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HomeMy WebLinkAboutContract 39175 CITY oN RACTERI� I rJ PROFESSIONAL SERVICES AGREEMENT This PROFESSIONAL SERVICES AGREEMENT ("Agreement") is made and entered into by and between the CITY OF FORT WORTH (the "City"), a home rule municipal corporation situated in portions of Tarrant, Denton and Wise Counties, Texas, acting by and through Karen L. Montgomery, its duly authorized Assistant City Manager, and Mental Health Connection of Tarrant County ("Consultant"), a Texas, non-profit corporation, and acting by and through Patsy Thomas, its duly authorized president and CEO. 1. SCOPE OF SERVICES. Consultant hereby agrees to provide the City with professional consulting services for the purpose of[insert purpose of agreement]. Attached hereto and incorporated for all purposes incident to this Agreement is Exhibit "A," Statement of Work, more specifically describing the services to be provided hereunder. 2. TERM. This Agreement shall commence upon September 30,2008 ("Effective Date") and shall expire on September 29, 2009 unless terminated earlier in accordance with the provisions of this Agreement. [Insert any available options] 3. COMPENSATION. The City shall pay Consultant an amount not to exceed $24,999 in accordance with the provisions of this Agreement and the Payment Schedule attached as Exhibit "B," which is incorporated for all purposes herein. Consultant shall not perform any additional services for the City not specified by this Agreement unless the City requests and approves in writing the additional costs for such services. The City shall not be liable for any additional expenses of Consultant not specified by this Agreement unless the City first approves such expenses in writing. 4. TERMINATION. 4.1. Written Notice. The City or Consultant may terminate this Agreement at any time and for any reason by providing the other party with 30 days written notice of termination. 4.2 Non-appropriation of Funds. In the event no funds or insufficient funds are appropriated by the City in any fiscal period for any payments due hereunder, City will notify Consultant of such occurrence and this Agreement shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense to the City of any kind whatsoever, except as to the portions of the payments herein agreed upon for which funds shall have been appropriated. 4.3 Duties and Obligations of the Parties. In the event that this Agreement is terminated prior to the Expiration Date, the City shall pay Consultant for services actually rendered up to the effective date of termination and Consultant shall continue to provide the City with services requested by the City and in accordance with this Agreement up to the effective date of termination. 5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION. Form Services Agreement [Name of Consultant] Page 1 of 11 Consultant hereby warrants to the City that Consultant has made full disclosure in writing of any existing or potential conflicts of interest related to Consultant's services under this Agreement. In the event that any conflicts of interest arise after the Effective Date of this Agreement, Consultant hereby agrees immediately to make full disclosure to the City in writing. Consultant, for itself and its officers, agents and employees, further agrees that it shall treat all information provided to it by the City as confidential and shall not disclose any such information to a third party without the prior written approval of the City. Consultant shall store and maintain City Information in a secure manner and shall not allow unauthorized users to access, modify, delete or otherwise corrupt City Information in any way. Consultant shall notify the City immediately if the security or integrity of any City information has been compromised or is believed to have been compromised. 6. RIGHT TO AUDIT. Consultant agrees that the City shall, until the expiration of three (3) years after final payment under this contract, have access to and the right to examine at reasonable times any directly pertinent books, documents, papers and records of the consultant involving transactions relating to this Contract at no additional cost to the City. Consultant agrees that the City shall have access during normal working hours to all necessary Consultant facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this section. The City shall give Consultant reasonable advance notice of intended audits. Consultant further agrees to include in all its subcontractor agreements hereunder a provision to the effect that the subcontractor agrees that the City shall, until expiration of three (3) years after final payment of the subcontract, have access to and the right to examine at reasonable times any directly pertinent books, documents, papers and records of such subcontractor involving transactions related to the subcontract, and further that City shall have access during normal working hours to all subcontractor facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this paragraph. City shall give subcontractor reasonable notice of intended audits. 7. INDEPENDENT CONTRACTOR. It is expressly understood and agreed that Consultant shall operate as an independent contractor as to all rights and privileges granted herein, and not as agent, representative or employee of the City. Subject to and in accordance with the conditions and provisions of this Agreement, Consultant shall have the exclusive right to control the details of its operations and activities and be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors and subcontractors. Consultant acknowledges that the doctrine of respondeaf superior shall not apply as between the City, its officers, agents, servants and employees, and Consultant, its officers, agents, employees, servants, contractors and subcontractors. Consultant further agrees that nothing herein shall be construed as the creation of a partnership or joint enterprise between City and Consultant. 8. LIABILITY AND INDEMNIFICATION. CONSULTANT SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE ANDIOR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF CONSULTANT, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES. CONSULTANT COVENANTS AND AGREES TO, AND DOES HEREBY, INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS FOR EITHER PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO CONSULTANT'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND Form Services Agreement [Name of Consultant] Page 2 of 11 ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF CONSULTANT, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES. 9. ASSIGNMENT AND SUBCONTRACTING. Consultant shall not assign or subcontract any of its duties, obligations or rights under this Agreement without the prior written consent of the City. If the City grants consent to an assignment, the assignee shall execute a written agreement with the City and the Consultant under which the assignee agrees to be bound by the duties and obligations of Consultant under this Agreement. The Consultant and Assignee shall be jointly liable for all obligations under this Agreement prior to the assignment. If the City grants consent to a subcontract, the subcontractor shall execute a written agreement with the Consultant referencing this Agreement under which the subcontractor shall agree to be bound by the duties and obligations of the Consultant under this Agreement as such duties and obligations may apply. The Consultant shall provide the City with a fully executed copy of any such subcontract. 10. INSURANCE. Consultant shall provide the City with certificate(s) of insurance documenting policies of the following minimum coverage limits that are to be in effect prior to commencement of any work pursuant to this Agreement: 10.1 Coverage and Limits (a) Commercial General Liability $1,000,000 Each Occurrence $1,000,000 Aggregate (b) Automobile Liability $1,000,000 Each accident on a combined single limit basis or $250,000 Bodily injury per person $500,000 Bodily injury.per person per occurrence $100,000 Property damage Coverage shall be on any vehicle used by the Consultant, its employees, agents, representatives in the course of the providing services under this Agreement. "Any vehicle" shall be any vehicle owned, hired and non-owned (c) Worker's Compensation Statutory limits Employer's liability $100,000 Each accident/occurrence $100,000 Disease- per each employee $500,000 Disease- policy limit This coverage may be written as follows: Workers' Compensation and Employers' Liability coverage with limits consistent with statutory benefits outlined in the Texas workers' Compensation Act (Art. 8308 — 1.01 et seq. Tex. Rev. Civ. Stat.) and minimum policy limits for Employers' Liability of $100,000 each accident/occurrence, $500,000 bodily injury disease policy limit and $100,000 per disease per employee (d) Technology Liability (Errors & Omissions) [or other professional liability coverage Form Services Agreement [Name of Consultant] Page 3 of 11 depending on type of agreement] $1,000,000 Each Claim Limit $1,000,000 Aggregate Limit Technology coverage may be provided through an endorsement to the Commercial General Liability (CGL) policy, or a separate policy specific to Technology E&O. Either is acceptable if coverage meets all other requirements. Coverage shall be claims-made, and maintained for the duration of the contractual agreement and for two (2) years following completion of services provided. An annual certificate of insurance shall be submitted to the City to evidence coverage. 10.2 Certificates. Certificates of Insurance evidencing that the Consultant has obtained all required insurance shall be delivered to the City prior to Consultant proceeding with any work pursuant to this Agreement. All policies shall be endorsed to name the City as an additional insured thereon, as its interests may appear. The term City shall include its employees, officers, officials, agent, and volunteers in respect to the contracted services. Any failure on the part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirement. A minimum of thirty (30) days notice of cancellation or reduction in limits of coverage shall be provided to the City. Ten (10) days notice shall be acceptable in the event of non-payment of premium. Such terms shall be endorsed onto Consultant's insurance policies. Notice shall be sent to the Risk Manager, City of Fort Worth, 1000 Throckmorton, Fort Worth, Texas 76102, with copies to the City Attorney at the same address. 11. COMPLIANCE WITH LAWS ORDINANCES RULES AND REGULATIONS. Consultant agrees to comply with all applicable federal, state and local laws, ordinances, rules and regulations. If the City notifies Consultant of any violation of such laws, ordinances, rules or regulations, Consultant shall immediately desist from and correct the violation. 12. NON-DISCRIMINATION COVENANT. Consultant, for itself, its personal representatives, assigns, subcontractors and successors in interest, as part of the consideration herein, agrees that in the performance of Consultant's duties and obligations hereunder, it shall not discriminate in the treatment or employment of any individual or group of individuals on any basis prohibited by law. If any claim arises from an alleged violation of this non- discrimination covenant by Consultant, its personal representatives, assigns, subcontractors or successors in interest, Consultant agrees to assume such liability and to indemnify and defend the City and hold the City harmless from such claim. 13. NOTICES. Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received by the other party by United States Mail, registered, return receipt requested, addressed as follows: To The CITY: To CONSULTANT: City of Fort Worth Form Services Agreement [Name of Consultant] Page 4 of 11 Attn: [insert department/contact] 1000 Throckmorton Fort Worth TX 76102-6311 Facsimile: (817) 392-8654 14. SOLICITATION OF EMPLOYEES. Neither the City nor Consultant shall, during the term of this agreement and additionally for a period of one year after its termination, solicit for employment or employ, whether as employee or independent contractor, any person who is or has been employed by the other during the term of this agreement, without the prior written consent of the person's employer. 15. GOVERNMENTAL POWERS. It is understood and agreed that by execution of this Agreement, the City does not waive or surrender any of its governmental powers. 16. NO WAIVER. The failure of the City or Consultant to insist upon the performance of any term or provision of this Agreement or to exercise any right granted herein shall not constitute a waiver of the City's or Consultant's respective right to insist upon appropriate performance or to assert any such right on any future occasion. 17. GOVERNING LAW/VENUE. This Agreement shall be construed in accordance with the internal laws of the State of Texas. If any action, whether real or asserted, at law or in equity, is brought on the basis of this Agreement, venue for such action shall lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort Worth Division. 18. SEVERABILITY. If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired. 19. FORCE MAJEURE. The City and Consultant shall exercise their best efforts to meet their respective duties and obligations as set forth in this Agreement, but shall not be held liable for any delay or omission in performance due to force majeure or other causes beyond their reasonable control (force majeure), including, but not limited to, compliance with any government law, ordinance or regulation, acts of God, acts of the public enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor restrictions by any governmental authority, transportation problems and/or any other similar causes. 20. HEADINGS NOT CONTROLLING. Headings and titles used in this Agreement are for reference purposes only and shall not be deemed a part of this Agreement. 21. REVIEW OF COUNSEL. The parties acknowledge that each party and its counsel have reviewed and revised this Form Services Agreement [Name of Consultant] Page 5 of 11 Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this Agreement or exhibits hereto. 22, AMENDMENTS/ MODIFICATIONS / EXTENSTIONS. No extension, modification or amendment of this Agreement shall be binding upon a party hereto unless such extension, modification, or amendment is set forth in a written instrument, which is executed by an authorized representative and delivered on behalf of such party. 23. ENTIRETY OF AGREEMENT. This Agreement, including the schedule of exhibits attached hereto and any documents incorporated herein by reference, contains the entire understanding and agreement between the City and Consultant, their assigns and successors in interest, as to the matters contained herein. Any prior or contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict with any provision of this Agreement. 24. SIGNATURE AUTHORITY. The person signing this agreement hereby warrants that he/she has the legal authority to execute this agreement on behalf of the respective party, and that such binding authority has been granted by proper order, resolution, ordinance or other authorization of the entity. The other party is fully entitled to rely on this warranty and representation in entering into this Agreement. [SIGNATURE PAGE FOLLOWS] Form Services Agreement [Name of Consultant] Page 6 of 11 IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples this 28th day of September, 2009. CITY OF FORT WORTH: MENTAL HEALTH CONNECTION: By: By. Assistant City Manager Name: Pa Thomas Title: Pre Ident Date: O9, z 9. 09- Date: September 28, 2009 ATT T: � ATTEST: By: City Secrets By: APPROVED AS TO FORM AND LEGALITY: II By:— Asli6lant City 1mey CONTRACT AUTHORIZATION: M&C: . A), Date Approved: OPF'1iC/AL RECOND CITE'S CRETARY F?: WORTH, TX Form Services Agreement (Name of Consultant] Page 7 of 11 EXHIBIT A STATEMENT OF WORK WHEREAS, Mental Health Connection is a collaboration of public and private entities and individuals working in concert with consumers of mental health services and their caregivers; and whereas, the purpose of Mental Health Connection is to create and implement strategies to improve and ensure an accessible, quality, strengths-based, family-driven mental healthcare system in Tarrant County for people of all ages; and whereas members of Mental Health Connection recognize that transformation of the mental health system can be more readily achieved by the community as a whole, rather than by one group or individual working alone, the Board of Mental Health Connection, in accordance with the bylaws, commits to support the establishment and work of the following committees to accomplish the strategic goals approved by the membership of the Mental Health Connection in 2007 pursuant to this resolution for the period beginning January 1, 2009 and ending December 31, 2009. WHEREAS, membership on all the following committees shall include family members, substance abuse treatment providers and other individuals with the special skills and expertise to help accomplish the work of each committee as described in this resolution, and WHEREAS, each committee shall determine a schedule of meetings necessary to accomplish its prescribed scope of work for 2009, and WHEREAS, each committee shall record its deliberations, actions and recommendations and submit minutes of each of its meetings to the President of Mental Health Connection within ten days after the meeting, and WHEREAS, the Board Liaison for each committee in this Resolution shall be responsible for bringing requests for action to the Board for approval and keeping the board apprised of the work of the committees, NOW, THEREFORE, BE IT RESOLVED that the Board establishes the TECHNOLOGY COMMITTEE with the following goals: One, to create a strategic plan for technology transformation, which includes, but is not limited to: • Maximizing use of technologies to increase information sharing across agencies, resulting in consumers' ability to access services more readily and increasing agency efficiency. • Determining.effective ways for collecting and storing and sharing data using technology. • Determining ways to include data about Evidence-Based-Practices, outcomes, and screening instruments to assist with decision-malting and improving access to appropriate services. Two,to oversee CSMIS including: • Increasing utilization of current CSMIS users Form Services Agreement [Name of Consultant] Page 2 of 11 • Increasing participation in CSMIS • Making recommendations to Governance Committee regarding develop of governance structure for managing/sustaining CSMIS • Creating a plan for sustainability of CSMIS • Creating a plan for evaluation of CSMIS FURTHER RESOLVED,that the Board establishes the COMMUNICATIONS COMMITTEE with the goals to: • Increase understanding of mental illness • Reduce stigma regarding mental illness • Assist with preparation of a social marketing plan for Hand in Hand • Create strategies for branding the No Wrong Door philosophy. • Develop and implement strategies for internal and external communications of the collaboration • Increase communication with consumer advocacy and support groups. FURTHER RESOLVED, that the Board establishes the FAMILY CONNECTION COMMITTEE with the goals to: • Strengthen relationships and build collaborations with advocacy groups/peer support groups. • Ensure the"family voice" in all MHC activities FURTHER RESOLVED, that the Board establishes the MEMBERSHIP COMMITTEE with the goals to: • Plan monthly meetings of Mental Health Connection membership which shall occasionally provide collaborative education and training opportunities, including leadership and skills-based training, based on the interests, desires and needs of the membership. • Create strategies for communicating the benefits of MHC membership to the community • Create strategies to ensure meaningful participation of each member in the collaboration. • Maintain list of MHC members • Review annual dues structure FURTHER RESOLVED, that the Board establishes the SYMPOSIUM COMMITTEE with the goals to: • Plan the 2009 Bridging the Gap symposium, including recruiting faculty, handling logistics, determining an agenda. • Plan post-symposium learning activities • Create a strategic plan for symposia in 2010 and 2011. FURTHER RESOLVED, that the Board establishes the IMPLEMENTATION COMMITTEE with the goals to: • Oversee implementation of the EBP pilot programs recommended by the 2007-8 Learning Communities • Ensure finalization of implementation plans including budgets, social marketing strategies, evaluation plans, action steps. • Recruit and train volunteers to complete the work. • Determine future needs for supporting and sustaining of the work of the teams. FURTHER RESOLVED, that the Board establishes the GRANTS COMMITTEE with the goals to: • Research funding opportunities to support shared goals of the collaborative partners. Form Services Agreement [Name of Consultant] Page 3 of 11 • Develop collaborative funding opportunities to support the goals of Mental Health Connection. • Consider and recommend Mental Health Connection's support of grant applications by community organizations, when requested. FURTHER RESOLVED, that the Board establishes the RESEARCH COMMITTEE with the goals to: • Provide education, consultation and support for agencies engaged in developing and maintaining program evaluation and meaningful outcomes, including cost benefit analysis. • Work with local universities, medical centers, and other research institutions to build alliances to create a body of local data for effective decision-making, including EBP's. FURTHER RESOLVED,that the Board establishes the ADVOCACY COMMITTEE with the goals to: • Educate decision makers and encourage support of policies that demonstrate Tarrant County's priorities for a quality, accessible mental health care system. • Ensure that MHC's collaborative legislative priorities are promoted during the 2009 legislative session • Evaluate benefit/value of state and federal professional consultants. • Continue to develop policy priorities that are the consensus of the collaboration members. FURTHER RESOLVED, that the Board establishes the GOVERNANCE COMMITTEE with the goals to: • Recommend policies/procedures for managing the work of the collaboration (examples: accounting, administrative procedures, grants review process, expectations/responsibilities of collaborative activities) • Recommend policies/procedures for implementation of the Evidence Based Practices Pilots • Recommend Policies/procedures for data sharing projects, including CSMIS • Review the Standards of Care adopted in 2004 by MHC membership, recommend changes for membership approval, and develop a plan for institutionalizing the standards of care. FURTHER RESOLVED, that the Board establishes the WORKFORCE COMMITTEE with the goals to: • Develop strategies/policies/procedures to identify,recruit and sustain a highly qualified mental health workforce in Tarrant County • Facilitate research/data gathering to track local mental health workforce needs. FURTHER RESOLVED, that the Board establishes the FINANCE COMMITTEE which shall provide oversight to the fiscal management of Mental Health Connection including regularly reviewing income and expenses, assisting with preparation of an annual budget, and making recommendations to the Board regarding MHC's annual audit. BE IT RESOLVED, by unanimous action of the Board on December 10, 2008. Susan Garnett,Board Chairperson December 10, 2008 Form Services Agreement [Name of Consultant] Page 4 of 11 EXHIBIT B PAYMENT SCHEDULE Form Services Agreement [Name of Consultant] Page 5 of 11 �+ Client#: 67530 18MENTAHEA1 DATE(MMIDDNYYY ACORD. CERTIFICATE r c LIABILITY 09/28/2009 ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wortham Insurance&Risk Mgt ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1600 West Seventh Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Worth,TX 76102-2505 817 336-3030 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Philadelphia Indemnity Insuranc 18058 Mental Health Connection of Tarrant Cty INSURER B: Hartford Underwriters Insurance 30104 3131 Sanguinet St. INSURERC: Fort Worth,TX 76107 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDD DATE MM/DD A GENERAL LIABILITY PHPK445655 08/26/09 08/26/10 EACH OCCURRENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY PREA SESOEa occurr ce $1 OO 000 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 00O o00 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY F PRO LOC JECT A AUTOMOBILE LIABILITY PHPK445655 08/26/09 08/26/10 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 46WECGG6975 05/07/09 05/07/10 X W C STATu- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT s500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SEE BELOW&PAGE 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION For Info Only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S123352IM123351 18KSC © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CANCELLATION NOTICE The CANCELLATION NOTICE on the CERTIFICATE OF INSURANCE is amended to include the following wording:The Insurance Companies may cancel the described policy(ies)by mailing or delivering ten (10) days written notice of cancellation to the Named Insured for: (1)Non Payment of premium or(2)any other circumstance permitted by state law or policy conditions. ADDITIONAL INSURED DISCLAIMER Coverage for Additional Insureds can vary significantly from policy to policy and thus Additional Insured status does not guarantee protection for all losses.Coverage is subject to actual policy terms and conditions. ACORD 25S(2001/08) 2 of 2 #S123352/M123351