to approve any modifications, changes, or alternative mobile food truck. The mobile food truck is subject to inspection by the City. The mobile food truck must be maintained and repaired to the City's satisfaction. The mobile food truck must be removed from the site when not in use. H. Restrictions: Equipment such as tables, chairs, benches and displays not attached to the truck may not be used except for items and equipment authorized, in writing, by the City Representative. Merchandise must be restricted to the mobile food truck. A tarp or other protective medium must be placed underneath truck to protect underlying surface. Mobile food truck must be located in approved location site and cannot impede vehicular or pedestrian flow. I. Cleanliness: Concessionaire shall keep the concession area clean of all trash within a one- hundred (100) foot radius of site. Food Concessionaires must use a tarp under the serving area, to minimize grease deposits and spillage. DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 3 of 10 7632 Outdoor Concessionaires – Downtown Transit Center Concessionaire shall pay the City Twenty Dollars ($20.00) per month cleaning fee for power washing of the site granted. The Cleaning fee is subject to change during term of Agreement based on frequency required with at least thirty (30) days’ notice to the Concessionaire. City fees associated with the concession operation must be filed by their due date. No assessment fees, penalties or interest will be waived by the City. J. Power Source: Portable generators will be permitted if contained within the designated concession area. Use of a power generator must not violate the noise regulations contained in the City’s Noise Control Ordinance (Chapter 20, Article II) of the City Code. For more information, visit www.colocode.com/fcmunihtml.html. K. Stock: The Concessionaire shall maintain an adequate stock of supplies on hand for all occasions in order to supply to the needs of parties desiring to patronize the concession area. L. Hours: The Concessionaire must keep the concession area open for business as agreed to in this contract. Beginning from the contract start date and ending thirty-one (31) days from that date, the Concessionaire shall submit, verbally or in writing, the days and hours of operation for approval by the City Representative. The Concessionaire shall notify, verbally or in writing, the City Representative of any changes to operating days and hours during this period, subject to approval by the City Representative. After conclusion of the one month period, the ongoing days and hours will be determined through negotiation between the Concessionaire and the City Representative. The agreed upon days and hours will be reflected in an amended contract. Any adjustments to the ongoing days and hours shall be requested in writing and are subject to approval by the City Representative. Concessionaire is not required to operate on days when Transfort is not operating transit services out of the Downtown Transit Center. Inclement Weather: The Concessionaire shall not be required to operate the concession when it is raining, snowing, hailing, and abnormally windy or when the air temperature is below 50 degrees Fahrenheit. M. Product: The products authorized are as described in Concessionaire's proposal and agreed to by the City Representative. The City Representative will not pre-authorize new products but does reserve the right to review any new products that may be added. This is to ensure that the new products meet the same quality as those proposed in the original Request for Proposal. Smoking instruments, tobacco and tobacco products, gum and alcohol will not be sold. The City recommends the Concessionaire incorporate the Dietary Guidelines for Americans, as outlined on www.health.gov/dietaryguidelines. The Dietary Guidelines encourage Americans to focus on eating a healthy diet, one that focuses on foods and beverages that help achieve and maintain a healthy weight, promote health and prevent disease. N. Customer Service: Concessionaire is required to uphold high standards of customer service by addressing customer complaints in a prompt and courteous manner. DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 4 of 10 7632 Outdoor Concessionaires – Downtown Transit Center Concessionaire will also provide contact information to the City Representative, updated as needed. The personal conduct of the Concessionaire has a direct impact on the quality of performance. Unacceptable personal conduct/behavior by the Concessionaire may result in immediate or early termination of the Agreement. Section 4. General Conditions A. The Concessionaire shall neither assign any of the rights nor delegate any of the duties under the provisions of this Agreement without having first obtained the written permission of the City. The Concessionaire shall not sublet any portion of the concession area or allow any other person to take possession of any portion of the concession areas without prior written consent of the City. Any such assignment or subletting without the City’s prior written consent shall be deemed null and void and of no effect. B. This Agreement may not be enlarged, modified or altered except in writing, signed by the parties as an amendment hereto. C. No waiver of any breach of this Agreement shall be held or construed to be a waiver of any subsequent breach thereof. D. It is expressly understood and agreed by and between the parties hereto that in the performance of the terms and conditions of this Agreement, time is of the essence. E. The location assigned is not transferable to another vendor or Concessionaire. F. Fixtures and Improvements: 1. The Concessionaire agrees that all auxiliary equipment needed to operate the Concession shall be installed at its expense. Prior to making any and all improvements on said premises, the Concessionaire agrees to obtain the approval of the appropriate City Department and shall supervise the construction of said improvements. 2. Upon the termination of this Agreement the Concessionaire shall remove any fixtures or improvements made by it to the concession area. However, the concession area must be restored to as good a condition as the premises were in at the time the Concessionaire took possession thereof. G. This Agreement shall be binding upon and inure to the benefit of the heirs, successors, and assigns of the parties hereto. H. If either party must resort to legal action to enforce the terms of this Agreement, the prevailing party shall be awarded its costs and reasonable attorney's fees. J. Any notice required or desired to be given under this Agreement will be considered delivered to the other party upon hand delivery or upon its deposit in the United States mail, postage prepaid, sent by registered mail, addressed to the other party at the following addresses: DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 5 of 10 7632 Outdoor Concessionaires – Downtown Transit Center City: Copy to: Concessionaire: City of Fort Collins City of Fort Collins Common-Link, LLC Purchasing Division Transfort Attn: Jesse Doerffel P.O. Box 580 Attn: Timothy Wilder P.O. Box 21 Fort Collins, CO 80522 P.O. Box 580 Fort Collins, CO 80522 Fort Collins, CO 80522 K. Notwithstanding the time periods contained herein, either party may terminate this Agreement at any time without cause by providing written notice of termination to the other party. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the above addresses. Section 5. Default A. The Concessionaire shall be in default under the terms and conditions of this Agreement, if the Concessionaire fails to cure the default within ten (10) days after written notice setting forth the nature of the default is delivered to the Concessionaire. B. In the event the default is not timely cured, the City may elect to (a) terminate this Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance measures or (c) avail itself of any other remedy at law or equity. Section 6. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: A. As of the date of this Agreement: 1. Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2. Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the "e-Verify Program") or the Department Program (the "Department Program"), an employment verification program established pursuant to Section 8-17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. B. Service Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. C. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. D. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Service DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 6 of 10 7632 Outdoor Concessionaires – Downtown Transit Center Provider shall: 1. Notify such subcontractor and the City within three days that Service Provider has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three (3) days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. E. Service Provider shall comply with any reasonable request by the Colorado Department of Labor and Employment (the "Department") made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17 .5-102 (5), C.R.S. F. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17 .5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider's violation of Subsection 8-17.5-102, C.R.S. G. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breach. Section 7. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit "C", Affidavit Pursuant to C.R.S. 24-76.5-103, consisting of one (1) page, attached hereto and incorporated herein by this reference. DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 7 of 10 7632 Outdoor Concessionaires – Downtown Transit Center CITY OF FORT COLLINS, COLORADO a municipal corporation By:_______________________________ Gerry Paul Director of Purchasing and Risk Management Date:_____________________________ ATTEST: _________________________________ City Clerk APPROVED AS TO FORM: ________________________________ Assistant City Attorney Common-Link, LLC By:_______________________________ __________________________________ PRINT NAME __________________________________ TITLE Date:_____________________________ DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 6/30/2014 Jesse Doerffel JESSICA DOERFFEL 7/1/2014 Concession Agreement Page 8 of 10 7632 Outdoor Concessionaires – Downtown Transit Center Exhibit A Map of Downtown Transit Center Mobile Vendor Parking Location DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 Concession Agreement Page 9 of 10 7632 Outdoor Concessionaires – Downtown Transit Center EXHIBIT B INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: "The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins." In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insured on the Service Provider's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverage shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 New insurance Concession Agreement Page 10 of 10 7632 Outdoor Concessionaires – Downtown Transit Center EXHIBIT C AFFIDAVIT PURSUANT TO C.R.S. 24-76.5-103 I, __________________________________, swear or affirm under penalty of perjury under the laws of the State of Colorado that (check one): ___ I am a United States citizen, or ___ I am a Permanent Resident of the United States, or ___ I am lawfully present in the United States pursuant to Federal law. I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. ___________________________ _______________ Signature Date DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 6/30/2014 Jesse Doerffel X 100,000.00 500,000.00 100,000.00 1,000,000.00 300,000.00 5,000.00 1,000,000.00 2,000,000.00 2,000,000.00 74918989 06/30/2014 06/30/2015 4991898900 06/30/2014 06/30/2015 4165719 07/01/2015 A A 18988 1,000,000.00 MOBILE FOOD SALES CITY OF FORT COLLINS IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. Fort Collins, CO 80525 4033 Boardwalk Drive, Suite #200 PO BOX 21 FORT COLLINS, CO 80522 970 Common-Link, LLC (970) 206-1810 City of Fort Collins Attn: Purchasing PO Box 580 Fort Collins, CO 80522 Welsh Insurance Agency, Inc. F: 970-224-6134 Phone Fax (970) 206-1808 Auto Owners Insurance Co. Pinnacol D Y 07/01/2014 Y (970) 206-1810 (970) 206-1808 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDLSUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 100,000.00 500,000.00 100,000.00 1,000,000.00 300,000.00 5,000.00 1,000,000.00 2,000,000.00 2,000,000.00 74918989 06/30/2014 06/30/2015 4991898900 06/30/2014 06/30/2015 4165719 07/01/2015 A A 18988 1,000,000.00 MOBILE FOOD SALES CITY OF FORT COLLINS IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY AND AUTO LIABILITY. Fort Collins, CO 80525 4033 Boardwalk Drive, Suite #200 PO BOX 21 FORT COLLINS, CO 80522 970 Common-Link, LLC (970) 206-1810 City of Fort Collins Attn: Purchasing PO Box 580 Fort Collins, CO 80522 Welsh Insurance Agency, Inc. F: 970-224-6134 Phone Fax (970) 206-1808 Auto Owners Insurance Co. Pinnacol D Y 07/01/2014 Y Y (970) 206-1810 (970) 206-1808 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDLSUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP (Any one person $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO- $ POLICY JECT LOC COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 06/30/14 Bruce@wiainsurance.com DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP (Any one person $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO- $ POLICY JECT LOC COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 06/30/14 Bruce@wiainsurance.com DocuSign Envelope ID: F6C4E742-44DB-474C-BE36-9194BDB34A88