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Item C12
C12 BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE i Mayor Holly Merrill Raschein,District 5 The Florida Keys Mayor Pro Tern James K.Scholl,District 3 Craig Cates,District 1 Michelle Lincoln,District 2 ' David Rice,District 4 Board of County Commissioners Meeting January 31, 2024 Agenda Item Number: C 12 2023-2003 BULK ITEM: Yes DEPARTMENT: Social Services TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham N/A AGENDA ITEM WORDING: Ratification of Amendment#6 to Agreement between GA Food Services, Inc. and Monroe County Board of County Commissioners/Monroe County Social Services/Nutrition Services (for the provision of Congregate and Home Delivered Meals throughout Monroe County) to extend the contract for a contract period of 07/01/2023 through 06/30/2024. ITEM BACKGROUND: GA Food Service, Inc., is the food vendor which provides the meals for the Monroe County Nutrition Program operated by Monroe County Social Services. PREVIOUS RELEVANT BOCC ACTION: GA Food Amendment#5 was BOCC approved on 12/7/2022. INSURANCE REQUIRED: Yes CONTRACT/AGREEMENT CHANGES: Extension STAFF RECOMMENDATION: Approval DOCUMENTATION: BACI,'UP GA Food Amendment#5 Fully executed.pdf ga food amend 6 .pdf Monroe Co. BOCC COI 3-15-2022 ® 3®15®2023.pdf Monroe Co. BOCC COI 3-15-2023 ® 3®15®202 .pdf GA_Foods_COI2023m2024_Renewed signed.pdf 919 FINANCIAL IMPACT: N/A 920 GVS COURTq° o: A Kevin Madok, CPA - �o ........ � Clerk of the Circuit Court& Comptroller Monroe County, Florida �z cooN DATE: December 16, 2022 TO: Sheryl Graham, Director Social Services ATTN: Lourdes Francis, Administrator Social Services Kim Wilkes Wean, Sr. Administrator Social Services FROM: Liz Yongue, Deputy Clerk SUBJECT: December 7th BOCC Meeting The following item has been executed and added to the record: S4 5th Amendment to Agreement with G.A. Food Services, Inc., and Monroe County /Monroe County Social Services/Nutrition Services (for the provision of Congregate and Home Delivered Meals throughout Monroe County)to adjust the CPI-U by 20%. This is an increase of $0.83 per meal ($4.11 per meal to $4.94 per meal)which becomes effective 9/14/2022, for the contract period of July 1, 2022 through June 30, 2023. Should you have any questions please feel free to contact me at(305) 292-3550. cc: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 921 5th AMENDMENT TO AGREEMENT Monroe County Nutrition Program This 5th Amendment to Agreement ("Extension") is entered into this 7fh day of December, 2022, by and between the Board of County Commissioners of Monroe County, Florida, a political subdivision of the State of Florida hereinafter called the Coun , and GA Food Service, LLC, a Florida corporation whose mailing address is 12200 32nd Court North, St. Petersburg, Florida, 33716, hereinafter called the Contractor. WITNESSETH WHEREAS, the parties entered into an agreement dated July 1, 2019, for provision of meals for the Monroe County Nutrition Program Congregate and Home Delivered Meals program operated by the County. NOW, THEREFORE, in consideration of the mutual covenants and obligations contained in this Extension and rate adjustment in the original agreement, the parties agree as follows: 1. Beginning September 14, 2022, the Contractor shall continue to provide meals pursuant to the original agreement dated July 1, 2019, and any amendments thereto on a month-to-month basis, not to extend beyond June 30, 2023, with an adjusted CPI-U rate of 20% or $4.94 per meal. 2. County may terminate the original GA Food Service Agreement dated July 1, 2019, and all amendments thereto upon 30 days written notice provided by the Sr. Director of Social Services. 3 Contractor shall comply with all federal, state, and local food safety regulations and the Department of Elder Affairs Programs and Services Handbook, revised February 2020. Pursuant to paragraph 15 of the original Agreement and the Department of Elder Affairs Programs and Services Handbook, Chapter 3: Older Americans Act Service Requirements: Section 3, Nutrition Program Policies Food Service Contract Provisions, revised February 2020, the county may cancel this Agreement if any of the following occur: a. A temporary or permanent closure related to food service violations, b. Administrative Complaints regarding food safety, or c. 10 or more high priority/significant findings on sanitation inspections within the past 12 months, beginning July 1, 2018 ("an unsatisfactory inspection means that the violations were a significant threat to public health and sanitation and require correction before the next routine inspection.") 4. Contractor shall maintain a food safety management program within the facility that meets or exceeds the minimum requirements of federal, state, municipal, or other agencies authorized to inspect or accredit the food service operation and shall, upon request of the County,provide documentation of said food safety management program and the results of any inspections related thereto. 5. Within 30 days of execution of this Agreement, Contractor shall provide documentation of the three most recent food preparation inspections conducted by the state regulatory authority to the County. 6. Within 30 days of execution of this Agreement, Contractor shall provide County with a written plan of correction for any high priority or significant findings on sanitation inspections. 7. Contractor shall immediately notify the County of any closures or Administrative Complaints regarding food safety or of any sanitation inspections as referenced in the Department of Elder Affairs Programs and Services Handbook Chapter 3: Older Americans Act Service Requirements: Nutrition Program Policies Food Service Contract Provisions, revised February 2020,pp. 3-143. 922 8. Within 30 days of execution of this Agreement Contractor shall provide County with a description of Contractor's delivery standards and sanitation that includes holding temperatures for transporting and serving food. 9. County, Alliance for Aging, and/or Department of Elder Affairs staff shall have the right, upon 24 hours written notice, to inspect the food preparation and storage areas. 10. All other terms and conditions of the contract dated July 1, 2019, and any amendments thereto, shall remain in full force and effect. BOARD OF COUNTY COMMISSIONERS t e t , ;", ` DOK, CLERK OF MONRQFJOUNTY, F ORIDA By: As7Wty Clerk 0 V U Mayor Cr g Cates GAZOOP SERVICE, INC. By: a- President,Vice President,or Designee Approved as to form and legal sufficiency Monroe County Attorney's Office Christina Cory,Assistant County Attorney Date:12/2122 _ o -- r-a —i CD 923 Iq C14 6th AMENDMENT TO AGREEMENT Monroe County Nutrition Program This 6th Amendment to Agreement ("Extension") is entered into this 18th day Of July, 2023, by and between the Board of County Commissioners of Monroe County, Florida, a political subdivision of the State of Florida hereinafter called the County,, and GA Food Service, LLC., a Florida corporation whose mailing address is 12200 32 nd Court North, St. Petersburg, Florida, hereinafter called the Contractor, WITNESSETH WHEREAS, the parties entered into an agreement dated July 1, 2019, for provision of meals for the Monroe County Nutrition Prograrn Congregate and Home Delivered Meals program operated by the County, WHEREAS, the Original agreement and the subsequent five (5) amendments were entered into between the County and the Contractor formerly titled as: GA Food Service, Inc.; and WHEREAS, the Contractor has requested that the County acknowledge the registered business name NOW, THEREFORE, in consideration of the riititual covenants and obligations contained in this Extension and business name change, the parties agree as follows: 1. Beginning July 1, 2023, the Contractor shall Continue to provide meals pursuant to the agreement dated July 1, 2019 and any amendments thereto on a month to month basis, not to extend beyond 6/30/2024. 2. For purposes of clarification, GA Food Service, Inc. shall henceforth be known as GA Food Service, LLC. 3. County may terminate the GA Food Service Agreement dated July 1, 2019 and all amendments thereto upon 30 days written notice provided by the Director of Social Services, 4, Contractor shall comply with all federal, state, and local food safety regulations and the Department of Elder Affairs Programs and Services most recent I landbook. Pursuant to paragraph 15 of the original Agreement and the Department of Elder Affairs Programs and Services Handbook,, Chapter 5: Older Americans Act (OAA) Title IITC: Section V: Contracts With Profit-Making Organizations, A. (revised 4/2023 DOEA) the county may cancel this Agreement if any of the following occur: a. A temporary or permanent closure related to food service violations, b. Administrative Complaints regarding food safety, or c. 12 or more high priority/significant findings on sanitation inspections within the past 12 months, beginning July 1, 2018. ("an unsatisfactory inspection means that the violations were a significant threat to public health and sanitation and require correction before the next routine inspection,") 5. Contractor shall maintain a food safety management program within the facility that rnects or exceeds the minimum requirements of federal, state, municipal, or other agencies authorized to inspect or accredit the food service operation and shall, upon request of the County, provide documentation of said food safety management program and the results of any inspections related thereto. 6. Within 30 days of execution of this Agreement Contractor shall provide documentation of the three most recent food preparation inspections conducted by the state regulatory authority to the County, 7. Within 30 days of execution of this Agreement Contractor shall provide County with a written plan of correction for any high priority or significant findings on sanitation inspections. LO CN 8. Contractor shall immediately notify the County of any closures or Administrative Complaints regarding food safety or of any sanitation inspections as referenced in the Department of Elder Affair's Programs and Services Handbook Chapter 3: Older Americans Act Service Requirements: Nutrition Prograrn Policies Food Service Contract Provisions, revised April 2023. 9. Within 30 days of execution of this Agreement Contractor shall provide County with a description of Contractor's delivery standards and sanitation that includes holding temperatures for transporting and serving food. 10. County, AAA, and/or Department of Elder Affairs staff shall have the right, upon 24 hours written notice, to inspect the food preparation and storage areas. 11. All other terms and conditions of the contract dated July 1, 2019, and any amendments thereto, shall remain in full force and effect. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA B Sheryl L.Graham y: 03 i5 3 0 02 0500 ............................... MCSS Sr. Director, Sheryl Graham GA FOOD SERVK'E, LLC By: SIGNED BY: -- -resideor Designee NAME: TITLE: MAYOR DATE: CI ient#: 1458462 GAFOO D DATE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 3/15/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Insurance Services LLC PHONE FAX A/C,No,Ext: A/C,No): 9910 Dupont Circle Dr. E E-MAIL ADDRESS: Suite 120 INSURER(S)AFFORDING COVERAGE NAIC# Fort Wayne, IN 46825 INSURER A:Pennsylvania lvania Manufacturers Assoc.Ins. 12262 INSURED INSURER B:AXIS Surplus Insurance Company 26620 G.A. Food Services of Pinellas County, L GuideOne National Insurance Company 14167 INSURER C: P Y Jaguar Topco, LLC, Jaguar Borrower, LLC Federal Insurance Company 20281 INSURER D: P Y 12200 32nd Ct North Hanover Insurance Company 22292 INSURER E: P Y Saint Petersburg, FL 33716 INSURER F: Travelers Casualty Tl &SurietYAnneCo.of Anne 131194 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY 3022000298901 3/15/2022 03/15/2023 EACH OCCURRENCE $1 000 000 CLAIMS-MADE F_X] OCCUR PREMISESOEa occur°nce $100,000 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 1522750298901 3/15/2022 03/15/202 (Ea acciden SINGLE LIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident) ccident $ B UMBRELLA LIAB OCCUR P00100079730301 3/15/2022 03/15/2023 EACH OCCURRENCE s2,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 2022750298201 3/15/2022 03/15/2023 X STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 00O 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C 2nd Layer Excess 56000299700 3/15/2022 03/15/2023 $2,000,000 D 3rd Layer Excess 79892909 3/15/2022 03/15/2023 $10,000,000 E Emply Dishonesty BDYH44261001 12/01/2021 12/01/2022 $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Additional Named Insureds: Jaguar Intermediate, LLC; Clossman Catering, LLC This certificate is issued for the named insured operations usual to the maker of nutritious meals for healthcare patients, senior citizens, children, military and emergency responders. Cyber Liability: Carrier F-Travelers Casualty&Surety Co of America, Policy#107547037, Policy dates 12 1-2021 to 12-1-2022, Policy Limit: $5,000,000 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St, 2nd Floor ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040-0000 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD 926 #S35311143/M35289907 SAJZP DESCRIPTIONS (Continued from Page 1) Monroe County BOCC is included as an additional insured as it relates to the General and Automobile Liability in accordance with the policy terms and conditions. Bayshore Manor is named as an additional insured as it relates to General Liability and Automobile Liability in accordance with the policy terms and conditions. SAGITTA 26.3(2016/03) 2 of 2 #S35311143/M35289907 927 CI ient#: 1458462 GAFOO D DATE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 3/16/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Insurance Services LLC PHONE FAX A/C,No,Ext: A/C,No): 9910 Dupont Circle Dr. E E-MAIL ADDRESS: Suite 120 INSURER(S)AFFORDING COVERAGE NAIC# Fort Wayne, IN 46825 INSURER A:Pennsylvania lvania Manufacturers Assoc.Ins. 12262 INSURED INSURER B:AXIS Surplus Insurance Company 26620 G.A. Food Services of Pinellas GuideOne National Insurance Company 14167 INSURER C: P Y County, LLC; 12200 32nd Ct., North Federal Insurance Company 20281 INSURER D: P Y Saint Petersburg, FL 33716 Hanover Insurance Company 22292 INSURER E: P Y INSURER F: Manufacturers Alliance 36897 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY X 3023000298901 3/15/2023 03/15/2024 EACH OCCURRENCE $1 OOO 000 CLAIMS-MADE F_X] OCCUR PREMISESOEa occur°nce $100,000 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ F AUTOMOBILE LIABILITY X 1523750298901A 3/15/2023 03/15/202 (Ea acciden SINGLE LIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident) ccident $ B X UMBRELLA LIAB X OCCUR P00100079730302 3/15/2023 03/15/2024 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 2023750298201 3/15/2023 03/15/2024 X STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C 2nd Layer Excess 56000299701 3/15/2023 03/15/2024 $2,000,000 D 3rd Layer Excess 79892909 3/15/2023 03/15/2024 $10,000,000 E Emply Dishonesty BDYH44261002 12/01/2022 12/01/2023 $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Additional Named Insureds: Jaguar Topco, LLC; Jaguar Borrower, LLC;Jaguar Intermediate, LLC; Clossman Catering, LLC; This certificate is issued for the named insured operations usual to the maker of nutritious meals for healthcare patients, senior citizens, children, military and emergency responders. CYBER LIABILITY: Carrier:Travelers Casualty&Surety Co. of America, NAIC#31194; Policy Dates 12/1/2022 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St, 2nd Floor ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040-0000 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD 928 #S39414976/M39411793 SGSZR DESCRIPTIONS (Continued from Page 1) to 12/1/2023; Policy Limits: $5,000,000, Deductible:$25,000 Workers Compensation applies to the following states:AL,AR, CA, CO, FL, GA, IL,KY, MO, NC, NJ, PA, SC, TN, TX,VA, OH, NY Monroe County BOCC is included as an additional insured as it relates to the General and Automobile Liability in accordance with the policy terms and conditions. Bayshore Manor is named as an additional insured as it relates to General Liability and Automobile Liability in accordance with the policy terms and conditions. SAGITTA 26.3(2016/03) 2 of 2 #S39414976/M39411793 929 CI ient#: 1458462 GAFOO D DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 12/08/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Insurance Services LLC PHONE FAX A/C,No,Ext: (A/C,No): 9910 Dupont Circle Dr. E E-MAIL ADDRESS: Suite 120 INSURER(S)AFFORDING COVERAGE NAIC# Fort Wayne, IN 46825 INSURER A:Pennsylvania Manufacturers Assoc.Ins. 12262 INSURED INSURER B:AXIS Surplus Insurance Company 26620 G.A. Food Services of Pinellas GuideOne National Insurance Company 14167 INSURER C: P Y County, LLC; 12200 32nd Ct., North Federal Insurance Company 20281 INSURER D: p Y Saint Petersburg, FL 33716 Hanover Insurance Company 22292 INSURER E: p Y INSURER F: Manufacturers Alliance 36897 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY X X 3023000298901 3/15/2023 03/15/2024 EACH OCCURRENCE $1 90009000 CLAIMS-MADE 4 OCCUR PREMISESOERENTED r nce $1009000 APPROVED BY RISK MANAGEMENT MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1 90009000 GEN'L AGGREGATE LIMIT APPLIES PER: DATE i i o2624 GENERAL AGGREGATE $2,000,000 PRO- WAIVER N/A_YES_ PRODUCTS-COMP/OP AGO s2,000,000 POLICY JECTPRO- LOG OTHER: $ F AUTOMOBILE LIABILITY X X 1523750298901 A 3/15/2023 03/15/202 COMBINED SINGLE LIMIT 22> >000 000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PerOa c TY DAMAGE AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB X OCCUR P00100079730302 3/15/2023 03/15/2024 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION 202375029801 3/15/2023 03/15/202 X PER OTH- AND EMPLOYERS'LIABILITY TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $190009000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,0009000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C 2nd Layer Excess 56000299701 3/15/2023 03/15/202 $290009000 D 3rd Layer Excess 79892909 3/15/2023 03/15/202 $1090009000 E I Emply Dishonesty BDYH44261003 12/01/2023 12/01/202 $390009000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Named Insureds: Linden Ventures, LLC;Jaguar Borrower, LLC;Jaguar Intermediate, LLC; Clossman Catering, LLC CYBER LIAB: Carrier:Travelers Casualty&Surety Co.of America; NAIC#31194; Policy#1075470367; Policy Dates: 12/1/2023 to 12/1/2024; Limits of Liability:$5,000,000 Deductible$25,000 Workers Compensation applies to the following states: AL,AR, CA, CO, FL GA, IL, KY, MO, NC, NJ,PA, SC,TN, (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION G.A. Food Services Of Pinellas SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN County LLC ACCORDANCE WITH THE POLICY PROVISIONS. 12200 32nd Ct, North Saint Petersburg, FL 33716-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reservpri ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD 930 #S42833032/M42833020 RXRAM DESCRIPTIONS (Continued from Page 1) TX,VA, OH, NY SAGITTA 25.3(2016/03) 2 Of 2 931 #S42833032/M42833020