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HomeMy WebLinkAbout05/27/2025 Agreement Monroe County Purchasing Policy and Procedures COUNTY ADMINISTRATOR CONTRACT SUMMARY FORM FOR CONTRACTS $100,000 00 and Under „r• , QSat kX ISlandsPUre ith: Contract # /ai r/ Contract Purpose/Description:. Contract is Original Agreement Contract Amendment/Extension Renewal NO Contract Manager Glovanria Basham Nlna 44 ,,,,,,,•,,, ; CONTRACT COSTS Total Dollar Value of Contract: $ f' '//% Current Year Portion $ (must be$100,000,00 or less) "=" %' (If multiyear agreement then requires BOCC approval,unless the togall nr5 Budgeted? Yesv NoE] Grant: $ County Match: $ /O//i Fund/Cost Center/Spend Cate o ADDITIONAL COSTS Estimated Ongoing Costs: $1j9kJyr For: N/A (Not included in dollar value above) (e.g. maintenance, utilities,janitorial, salaries, etc.) Insurance Required: YES ❑NO IiO CONTRACT REVIEW Reviewer Date In Judith Clarke, P.E. 0igl Ilysignedby Judlh Clarke PE Department Head Signature: Datb 2025 05 06 11 05 18 0400 Christine Limbert-Barrows Dig itallysigned byChnstine`'mbert6arn— County Attorney Signature: Dale 2025 05 22 10 14 43-0'00 Digitally signed by Jaclyn Flalt Risk Management Signature: Jaclyn Flatt Date 202505 06 12 12 12-04'00 Lisa Abreu Digitally signed by Lisa Ab`eu Purchasing Signature: Dale 2025 05 22 10 50 43 04'00' Digitally signed by John Quinn OMB Signature: John Quinn Date 2025 05 22 11 06 25-04 00' Comments: Revised BOCC 4/19/2023 Page 84 of 105 RENTAL AGREEMENT Ph: 1-866-505-2799 Fax: 1-800-426-2626 PROPOSAL# '=MEMO= Name ame7 .......... Contact Phone umber 177caontact Phone Number Address Address A-7-3 City,State,Zip G City,State,Zip I EIN(Federal Tax ID*Required) E-mail Address Distributor: Island Pure .............. Reference M Contact: Phone Nu 385-4966) NINE= !!!!!!I jill-lill 1111 1 1 all Rental Term Payment(+applicable taxes) 60 MOs- $ Billing Frequency Pmt. Method: .. ......................... . Special Provisions: I Installation ........... Ins lia -o n Fee 7 7Total Due - s Agreed: Date: Ccdv�%&wu-a stil Customer: 'Q Distributor: Digitally signed bychdstin—Z Christine HurleyHurley ByDate:2025.05'.27 11 53 16-04'00' By (Authorized Signature) (Authorized Signature) Name -Christine HyE!2y Name: rne: Count Administrator Title: CUSTOMER ACKNOWLEDGES HAVING READ AND UNDERSTOOD ALL OF THE TERMS AND PROVISIONS OF THIS RENTAL AGREEMENT (THIS "AGREEMENT"), INCLUDING THE REVERSE SIDE HEREOF,AND AGREES TO BE BOUND BY ALL OF THE TERMS AND PROVISIONS CONTAINED HEREIN UPON THE EXECUTION OF THIS AGREEMENT. CUSTOMER AGREES THAT UPON ACCEPTANCE OF THE EQUIPMENT BY CUSTOMER THIS AGREEMENT WILL BE AN UNCONDITIONAL OBLIGATION OF CUSTOMER TO PAY WHEN DUE ALL RENTAL PAYMENTS AND OTHER PAYMENTS, AND CUSTOMER CANNOT TERMINATE OR CANCEL THIS AGREEMENT, EXCEPT AS OTHERWISE EXPRESSLY STATED HEREIN, OR WITHHOLD, SET OFF OR REDUCE ANY SUCH PAYMENT,FOR ANY REASON WHATSOEVER. DISTRIBUTOR MAY SELL,ASSIGN OR TRANSFER ALL OR SOME OF ITS RIGHTS IN THIS AGREEMENT OR IN DISTRIBUTOR'S RIGHTS IN THE EQUIPMENT(SUBJECT TO CUSTOMER'S RIGHTS IN THE EQUIPMENT UNDER THIS AGREEMENT)AT ANY TIME AND WITHOUT NOTICE. RENTAL AGREEMENT TERMS AND CONDITIONS PROPOSAL# 1. Distributor Guarantees to Customer: (a) Upgrade Guarantee: At any time during this Agreement term, or any extension thereof(the "Rental Period'), upon approval of additional credit, Customer may upgrade the equipment identified above (including all replacements, parts, repairs, additions and accessories, the "Equipment')for the difference in price, plus any termination value and installation fees, if applicable. (b) Guarantee Fulfillment: Customer must be and remain current on all Rental Payments and other payments before, during and after any upgrades, repairs or modifications are made. 2. Ownership of Equipment; Taxes and Fees: Distributor is the sole owner and titleholder of the Equipment. Customer agrees to keep the Equipment free and clear of all liens. This is a "net" lease and Customer agrees to pay any and all taxes, filing fees, interest and penalties relating to this Agreement or the Equipment. 3. Complete Agreement; Amendments: Customer agrees that no promises or agreements regarding the subject matter hereof or the Equipment have been made by Distributor or anyone else which are not part of this Agreement. Revisions to this Agreement must be signed by an authorized representative of Distributor and Customer. Any agreement regarding Equipment maintenance or servicing is separate and apart from this Agreement and shall not affect Customer's obligations hereunder. 4. Authorized Signer: The person(s) signing this Agreement on behalf of Customer or signing any Guaranty represents that he or she has the authority to do so and that no information supplied by any of them is false or misleading. 5. Liability and Insurance: Customer is responsible for any damages or losses to or injuries caused by the Equipment, including any casualty or theft, and shall keep the Equipment fully insured against such losses during the Rental Period. If Customer fails to provide satisfactory proof of insurance within thirty (30) days of request therefor, Distributor may obtain insurance at Customer sole expense, which may result in higher costs to Customer. 6. Use and Location of Equipment: Customer will use the Equipment only for business purposes and will keep the Equipment at the location specified in this Agreement. Distributor or an authorized agent(for reasonable and customary charges) must perform any relocation of the Equipment. 7. Assignment; Waiver of Warranties: Customer may not sell, transfer, encumber or assign the Equipment or this Agreement without express prior written consent of Distributor. Distributor may sell, transfer, encumber or assign all or part of its interests in the Equipment and/or this Agreement, and its assignee will have all its rights and benefits under this Agreement but none of its obligations (other than the covenant of quiet enjoyment while no default exists). No assignee of Distributor(a) has any responsibility for the selection or performance of the Equipment and (b) makes any express or implied representations or warranties whatsoever regarding the Equipment, including that the Equipment will be fit for a particular purpose. Customer will settle any claims, defenses and setoffs it may have directly with Distributor, Distributor or any other third party without affecting Customer's obligations to pay Rental Payments or other payments without offset or abatement to assignee. Customer agrees it will have no claim against an assignee relating in any way to the Equipment B. Renewal/Price Protection: After the initial rental term (or extension previously agreed to), this Agreement will automatically renew for an additional 12 months and annually thereafter at the same monthly rate unless Customer notifies Distributor in writing 90 days prior to expiration of the initial term or extension that Customer does not intend to renew this Agreement. 9. Agreement Inception, Due Dates and Payment Requirements: Rental Payments begin on the delivery and acceptance date and continue on the same day of each month thereafter; provided that Distributor will establish the due date for the monthly (or other periodic) payments owing under this Agreement, including the first regular payment. If any payment is not made within 15 days of when due, Customer shall pay a late charge equal to 15% of the late payment or$20, whichever is greater„ Customer agrees to pay $35.00 for each returned payment. 10. Early Termination: Customer may terminate this Agreement upon 30 days prior written notice to Distributor if Customer is not in default hereunder upon payment on the termination date of the discounted present value of all remaining Rental Payments using a three percent (3%) simple interest discount rate, plus fees. 11. Installation, Maintenance and Care: Distributor, or its authorized agent, agrees to install the Equipment in accordance with manufacturers specifications. Customer agrees to use and maintain the Equipment in accordance with the manufacturer's specifications. Customer will also make the Equipment available and accessible to the Distributor or its authorized agent for maintenance. The Equipment shall at all times remain personal property. 12. UCC Filings: Customer authorizes the filing of any Uniform Commercial Code ("UCC") financing statements deemed necessary or desirable to protect the interest of Distributor(or any assignee) in the Equipment. 13. Default: Customer is in default of this Agreement if it does not pay any amount when due, or breaches any other term of this Agreement, and Distributor may thereafter exercise any and all remedies under the UCC and other applicable laws, including repossession the Equipment, termination of maintenance agreements and acceleration of the remaining balance due hereunder. Any failure to exercise any rights or remedies does not prevent any later exercise. Distributor's rights survive termination of this Agreement until payment and performance by Customer of all of its obligations. Customer shall pay all costs and expenses, including attorneys' fees, associated with enforcement of Customer's obligations or repossession or disposal of the Equipment. 14. Governing Law; Jury Trial Waiver: This Agreement will be governed by the internal laws of the Commonwealth of Pennsylvania, Any legal action, suit, or proceeding with regard to or arising out of this Agreement, or the Equipment, may be brought in the courts of the Commonwealth of Pennsylvania, and all parties consent to the jurisdiction of such courts as to all such actions. The parties hereto waive any right to a trial by jury. 15. Equipment Return: At the end of the Rental Period or earlier termination of this Agreement Customer shall relinquish possession of the Equipment in the same condition and working order as of the date of its acceptance, ordinary wear and tear resulting from proper use excepted. 16. General. It is the express intent of the parties not to exceed the maximum amount of interest legally permitted to be charged or collected, and any excess payment will be applied to Rental Payments in inverse order of maturity, and any remaining excess will be refunded. Neither the word "including" nor any headings shall imply any limitation. If any part of this Agreement is found to be invalid, then it shall not invalidate any of the other parts, and this Agreement shall be modified as permitted by law. Where applicable "Distributor" means and includes its assignee. A fax or electronic version of Customer's or Distributors signature when received by Distributor will be binding upon such party. The parties agree that the copy with Distributor's original signature shall constitute the original authoritative version for all purposes, including best evidence. The USA PATRIOT Act requires us to obtain, verify, and record information that identifies you thus we ask for your name, address and other information or documents that substantiate your identity. Ph: 1-866-505-2799 Fax: 1-800-426-2626 RENTAL AGREEMENT DELIVERY& ACCEPTANCE CERTIFICATE Customer Name: , Proposal Number: M Customer and Distributor certify that all Equipment described in the Rental Agreement has been delivered and properly installed according to the Rental Agreement. Customer acknowledges that the Equipment is in good condition and is performing satisfactorily. Customer hereby accepts the Equipment unconditionally and irrevocably in accordance with the Agreement. Customer. Do not sign this Certificate until you have actually received, installed, inspected and accepted all units of the Equipment described in the Agreement. X Customer (Authorized Signature) Name (Print) Title � Date X Distributor (Authorized Si na__tu re—) _. ...�..._._ pa te __.�Name (Print) Title (OPHS1 , State and Local Government Addendum Reference: Application No. 1020198 This State and Local Government Addendum (this "Addendum") is made part of the Agreement related to the above referenced application number ("Agreement") between Pure Health Solutions, Inc. ("we" "us" and "ours") and Qount of Monco-p dba lagand of County Commissioners ("you" and "ygur"). Capitalized terms used but not defined will have the meaning given to them in the Agreement. If there is any conflict between the terms of this Addendum and the terms of the Agreement, the terms of this Addendum will control and prevail. The parties hereby agree as follows: 1. Funding Intent. You reasonably believe that funds can be obtained sufficient to make all Payments set forth in the Agreement and any other amounts owed during the term of the Agreement. You agree that your chief executive or administrative officer (or your administrative office that has the responsibility of preparing the budget submitted to your governing body, as applicable) will provide for funding for such payments in your annual budget request submitted to your governing body. You covenant that you will do all things lawfully within your power to obtain, maintain and properly request and pursue funds from which the Payments may be made, including making provisions for such payments to the extent necessary in each budget submitted for the purpose of obtaining funding, using your best efforts to have such portion of the budget approved and exhausting all available administrative reviews and appeals in the event such portion of the budget is not approved. If your governing body chooses not to appropriate funds for such payments, you agree that your governing body will evidence such nonappropriation by omitting funds for such payments due during the applicable fiscal period from the budget that it adopts. You and we agree that your obligation to make payments under the Agreement will be your current expense and will not be interpreted to be a debt in violation of applicable law or constitutional limitations or requirements. Nothing contained in the Agreement will be interpreted as a pledge of your general tax revenues, funds or moneys. 2 Nona aoro riatilon of Funds. If (a) sufficient funds are not appropriated and budgeted by your governing body in any fiscal period for Payments set forth in the Agreement or any other amounts owed to us and (b) you have exhausted all funds legally available for such payments due under the Agreement (together, a "Non- A ro rlation w "), then you will give us not less than ninety (90) days written notice (a "Termination tice") and the Agreement will terminate as of the last day of your fiscal period for which funds for such payments are available ("Termination Da Le"). Such termination is without any expense or penalty, except for the portions of such payments and those expenses associated with your return of the Equipment in accordance with the Agreement for which funds have been budgeted or appropriated or are otherwise legally available. You agree that, to the extent permitted by law, you will not terminate the Agreement if any funds are appropriated by you or to you for the acquisition or use of equipment or services performing functions similar to the Equipment during your fiscal period in which such termination would occur. You shall (i) on or before the Termination Date, return the Equipment in accordance with the return requirements set forth in the Agreement, (ii) provide in the Termination Notice a certification of a responsible official that a Non-Appropriation Event has occurred, (iii) deliver to us, upon our request, an opinion of your counsel (addressed to us) verifying that the Non-Appropriation Event as set forth in the Termination Notice has occurred, and (iv) pay us all sums payable to us under the Agreement up to and including the Termination Date. You acknowledge and agree that, in the event of the termination of the Agreement and the return of the Equipment as provided for herein, you shall have no interest whatsoever in the Equipment or proceeds thereof and we shall be entitled to retain for our own account the proceeds resulting from any disposition or re- leasing of the Equipment along with any advance rentals, security deposits or other sums previously paid by you pursuant to the terms of the Agreement. 3. Authority and Authorization,. You represent and agree that: (a) you are a state or a political subdivision or agency of a state; (b) the entering into and performance of the Agreement is authorized under your state laws and Constitution and does not violate or contradict any judgment, law, order, or regulation, or cause any default under any agreement to which you are party; (c) you have complied with all bidding requirements and, where necessary, have properly presented the Agreement for approval and adoption as a valid obligation on your part; and (d) you have sufficient appropriated funds or other moneys available to pay all amounts due under the Agreement for your current fiscal period. Upon our request, you agree to provide us with an opinion of counsel as to clauses (a) through (d) above, an incumbency certificate, and other documents that we request, with all such documents being in a form satisfactory to us. Page 1 of 2 S13 9-19-2024 App=1020198 4 Government iUse. You agree that (a) you will comply with all information reporting requirements of the Internal Revenue Code of 1986, as amended, including but not limited to the execution and delivery to us of information statements requested by us, and (b) the use of the Equipment is essential for your proper, efficient and economic operation, you will be the only entity to use the Equipment during the term of the Agreement and you will use the Equipment only for your governmental purposes. Upon our request you will provide us with an essential use letter in a form satisfactory to us as to clause (b) above. 5. Insurance. You agree to provide and maintain at your own expense (a) property insurance against the loss, theft, destruction of, or damage to, the Equipment for its full replacement value, naming us as loss payee, and (b) public liability and third party property insurance, naming us as an additional insured. You will give us certificates or other evidence of such insurance on the Equipment at such times as we request. All insurance obtained from a third party insurer will be in a form, amount and with companies acceptable to us, and will provide that we will be given 30 days' advance notice of any cancellation or material change of such insurance. If you do not provide us with proof of such insurance, we may secure insurance on the Equipment to cover our interests (and only our interests). If we obtain such insurance, you will pay us an additional amount for the cost of such insurance and an administrative fee, the cost of which may be more than the cost to obtain your own insurance and on which we may make a profit. 6. Indemnification. With respect to any claims, actions, or suits that are made against us as a result of your actions, omissions, negligence or willful misconduct ("Claims"), to the extent permitted by law, you agree to reimburse us for, and if we request, defend us against, any such Claims. 7. Choice of Law. Regardless of any conflicting provision in the Agreement, THE AGREEMENT WILL BE GOVERNED BY THE LAWS OF THE STATE IN WHICH YOU ARE LOCATED. 8. This Addendum supplements and amends the Agreement only to the extent and in the manner set forth, and in all other respects, the Agreement will remain in full force and effect. IN WITNESS WHEREOF the parties hereto, by their authorized signatories, have executed this Addendum at the date set forth below their respective signatures. ................................... .............._................. ................... _.a--............_........._ CUSTOMER: County of Monroe dba Board of County PURE HEALTH SOLUTIONS, INC. Commissioners ............... Christine Hurle Digitally signed by Christine Hurley By: Y_Qw to 2025.05.27 17:35:47 04 00_ By: Print Christine Hurley Print Name: ....._.__._ ._.._ mmmmr. �__ ............. Name: ......._ ...__..... _ .. Title: County Administrator Title: Date:M.ay 7 2f)25 .........__ _. Date:-.... ..... .....__.. Page 2 of 2 S13 9-19-2024 App=1020198 , � ^ [:DATE(MM/DD/YYYY) EVIDENCE OF PROPERTY INSURANCE 13/2025 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. ., PHONE -.... .- COMPANY AGENCY talc,No,Ex MARSH USA LLC q: (See Attached) 1560 Sawgrass Corporate Pkwy,Suite 300 Sunrise,FL 33323 CN101629253-BayC Prop-24-Prop FAX E-MAIL (A)Pr No). _ ... ......ADDRESS: ................ CODE: SUB CODE: AGENCY C,U$TOM,r;R tD#, INSURED LOANNUMBER . POLICY NUMBER Bay County Board of County See Attached Commissioners �,-. ................ m.,. _....._. _..- 640 West 11th Street EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL Panama City,FL 32401 06/15/2024 06/15/2025 TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION Re-Water Cooler Rental -123 Overseas Highway,Rocklnad Key FL 33040 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION PERILS INSURED BASIC BROAD X SPECIAL COVERAGE/PERILS IFORMS I AMOUNT OF INSURANCE DEDUCTIBLE , . ...... ...®..,, ,.,, ......... _ ... ....... ,,,,,,,,, ....... ,,, ,,............,�_ LIMIT $10,000X0 10 ,000 All Risk including Flood and Earth Movement,excluding Boiler and Machinery SUBLIMITS: Earthquake $30,000,000 Annual Agg Flood $30,000,000 Annual Agg Named Windstorm $30,000,000 Annual Agg Valuation: Property:Replacement Cost BI:Actual Loss Sustained REMARKS('Including Special Conditions Island Pure is/are loss payee,as required by written contract,with respect to Property. Island Pure islare included as additional insured where required by written contract. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST ATL-006010729-01 NAME AND ADDRESS X ADDITIONAL INSURED LENDER'S LOSS PAYABLE X LOSS PAYEE MORTGAGEE Island Pure LOAN# 600 Capital St Suite E Jupiter,FL 33456 AUTHORIZED REPRESENTATIVE ACORD 27(2016/03) ©1993-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101629253 LOC#: Lauderdale ADDITIONAL REMARKS SCHEDULE Page 2 of 4 �- . -......... ..... AGENCY NAMED INSURED MARSH USA LLC Bay County Board of County .................... __ ... _______ .. ___. Commissioners POLICY NUMBER 840 West 11th Street Panama City,FL 32401 ..._ ..... ......... ......_....._............... CARRIER NAIC CODE EFFECTIVE DATE: vvVvv ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 27 FORM TITLE: Evidence of Property! Insurance Total Insured Values:$531,951,590 SCHEDULE OF INSURERS: Ironshore Specialty Insurance Co. Policy#100054412103 $1,000,000 part of$10.000.000 per occurrence Westchester Surplus Lines Insurance Co Policy#D42310670005 $3.250,000 part of$10,000,000 per occurrence Sutton Specialty Insurance Co. Policy#24XSP0480 $1,000.000 part of$20,000,000 excess of$10,000,000 per occurrence Allied World Assurance Company Policy#031388041 A $2,250,000 part of$20.000,000 excess of$10,000,000 per occurrence Evanston Insurance Company Policy#MKLV2XPR002257 $5.000,000 part of$20,000.000 excess of$10.000,000 per occurrence 5555 CPS Lloyd's Syndicate Policy#B0509MPSPB2401865 $1,500,000 part of$30.000,000 per occurrence 4444 CNP Lloyd's Syndicate Policy#B0509MPSPB2401865 $750,000 part of$30.000,000 per occurrence Palms Specialty Insurance Company Policy#PLM0081924 $750,000 part of$30.000,000 per occurrence Endurance American Specialty Ins.Co, Policy#ESP30001126205 $3,000,000 part of$30,000,000 per occurrence Starstone Specialty Insurance Co. Policy#CSP00149749P00 $4.500.000 part of$30,000,000 per occurrence National Fire&Marine Insurance Cc Policy#42PRP31117305 $6,750,000 part of$30,000.000 per occurrence 4444 CNP Lloyd's Syndicate ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101620253 ----------------- LoC#: Loudendo|o AGENCY CUSTOMER ID: CN101629253 LOC#: Lauderdale ................. ADDITIONAL REMARKS SCHEDULE Page 4 of 4— AGENCY NAMED INSURED MARSH USA LLC. Bay County Board of County Commissioners POLICY NUMBER 840 West 11 th Street Panama City,FL 32401 CARRIER NAIC CODE ................................................... EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 27 FORM TITLE: Evidence of Erorrly Insurance ........... .............. Deductible$5.000 property damage/extra expense Travelers Property Casually Company of America Policy Number:BME19P303873TIL24 Terrorism&Sabotage- Limit:$70.000.000 Per Occurrence Deductibles:$50,000 Property Damage/Business Interruption Combined Per Occurrence Carrier:Indian Harbor Insurance Company Policy Number:US00075748SP24A Other deductibles may apply per policy terms and conditions. ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD