08/10/2021 Agreement Persephone & Dwayne SMIMM'S
305 Cross Street
Key West, FI 33040
(305) 240-0701
Job#; 06/1852-2 1 SHIP Reffih
INDEPENDF,NT CONTRACTOR ACIR FF X/1 Py
Persephone-& Dwzavne SLJJllnlers, 3-05 Cross St K-Y��sl, FL 33040 Jobt 06-1852-
21Ship_Rchab
This Independent Contractor Aureement is made this#d'ay of ALIc'USt, 2021, by and
between Monroe County, a political ,subdivision of the State Of Florida, (hereafter
County) and Gary I'lie Carpenter Construction, Inc., (hereinafter referred to as the
"Contractor-), for .services descrihed in Scope of Work, attachment A, and Contractor's
proposal, attached hereto and made it part hereof. The parties agree its foltowvs:
L RELATIONSHIP
Nothing contained in this Agreement shall be deemed or construed as creating army other
husiness relzitionship, partnership or joint venture between Contractor and NIonroe
County Board of County Cotl�lliissioners/,Nvf(.)tlt-oc County Social Services/Nlonroe
County Wcatherization Assistance Pro ,.-,ram andlor WAP-LIFIEAP Program, and/or
SHIP Program (hereinafter referred to as the "County").
If. SERVICES TO BE PERFORMED
Contractor a'rees to provide the services listed in the Scope of WOrk (Attachment A) and
in the Contractor's proposal to the satisfaction of tile County and in accordance with
federal and state regulations for the WeatherizaLion Assistance Program and/or '�VAP-
LIHEAI) Program, and/or SHIP Program.
Ill. NJANNEIR OF PERFORMANCE
Contractor shall properly Supervise and direct completion of weatherization and/or
rehabilitation nleaSLII-CS On all units assigned under this agreement. COntractor shall be
1- 11
solely responsible for coordinating all work conducted Linder the contract. Contractor
shall provide and pay for all labor, materials, equipment, tools, equipment/machinery,
tranSpOftaLiOrl, and services necessary for the Proper completion of work. Contractor
,,hall comply with all laws, ordinances, I'LlICS, regulations and orders of any
governmental authority bearing on the performance of the he work, including local building
C� C,
codes and permits. Contractor shall be responsible for the acts and omissions of
employees and Subcontractors. Contractor at all finies shall keep the premises free from
accumulation of waste materials or rubbish caused by the operation. At completion,
Contractor shall remove all waste and surplus materials and rubbish from and about the
premises, and if applicable, shall clean all glass surfaces and shall leave tile work
"broom clean." 0
IV. CONFIDENTIALITY
I
Persephone &7 Dwayne Summers
305 Cross Street
Key West, Fl 33040
(35) 24110701
Joh#; 06/1852-21 SIlfP Rellah
Contractor agrees to keep, confidential all client information Provided to Contractor
anWor emphyLes by County, excepting such information as is already known to the
pubhc and not to release, use, clisclose, same, directly or indirectly, to any wher person
or business, except with prior written PerndSSiOn Of County,
V. N0N-F�,XVC'TIAUJSjVE-, RIEL,\-�Jc)IN,SHlp
`either Contractor nor (.'Ounty has an exclusive rekltionship, with the Met% Contractor
is free to petUnn the above described servie:es for any other per,ojj rat- business, 'st) long
as this does not interfere with Contractor's satisfactory and timely perro ., I ce of
7
services Or COUnty Linder this agreement,
U SI-IB(--'0-NjRACQ
Contntctor shall not enter into any SUbCOME-aCt With stay subcontractor who has been
debanvd from perrornfing wtwk by any Agency of the, U'llited States Government or by
the State of Florida. Contractor Will be ruily responsible for the acts or ornkshns of
Sul-icontrotctors, said or persons either- dunecily or indirectly entlAoyal by litem. Out no
Chita shall any contract C", agreement between Antractor and a SUhConiracwr bc
conqrued a, a MOnship, Winal cm- NOW. bet%con the SW)C(Irltractor ,[not County,
°'I f' (M)
C'( AiIJAI,
COMISWUm gwwailtoc,, all work perUnrited Av a period of ono I I ) year from We date of f,f
acceWaflce Of' aft! "M reWhad by th bid proMosal, Connamir warranN to the cavner and
County that Al I'llaterials and CCItlipinellt Used in the work "ill be nox ,jn(j free of defects,
unless otherwise specified and approved in advance by an authorized rcpresentative of
County. All Manufacturers' and SLTMON' whaen gLiarantees and kvarralltieS COVVrifl� such
materials and equipment shall be furnished Cta the owner 01' oVeatherization household,
COMOMW agrees W cmuca any Men due to faulty workmanship, inatedals Or equipment
and shall pay for or repair any danmge to other work resulting, there front for as period of one
Yea'- fl-0111 the clite o[final acceptance of the cmitract woork,
VIII, �fQRK
Contractor warrants good title to all materials, supplies and eqUip[IlCul incorporated in tile
work and warrants that it is free front any claims, liens, or charges, and that Contractor nor
any other persoit finq or corporation, shall have tiny right to Put it lien upon the premises or
materials, supplies or equipment, Comm Must contact the homeowner within 7 days of
receiving a Notice to Proceed and Must complete all work within 180 days of receiving said
Notice, Contractor will contact the Weatherization Coordinator upon notice of the event
giving rise to the need for additional days beyond 180. Additional days may be granted upon
2
Persephone & Dvvayne Summers
305 Cross Street
Key 'NeMA133040
(305) 240-0701
Job-4: 06/18.52-21 SHIP Re[Jab
mutual agreement between Contriactor and COUWY
IX, E-FLO—TE—CTION' QF CMM N_)6L -A-4) PRQP ITT y
(Annuctor shall be rc,sponsihlc for initiating, maintaining and supervising all safety
precautions and pmgmnb in connection wit the "M and complyirig 1 1 a e
� w�ith all ,1)pC
i bl
laws. ordinances, rules, regulations. Contractor shall take all reasonable precautions for the
saki of, amf sJWH pnwide all reasonable protection to prevem damage, injury or loss to (I )
call cl"PIOYee,s on the work- site and other affected persons, (2) aall kk,;)rk, and I'laterials and
equipment at the she, and (3) other property at the site. Any darnage or Jos, to any
CaLISCCI in whole or in part by Contractor, SUhcontractor ()I, en1ployees, shall be remedied by
C0uI1'ACI0I_and County shall he held harmless,
X. Cf IANGE OR F'RS/
LIB--s
change orders must he approved in wNting [ay the Owner and txcupam it'qplicable,
Contractor, WcathcrizaIlion Insrcctor, all(] WeathorizatiOn Coordinator kvith review and sign
off by the Prograrn Director, prior to the comnxncenwnt of such %v& Any change order or.
WOrk kkaiver commenced prior to authodaMon shall he considered unmulAxNal wK and
wHI m; he rAmbivned by, Cmuny ff final invoke h"m Contnwhv exceeds the Bw pmTosal
J1110LIM, aM.l no change ordcr was appro ed' the invtdce wkill 1)e approved for only the
,1MOLIM tllloted in the Bid ProposJ.
Xf- Q)AUI`N1,SAT.IQN
of' pCruj ' C�)ntrator' a tfle". (li�crction, CMI illhffl�t invice [' mcw�-
percent 125%) of contri(act price,c "rhist initial invoice wil� lie decil,led ,,, pol-orcssor flay1nont.fivc
'4\
Copy of the issued permit Inust accompany invoice. Wmawwo a their dWsm, can
SUbMit ir]VotCc fifty percent (50%) of contract price Ul)o�l ClefiVeFY Or all I-CClUired Job
materials to job site. Verika6m of matedal delivey, gmA conch' on of rnawhWs and
assurance that all materials are secured at Qb she Ul be dmermhwd and doamwnted by
WeatheMatioti OVUM Wealhedzahon COMANaMr or Social Service, Senior
,VIrnmis[rator. Upon Col�ul?lei'oll Of OW W01, CMItraCtor Shall submit final invoke for
twenty.tIve percent (25%) of contract prier; to ('ounty. County's Weatherization Inspector
and/or Coordinator, Contractor, and Ovvner shall inspect, and approve in llhe v�
-hi , -or
A Hnal classed permit will be 1'eLlUired with final invoice, g, t
Contractor invoices will be processed Q reimbursement UpOtl verification that all conditions
under the agreement have been met. PaYmcflk will he issued in accordance with the Florida
Prompt Payment Act upon the satisfactory completion, post irispectjojys, and verification of
all MH&g data by he Clunty.
M L f N D E�WIANTI FRI_CAA T IROW
3
Pcrscphom & Dwayne Sultirtlers
305 Cross Street
Key Wev H 33040
(305) 240&701
JobAk 06/1852.21 SHIP Rellab
Contrackv agrees s) be solely resymstle, and shall hold harmless the (701inty, its officer,
directors, and employee, for any and all clabui brought against either Contractor or County,
or for liabilities irWilri-ed by County as a result of actions or omissions by the; Contractor,
whether under Workers' Conlivilsartion laws, or under any other federal, state, Or Municipal
laws, rules or regulations Which jllaay be applicab1c, or any Other set of circumstances not
specifically addressed herein.
X I I I ANC E
By the date, of the execMion. of this a ire cinent, Contractol, shall [)rOCUre and maintain for Elie
ch.1111thia of Wis agreement, hammcc agakst injuries to pemoni and clamagcs to prj) y ic
May arkc Out Of, carcarin connec pert v-.11 11
titan "", We Per"MaMe Of OW i"NCMML Contractor shall
Rirn kh evidence of Commercial Uneral 1.5hrility and ALItOIll0t)jjL Liability, Contractor shal I
obtain POHWiMl Occurrence Insurance if I-CLiLlired in tile SCOpc of Work. Contractor shall add
(OUrn) to its policies as an additional insured and shall provide as WON"& of inquarwe and
pulky endorsement as evkknce of coverage.
XIV. WORKER
KZ:S C
Wtinwwr %51 remain in comphaiwe "All the Workers' Compensatkul, law, for the—Tate of
Florida dirmigh the dUl-atiOn of this ryi-cemem. ("tar wic4yr studl provide as cor6ficatc or
inwrance or later of exemp6on by 11w date or execution of this agwement.
Xv.
")f' -Q 'jJ
Qmlinwsw SO! not discidminaw agairly any emNoycc or apiAikmi hm employmou bCMUNe
of race, Mor, religion, sex, cw naWn origin. Unwivivw "S take arrinnadve action to ensure
kit applicants are enipkjaL and that employees are mean! Whig aryk,mem, "Itima
regard to their race, color, religion. sex or national origin. Untractov ,we, to post in
COnSPiCUOUS places, imAlabW to employees and apphcants for entployniciat, notice,; setting
forth We pirmhNs it M nondiscrimination clause. All advertiserlielit will state that all
qualified applicants "S IrOve cutsideratimi without 1-09Md to their race, sAw, whg5n,
,sex or national orivin,
XVI. COPELA K102 C K,A-Cl
Contractor shall comply with the provisions of the federal Copeland "'anti-Kickback" Act
and agrees to mandate such emnpliance by its Sl.ibconmactcirs. Contractor or its
subcontractors shall not in any way induce ,in employee to give Lip any part of the
compensation to Mich SAW is entitled Linder his/her contract for eMploymcnL.
4
PCI-scphone & Dwayne SU111111ers
305 Cross Street
Key West, F1 33040
(3(1-5) 140-0701
Job#., 0611852-21 SHIP Rellub
XVIL CONTRACT �!A"ORK IIQ UR
�--�%1,N SAFETY STANDARD ACT
Contractor' Shall C(,)[jjply with the provisions or the fcdcral Contract Work I fours and Safety
Standards Act. Contra,�tor ';llafl compute wages of every mccharlic and lahorer of" tile basis of
a standard -10-hour work- weck. For work in cxces'; of the standard work week, Contractor
shall compensate worker(s) at a rate or not less than I "a ti'lle', tile, basic rate of pay for all
hours vorkcd in cxces,. o1'40 1101.1i", iC the %vork w%eek. Contractor shall not rC(jL1irC any laborer
Or mechanic to work in ;LJITOUI`Idin,)s Or U11,101- working CO[Iditi0n� that are ur,
hazardous, or dmj-ero�js.
Z7 lianitai*y,
XVIII. CLEAN AT) ATE(Z AC-1—`\ 1) E, FRAL WA TIT POLLUMON
ACT yT R Q1,
For contacts of, "SIO0,000 or stoic, Contractor mid its suhcontractori sjj;jlt c 0111piv %iti, all
apph,.ahlo st,mklard orders or roquirenienk IsNUCd Under section 306 of the (I'lean Air AC('
scction .508 of tile Clean Water Act. and the l"CLILral WItOC POHLMOD Contr()l Act.
XIX. 0—'ElIl AN 114—4 -B1-3 '1 N G A,%,I
END.MFN"l'
Forcoivract� of$j()(),O()() or niore. Contractorcertifie.i that lie/she will not iirl(l has jjci)t LiscLI
Federal appropriated fiincl; to PY Xly Person or organization fear jnt'lucjlcing
C 04. '1ttCiT)f)tiM) 10
Influence an officer or employee (if any federal �7 C,
p , ral agcncy' a meniher of Congress, officer or
enillioyce of C"onorre.,,s, or an eqjptc)
Z- yee, or as member of(A)n�,-Yreis in connection with obtaillit-1,,
any Federal cowract, grant, cal'any Other aIVard c U
covered by 31 ,Sk C
', 1352, 7
XX, DISAGRE -MENTS AND DISPUTES
In tile event that either Contractor or County commence an action for dama�ze's' injunctive
relief, or to, enforce the provkiOrls of this agreement, and either party prevails in any stash
action, the prevailing party shall be entitled to an award of its reasonable attorneys' fees Land all
costs incurred in connection
therewith as determined by the COLIf t in any stash action,
XXI. GOVERNING LAVV
This agn-ement shall be governed in accordance with the lam Of the State of Florida, and
v C I
venue for any action enforcing the terms of this Agreement shall be Monroe County, Florida.
5
Persephone 6, D"syne Surnmers
305 Cross Street
Key West, Fl 33040
(305) 240-0701
Job#: 06/1852-21 SHIP ReFlah
XXH. ASSIGN,\, i !T
This agreement nmy not be assigned viiMOUt F)fiOr Written consent of hoth parties. This
aIgreenlent will be binding upon, and %vHl inure to the benefit of, C,,Icll pafl-ty,s f)erjjjit,,(I
SUCCCISOTS and assigns.
XXlILjEVERAQjT 5-a,f ri�iL ur y
The parties agree that the covcnanti of this agreement ove tip; erable and that W imy s1gle
clause or clauses shall be Round unenforceable, dw Mire agreement studl not ['ail but shall he
construed and enk-ced without any severed cim"es in accordance with the terms of Olis
agreement,
XXIV- DURATION ANL)
If Contractor defaults or neglects to carry out any k%qnk in acconfance %101 Nis agnernem or
C.lik to perforni or comply \w'tb anY of this the County may, after
written notice to Comnwuw, rn,Q good such deficiencies and may deArct to cost incurred
faun the payment due to Chntracuw and/or County nmy termbate the ct)ajractOj-'N services and
lake possession of[lie site ank.1 of,,111 HlatOri.ds, eqUiptnent, Locals and COnStRlCtiOn CCILlipillont,
and inachiner) owned by Contractor, which were PUISASCLI %%'it]] wweathcri/ation and/or
'KAP4JHFAP funds and nmy knish No "uric If the expense of FhAsNng the =k coocoul,
the unpaid balance to Contrucurr, COMRoctur skH he We AV payinom of the dinbrence u)
COUnty. Contractor awl Coumy tnui terminate Me services contenipLaed this agreement at
au time for any reason upon 7 calendar days roxice W) Sher Party. OntnAlor shall be
required b) satisfacowdy Enid all work in [aria nss prior to termimaWn of the servkes.
Faihlro to do so by(Inumus skdl resuh in k0hiture of payment for any work- in progross.
XXV, EXAMINV71 —'`,�'..L\ I) R "R YRA "i QS. E R DS Contractor shall retain records 1.elathg to US CMV1'aCt for four YOM-,' after final payment is
nude this agmeruns If an audit, h6gation, or Mher action involvin,g the records is started
beive the end of to four-year-period, rcowdi nn"t be retained until all issues arising Out of the
action are resolved,tv until the end of the 011--year period, w'hichever is lawn clum" (n any
or its authorized representatives, shall have access to Corunictor records.
XXVL RUBtB C AlKly
ACCUM,
The County and UnPactor shall allots and permit reasonable access to, and inspection of, all
docurnents, papers, letters or other materials in its possession or under its control subject to
the provisions of Chapter 1191, Florida Statutes, and made or received by the COLHILy and
Contractor in conjunction ',vWi this agmement; and the County shall have the right to
unlamally terminate ContFUCtor's services upon violation of this provision by Contractor,
6
Pemcphmw & Dway ne Sunnism
305 (Irm Sheet
Key lVem, F] 33040
(305) 2440701
Job4': 06/185 2-2 @ S H I P Rel-I�tb
XNAIL QPTY15
H L\—D I N.G
The headOgN contained in I& agreement are Air rethrence purposes only and altect
tho m eaning or intorprelatij)II 1-cenj�,,jjl ag 7 .
THE, fx'l,,'MAINDER OFFIlls PVJ, II,- S BEEN IN'I'ENTIONALLY LI'll' BIXNK
7
Persephone &- Dw'j}[10 StI111111crs
305 Cro..�s Street
Kev West, F1 33040
(305) 240-0701
Job#: 06/1952-2 1 SHIP RcHab
IN '�VH'NESS WHEROF", County an() Contractor havc CXCCL]tCd this Independent Contj,Ltctor
A,creement as of the (late ri r,,t written above.
kVI-FNESSES
MONR 'T 1,
By:
Shery jrafllanl
N1011170e C'OLMIN' �V,,\P
Adminktrator
"110111-OC C(Wll[y SHIP Pro-gram Administrator
MONROE COUNTY ATTORNEY
PPROVED AS TO FORM
C'O NTF A C'-]-"0'-NL'� A ,
JAMES MptENAAR By-
----------
ASSIST Parses RTY
7 C
Dte aar,
a : Esq-
ty)
Print Nmne & 'T'itic:
STATE, 01"': Florida
COUYYY 0[7; �jk)nroc
I HEIZEBY CERTIFY that oil this
....... daAu-U 2)�v of '' �t, ( 4
[lie, all offK:C1,
(11.11y qualified to takeicknowledgments, personally appeared,
re to nle
known to he the Person (1-1,scribcd horelil Lklict kvilo excctjtckl the fol'C('0111" HIStrUll.1011t and
acknowledged hefore [lie that he/she MXLIted tile same. Driver Uc-enseshown ttti
Z7
identification.
SEAL,
�--�NOTA YPUBI,ICSIGN,,
th- Printed Narne of Notary: LAA�UV\A
C0111mis,,ion No.:,
ALEIIAI,!�RA
Nowy PUbjiC NICOLE ALSURY ikly Commission p1res:
•State of Fjon'dd
c
OMMISSJon#GG 224728
My Comm,Ex 'res Jun 4,2022
EorllldeC�through Eta Notary Assn.
Persephone & Dwayne ,,_,triniers
305 Cross Street
Key West, F1 33040
(1305) 240-0701
Job#: 06/1852-21 SHIP ReFlab
ATTACHMENTA. SCOpf�, ()I,' �VORK
All weatherization or rehabilitation rnCaSUrcs to be pro%'ided to ho'lles governed by this
aLyreenlern Must be in accordance with the "Pre-Work Order Agreement", "Bid Proposal/job #:
06-1852-21 SHIP ReHab " and [lie Weatherization Assistance Program and/or WAP-LIHEAP,
and/Or SHIP PI'O"raIll Riles and re(ILIlations. The followin"C, tn are the proccdt.ffeS for completing
the Scope of Work Per this Agreement: Z7
C7
1.
Contractor shall provide such IlleZISLINS as determined by tile Pre-Work Order
Agreement and Bid Proposal/Job #: 016-1852-21 SHIP ReHab pro'
viciccl to Colltl-actoI, by
C C,
01.111ty.
? Upon receipt of the Pro-Work ()rder Agreement, Contractor shall I)rOViCle County it
CILIOtC Via a hid proposal per home [*()I- the Cost of completion of %vC1lthCl'iZdti()Il InCLLSLII-CS as
Indicated in the Pre-Work Order(s).3.
Contractor shall Comilply "'tb a111 OrdillaflCCS, rUiCS, rCOUlatiolis ,tIj(j orders C)f
'IMI! OVeRinlental a arin on e wor
authority heg the Performance of thk, TrICILIdirC,)(1 local h1j1dincT
I I L' I , 1 �7
Codes and permits.
4. COLInt 'S�Nr WeLltbCrizajtmll Inspector, Weatherization Coordinator, and Pl-ouraill
Director shall approve the CILIOtCS Mid iS.SUe a Notice to Proceed to C,(Izlt z7 ractor. The Notice to
PIOCCCLI Silidl COIlta(ijj tile OW11CIMCCLIpant Ilitille, LIC[dreSs and telephone IlUmbcrs.
S. Contractor sInffl contact all ()wVIICIMCCLIJMMS fiSteCI III the Notice to Proceed within 7
clays Of receipt of the Notice and shall compiete all work within 90, days of receipt of the
notice- Co "tractOr will contact the Weatherization Coordinator Upon notice of the event
,giving rise to the need for additional days beyond 90. Additional days may be "I'alltOd Upon
C additional
ITILItUal agreement between COIItrLCtOI_ L111CI County.
6. ('ontractOr shall follow tile Pre-Work Order as written by County and approved by
Owner/Occupant,
7. If OWIlel'/OCCUpMlt I&LISCS LI Measure, Contractor shall contact Weatherization
Inspector inlinethately and [lie Owner/Occupant. and tile CI minty will document same III the
Client's file. If the refusal will CMISC the COUnty to be In 11011-compliance, it IIILI.St be referred
to the Weatherization Coordinator and the Program Director who �vilj jcl�-jse tile client than if
C7 n
the IlleaSUre prevents elimination of air infiltrations, County cannot proceed with
weatherizing the home unless the Owner/Occupant approves the measure. To the extent
C�
possible, all measures approved for the Unit ShOLIId be reviewed by staff with Owner/Occupant
in pre-work phase and approval obtained in writing before commencing work, The only
exception Would be in the rare case of change orders clue to Unforeseen condition.,,., as outlined
9
A _tL
LIAbILI I r
7THIS 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. THI'S 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 AD'DITIONA,L INSURED,UH thel: ADD
ITIONAL uulf 1VNAL INZSIURED provisions 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,).
PRODUCER
F
C r CONTACT Margaret Schneider
NAME:CLIFFORD INSURANCE CENTER, INC PHONE
9790 SE 160th Lane A/C No EM: (352)245-5455 Franc
E-MAI -9866
ADOR SS: certificates@cPiffordinsurance.net
Summerfield INSURER(S)AFFORDING COVERAGE
E FL 34491 NAIL N
INSURED INSURERA.- Southern Owners Insurance Co. 10190
Gary The Carpenter Construction,Inc. INSURER B:
$00 Simonton St INSURER C:
INSURER D:
Key West INSURER E:
FL 33040-7446
COVERAGES CERTIFICATE NUMBER: 2021-2022 REVISION R�
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N
WtU ABOVE FOR THE POLNUMBER.Y PERIOD
lNDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 INSR PAID CLAIMS,
LTR TYPE OF INSURANCE .POLICY EPF... I�PO CY EXP
-
INSD POLICY NUMBER
X COMMERCIAL GENERAL LIABILITY yy MM orfYYY LIMITS
EACH OCCURRENCE 1,000,000
OCCUR
CLAIMS-MADE Ln $
J fi
PREMISES Ea occurrence 300,000
A 78842358 MEDEXP(An oneparson) $ 10,000
05116/2021 05/16/2022 PERSONAL&ADV INJURY 1,000,000
GEN'L AGGREGATE LIMlT APPLIES PER $
POLICY
PRO.T LOC
GENERAL AGGREGATE $ 2,000,000
1:1 JFC D
ETHER_ PRODUCTS-COMP/OP AGG $ 2,000,000
AUTOMOBILE LIABILITY Premises/Operations $
COMBINED SINGLE LIMIT
ANYAUTO Ea accident $
OWNED SCHEDULED BODILY INJURY(Per person) $
AUTOS ONLY AUTOS
HIRED NON-OVVNED BODILY INJURY(Per accident) $
H
AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE --
Per accident S
UMBRELLA LIAR ---
OCCUR S.
EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE
DED RETENTION$ AGGREGATE $
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY PER OTH-
JPARTNERJEXECUTIVE STATUTE ER
ANY PROPRIETOR YIN
OFFICERIMEMBER EXCLUDED) NIA
(Mandatory In NH) E L,EACH ACC111111
If yes,describe under E.L DISEASE-EA EMPLOYEE S
DESCRIPTION OF OPERATIONS below
E.L.DISEASE POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS:I VEHICLES(ACORD 101,Additional'Remarks Schedule,may be attached It more space Is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD N F.THE
DATE
S OU
: P IN T:
HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
WITH H THE PO
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TAUT AUTHORIZED REPRESENTATIVE
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