Loading...
HomeMy WebLinkAboutPhaRmLogs LLC; 2023-06-30;PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|1 Module UNITS OR SCOPE MODULE LICENSE FEE SETUP FEE DRUG MODULE Tracks the shift counts, expiration dates, lot numbers, inventory, locations of controlled drugs. Tracks expiration dates, lot numbers of non-controlled drugs. 18/KITS or UNITS Controlled Drugs ($146/UNIT/Yr. | $100.00 SETUP) $2,628.00 Year 1 = Setup Fee Only Years 2+ = $2,628.00/Yr. $1800.00 $1,440.00 if signed within 30 days PPE MODULE Tracks expiration dates, unit cost, inspections, cleanings and personnel assignments of PPE 110 Assigned Users ($20/Assigned User | $20/Assigned User Setup) $2200.00 Year 1 = Setup Fee Only Years 2+ = Units/Scope Rate $2200.00 $1,760.00 if signed within 30 days SCBA MODULE Tracks inspections, maintenance, locations, service dates, hydro dates of SCBA. N/A ($45/SCBA | $45/SCBA Setup) N/A N/A CHECKS MODULE Document EMS, Vehicle and Equipment checkouts. Seamless integration with the Tickets Module. Alerts for due checks. Customizable to your operations. N/A ($12/Vehicle/Equipment | $250 Setup) N/A N/A LOGS MODULE Document notes, maintenance, equipment movement and other information for stations, vehicles and equipment & fuel. N/A ($90/Location | $90/Location Setup) Location = Vehicle/Station/Fuel Station N/A N/A TICKETS MODULE Create and track service/repair tickets for assets. Tickets can be generated directly from the Vehicle/Equipment Checkout Forms. N/A ($200/Year | $200 Setup) N/A N/A INVENTORY/SUPPLY Supplies can be requested/fulfilled through internal warehouse or through outside vendor. Warehouse Item inventories can be updated as items are fulfilled. 7 Stations/1 Warehouse $150/Year/Station 1 Time Setup $150/Station $1,200.00 Year 1 = Setup Fee Only Years 2+ = $1,200.00/Yr. $1,200.00 $960.00 if signed within 30 days TOTALS For All Priced Modules $6028.00 (Annual: US Currency) $5200.00 DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|2 $4160 if signed within 30 days (One Time: U.S. Currency) Year 1 Annual One Time One Time Paid by 7/12/23 Drug Module NA $ 1,800.00 $ 1,440.00 PPE Module NA $ 2,200.00 $ 1,760.00 Inventory/Supply NA $ 1,200.00 $ 960.00 Year 1 Totals - $ 5,200.00 $ 4,160.00 Year 2+ Drug Module $ 2,628.00 NA NA PPE Module $ 2,200.00 NA NA Inventory/Supply $ 1,200.00 NA NA Year 1 Totals $ 6,028.00 - - This quotation is subject to mutually acceptable terms and conditions. Upon agreement and payment of initial fee, the TraxWorx.com portal will be created and testing and implementation will begin. Upon agreement the client agrees to the privacy and the terms of non-Disclosure as outlined in attached Terms of Software as a Service Agreement (Pg. 4) The totals are paid on an annual basis starting on the date of the signing of this agreement. Payment Terms: Billed Annually, Net 30. /// /// /// /// /// /// DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|3 AGREED AND ACCEPTED: CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Information Technology Director (print name/title) ATTEST: By: (sign here) SHERRY FREISINGER City Clerk (print name/title) APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney By: _______________________ Deputy City Attorney /// /// /// /// /// DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 TraxWorx OwnerDenny Munson for for I rd>~Wor~< FIRE & EMS SOFTWARE j~ R-.. ~ ~ Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|4 SOFTWARE as a SERVICE (SaaS) AGREEMENT TraxWorx The purpose of this Agreement (hereafter referred to as the "Agreement") is to set forth to define an arrangement under which PhaRmLogs LLC (“Provider”) will provide Software as a Service ("SaaS"), with the product name of “TraxWorx”, for the benefit of the Customer. The standard SaaS Agreement with PhaRmLogs LLC is provided below. By purchasing and/or using our SaaS you are explicitly agreeing to all of the following terms and conditions: DEFINITIONS. "Software" shall mean the Software or Program(s) provided by PhaRmLogs LLC to Customer under this Agreement. "Hosting Services" shall mean the services provided by PhaRmLogs LLC to Customer under this Agreement. "Support Services" shall mean customer service and technical support provided to SaaS users as detailed under the Specifications. "SaaS" shall mean the combination of internet-based (cloud) Software, Hosting Services, and Support Services provided by PhaRmLogs LLC to Customer. "Source Code" shall mean the readable forms together with make and build files. "Delivery" shall mean the SaaS transmitted by PhaRmLogs LLC to Customer electronically and in accordance with security measures agreed upon by both parties as described in this Agreement. "TraxWorx Materials" shall mean any software, code, audio files, video files, data, graphics or other materials or resources transmitted to Customer in order to provide any of the services under this Agreement. Subject to the following terms and conditions of this Agreement, PhaRmLogs LLC will provide SaaS for Customer: 1. SAAS SPECIFICATIONS PhaRmLogs LLC agrees to provide Customer with SaaS according to the following Specifications (the "Specifications"): PhaRmLogs LLC provides SaaS in the form of cloud-based Software, Hosting Services, and Support Services. Software The TraxWorx narcotics log and equipment tracking web application enables clients to record daily narcotics counts, narcotics expiration dates and associated unit checkouts and vehicle log data. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|5 Hosting Services Fees for Hosting Services and Support Services are included in the SaaS licensing fees. Support Services Support Services are included with the SaaS license for licensed system administrator users. Services include: • SaaS (Software as a Service) o Hosting o All software updates o Daily backups o Access via any web connected standard browser • Initial setup o Establish Organization o Establish Database o Establish Modules & Sub-Modules o Establish Users & User Roles  Admin/Paramedic/EMT o Others as needed for custom modules • Webinar-based User Training • Technical Support o NOTE: PhaRmLogs LLC agrees to provide assistance in using SaaS based on the customer's needs via e-mail, phone, and PhaRmLogs LLC online meeting portal. 1.1 SERVICES PROVISIONS Rights and License Granted. Except for Customer use of the licensed SaaS, Customer is not granted any rights or license to the Software or Services under this agreement. Customer acknowledges that through its payments to PhaRmLogs LLC it is granted access to the SaaS. Customer further acknowledges that at no time shall it be entitled to download, distribute, install or otherwise redistribute the Software in any form not explicitly covered by this Agreement. The Customer understands that access to the SaaS ends when one of the following events takes place: 1) Customer payments are unpaid after sixty days (60 days) of the invoice date, or 2) Customer DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|6 cancels its subscription with an advanced 30-day written notice and Customer's account is paid in full. PhaRmLogs LLC reserves the right to remove any content PhaRmLogs views as harmful or content that could subject PhaRmLogs LLC or a customer to a penalty. Limitations to Rights and License. At no time will Customer hold title to or ownership of any of the SaaS, TraxWorx Data, Source Code or any Materials provided to Customer during the term of this Agreement. Customer access to Customer data records will be withheld at the end of Term until Customer's balance is fully paid. Upon completion of the term of the Agreement and payment in full, PhaRmLogs LLC will provide the Customer with the Customer’s data in electronic format. U.S. export control laws and other applicable export and import laws govern Customer's use of the SaaS, including technical data. Neither the TraxWorx Materials nor any direct product thereof may be exported, directly or indirectly, in violation of these laws, or may be used for any purpose prohibited by these laws including, without limitation, nuclear, chemical, or biological weapons proliferation. 1.2 LENGTH OF SERVICE Customer agrees to an initial term of service ("Term"). The length of contract term required will be 1 year, with the option to renew for 4 one-year term, based on the type of service desired by Customer and shall be determined solely by PhaRmLogs LLC as defined in the payment option selected by Customer. 1.3 SERVICE START DATE The first subscription payment plus setup charges, if any, shall be due full execution of this agreement. Service shall begin upon PhaRmLogs LLC receipt of payment for such first Term of service. 1.4 RENEWAL BY CUSTOMER In the case of subscription licenses this Agreement may be extended by written amendments to this agreement. After the initial term, renewal prices are subject to change but will not increase by more than 5% of the previous year’s license fees. Renewal of Services by Customer indicates agreement to any price changes. Renewal fees for the following Term will be automatically invoiced to Customer's account. 1.5 SAAS CUSTOMIZATION Customer acknowledges that the SaaS is provided "as is" and "as delivered". Customer assumes all responsibility to review and authorize all features of custom modules in the SaaS. Customization of the TraxWorx system customization for the Customer can be completed for an additional fee. This fee will be negotiated on a case-by-case basis and will require a written amendment. 1.6 SAAS SUPPORT All support for the SaaS shall be conducted as defined in the Specifications. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|7 2. END-USER PRICING AND SERVICES FEES End-User Pricing and Services Fees are subject to change at the sole discretion of PhaRmLogs LLC. Annual Service Fees shall not exceed 5% of the total cost of previous billing period. 3. TERMS OF PAYMENT Credit terms are net thirty (30) days upon receipt of invoice. PharmLogs LLC reserves the right to revoke any credit extended and suspend all SaaS if customer's payment is in arrears for more than sixty (60) days. 4. PROPRIETARY INFORMATION Proprietary information exchanged hereunder shall be treated as such by Customer. This information shall include, but is not limited to, the provisions of this Agreement, product and services information, materials, software, code, pricing, or any other materials transmitted to Customer under this Agreement (“Proprietary Information”). Customer agrees not to (a) decompose, disassemble, decode, or otherwise reverse engineer any PhaRmLogs LLC program, code, or technology installed or delivered to Customer or any portion thereof; (b) transmit or allow to be transmitted any such materials to any third party except as necessary for the fulfillment of this Agreement; (c) use any PhaRmLogs LLC Materials or SaaS in any way not intended or expressly provided for by this Agreement. Notwithstanding anything contained in this paragraph, Customer may disclose Proprietary Information if required by law. 5. CUSTOMER INFORMATION The Customer will own all right, title and interest in its data that is related to the services provided by this Agreement. PhaRmLogs LLC shall not access Customer user accounts or Customer data, except (1) in the course of data center operations, (2) in response to service or technical issues, (3) as required by the express terms of this contract, or (4) at the Customer’s written request. PhaRmLogs LLC shall establish and maintain during the term of this Agreement an information security policy providing for reasonable administrative, technical, physical safeguards and security measures designed to protect against the unintended or unauthorized destruction, loss, alteration, or access of any Customer Data in the possession or control of PhaRmLogs LLC, which safeguards and measures are compliant with applicable federal, state, or local laws, rules, and regulations. PhaRmLogs LLC will promptly notify the Customer of any data security breach or similar incident that has, or might have, compromised the privacy or security of any Customer Data. PhaRmLogs LLC will indemnify and hold harmless the Customer from and against any damages or losses asserted against or incurred by or related to a breach of a PhaRmLogs LLC’s data security obligations. PhaRmLogs LLC shall provide its services to the Customer and its end users solely from data centers in the U.S. Storage of Customer data at rest shall be located solely in data centers in the U.S. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|8 6. WARRANTIES PhaRmLogs LLC makes no warranties or representations of any kind, whether expressed or implied, for the SaaS PhaRmLogs LLC is providing. PhaRmLogs LLC and any suppliers of content materials also disclaim any warranty of merchantability or fitness for any particular purpose and will not be responsible for any damages that may be suffered by Customer, including loss of data resulting from delays, non-deliveries or service interruptions by any cause or due to errors or omissions of Customer. Use of any information obtained by way of PhaRmLogs LLC is at Customer's own risk, and PhaRmLogs LLC specifically denies any responsibility for the accuracy or quality of information obtained through its Services. Connection speed represents the speed of an end-to-end connection. PhaRmLogs LLC does not represent guarantees of speed or availability of end-to-end connections. PhaRmLogs LLC expressly limits its damages to Customer for any non-accessibility time or other downtime to the pro-rata monthly charge during the system unavailability. PhaRmLogs LLC specifically denies any responsibilities for any damages, direct or indirect, arising as a consequence of such unavailability. 6.1 SERVICE LEVEL AGREEMENT PhaRmLogs LLC shall use commercially reasonable efforts to make the service is available for use 24 hours a day, 7 days per week with the exception of maintenance downtime. All regular maintenance, updates and upgrades will be performed during non-business hours. Customer will be advised in advance of any scheduled maintenance downtime. Business hours, for this purpose, are defined as 6:00 AM – 6:00 PM local time. PhaRmLogs LLC expressly limits its obligation for any non-accessibility time or other downtime during normal business hours to the pro-rata charge during the system unavailability due to source code (programming) errors. Any requested and verified pro-rata charges for downtime will be credited to the customer’s license agreement fees for the next billing cycle. The service level agreement does not apply in the following cases: • Client system and infrastructure issues • Systemic Internet issues • Data issues resulting from client errors • Remote System issues due to natural disaster or upgrade to system 6.2 NO DUTY TO CUSTOMER'S USERS NOT DIRECTLY CONTRACTED WITH PHARMLOGS LLC PhaRmLogs LLC shall have no obligation to support, train or troubleshoot issues for any third-party user due to problems arising out of the use of the SaaS provided to Customer by PhaRmLogs LLC. Third parties shall include, but are not limited to: vendors, contractors, Customer's customers, Customer's clients or any third party not directly contracted with PhaRmLogs LLC for SaaS and SaaS Support. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|9 7. COPYRIGHTS AND TRADEMARKS Customer warrants that Customer has the right to use any applicable trademarks or materials that Customer installs, integrates or uses in connection with this SaaS. 8. TRANSFER OF AGREEMENT Customer may not assign or transfer this Agreement, in whole or in part, without the prior written consent of PhaRmLogs LLC. In the event that Customer contemplates whole or partial sale of Customer's business, ownership change, or change in jurisdiction, Customer shall notify PhaRmLogs LLC by mail, facsimile, or email no less than sixty (60) days prior to the effective date of the event. PhaRmLogs LLC may assign neither this Agreement nor any part of it, nor any monies due or to become due under it, without the prior written consent of Customer. 9. TERMINATION Either party may terminate this Agreement, with a written and signed 30-day notice, at its sole discretion upon the occurrence of one or more of the following events: 1) Customer's failure to comply with any provisions of the Agreement upon receipt of written notice from PhaRmLogs LLC of said failure, 2) appointment of receiver or the filing of any application by Customer seeking relief from creditors, or 3) upon mutual agreement in writing by PhaRmLogs LLC and Customer. The customer may terminate this agreement if PhaRmLogs LLC fails to comply with any provisions of the Agreement or the customer is compelled to end the use of the SaaS. Upon termination of this agreement, PhaRmLogs LLC will provide the Customer with the customer’s data for their organization in a mutually acceptable electronic format. 10. DISPUTES If legal proceedings are commenced to resolve a dispute arising out of or relating to this Agreement, the each party shall be responsible for its own costs, legal fees, and expert witness fees as well as any costs or legal fees in connection with any appeals. PhaRmLogs LLC agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this Agreement is the State Superior Court, San Diego County, California. 11. INDEMNIFICATION A. Customer shall indemnify and hold PhaRmLogs LLC harmless from and against any and all claims, judgments, awards, costs, expenses, damages, and liabilities (including reasonable attorney fees) of whatsoever kind and nature that may be asserted, granted, or imposed against PhaRmLogs LLC directly or indirectly arising from or in connection with Customer's marketing or Support Services of the product or Services or the unauthorized representation of the product and Services or any breach of this Agreement by Customer. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|10 B. PhaRmLogs LLC shall indemnify the Customer against all losses and expenses arising out of any claim that the Software, the SaaS the Source Code or the PhaRmLogs Materials infringe on such third party’s rights. 12. GENERAL If any provision of this Agreement is held to be unenforceable, the enforceability of the remaining provisions shall in no way be affected or impaired thereby. This Agreement and any disputes arising hereunder shall be governed by the laws of State of California. A failure by any party to exercise or any delay in exercising a right or power conferred upon it in this Agreement shall not operate as a waiver of any such right or power. The parties represent and warrant that, on start of service Term, they are authorized to enter into this Agreement in its entirety and duly bind their respective principals by their use of the SaaS provided by PhaRmLogs LLC. 13. SPECIFICATIONS Database – Data Container for all customer data Microsoft™ Sql Server Supported Client Browsers: Google™ Chrome, Microsoft™ Edge, Apple Safari Cookies & Javascript Enabled Internet Connected Client Devices: PC, Mobile PC, Mobile Devices with standard client web browsers SaaS Modules Drug Module (Price Quoted) PPE Module (Price Quoted) SCBA Module (Available For Purchase) LOGS Module (Available For Purchase) TICKET Module (Available For Purchase) EMS SUPPLY Module (Quoted Price) The customer acknowledges that all modules associated are custom to customer. Customer shall request customization of the SaaS in writing and provide detailed summary of what the module shall collect or report via an email or other written form. If additional costs are required, an amendment will be required. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|11 All modules will be tested with the customer on the production server. Once the customer authorizes the module to go live, then a live link to the new module will be provided through the SaaS program menu system or through hyper-links from one of the other authorized modules. All customer authorized modules are under the Service Level Agreement 6.1. 14. COMPLIANCE WITH LAWS PhaRmLogs LLC will comply with all applicable local, state and federal laws and regulations, including those prohibiting discrimination and harassment and will obtain and maintain a City of Carlsbad Business License for the term of this Agreement. 15. INSURANCE PhaRmLogs LLC will obtain and maintain policies of commercial general liability insurance, automobile liability insurance, cyber insurance and professional liability insurance from an insurance company authorized to transact the business of insurance in the State of California which has a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report, in an amount of not less than one million dollars ($1,000,000) each, unless otherwise authorized and approved by the Risk Manager or the City Manager. If PhaRmLogs LLC hires employees as defined in California Labor Code Section 3351, PhaRmLogs LLC agrees to obtain a combined policy of workers' compensation, employers liability insurance. PhaRmLogs LLC will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. The insurance will be in force during the life of this Agreement and will not be canceled without thirty (30) days prior written notice to the Customer by certified mail. Customer will be named as an additional insured on General Liability which shall provide primary coverage to the Customer. The full limits available to the named insured shall also be available and applicable to the Customer as an additional insured. PhaRmLogs LLC will furnish certificates of insurance to the Contract Department, with endorsements to Customer prior to Customer’s execution of this Agreement. DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs PhaRmLogs LLC | 23685 Spring Oak Pl., Murrieta, CA 92562 PAGE|12 Recommended Service & Equipment Links *** ALL EQUIPMENT & PRICES SUBJECT TO CHANGE *** ADDITIONAL SERVICES/EQUIPMENT Service/Product Description Price Customer Training Train the Trainer via Microsoft Teams $0.00 Custom Reports Build customized web reports, within the TraxWorx platform, for specific data needed by the client. $0.00 Recommended Equipment Links *** ALL EQUIPMENT & PRICES SUBJECT TO CHANGE *** Printers, Labels and Scanners are not proprietary and can be purchased by customer via the links below. These are just recommended hardware that have been tested and works with TraxWorx. PRINTERS Brother™ P-Touch PTP750w (TOP Recommended) (AMAZON) Wireless & USB, A/C & Battery Powered LABELS/PRINTER TAPE Labelife™ Compatible Label Tape Replacement for Brother TZ Tape 9mm 0.35" Laminated White Label Maker Tape TZe-221 TZ221 for P Touch PT-D200 PT-D210 PT-H100 PT-D400 PT-1290 PT-1750, 9mm x 8m, 5-Pack (Recommended for single vials) (AMAZON) BARCODE SCANNERS Symcode™ 2D QR Code Scanner (Top Recommended) (AMAZON) TraxWorx Contact: Denny Munson: (657) 224-0677, dmunson@traxworx.com DocuSign Envelope ID: AC844E99-B167-4A11-AB78-F26E81E6A8A1 I rd>~Wor~< FIRE & EMS SOFTWARE Pho~mlogs 06/30/2023 Knutson Reeves Insurance Services 41856 Ivy Street, Suite 105 Murrieta, CA 92562 License #: 0E22572 Shirley Parker (951)600-8100 (951)600-8013 shirley@krpatriot.com 10001068-13518 2 Pharmlogs, LLC DBA Traxworx 23685 Spring Oak Place Murrieta, CA 92562 Hiscox Ins Co Inc 10200 A Y P102.081.966 06/30/2023 06/30/2024X X X 1,000,000 5,000 1,000,000 2,000,000 INCLUDED Spinnaker Ins Co 24376 B FLY-CB-BNF5X5WYZ 06/17/2023 06/17/2024Cyber Liability Aggregate Limit 1,000,000 Hiscox Ins Co Inc 10200 A Y P102.081.956 06/30/2023 06/30/2024Professional Liab Prof Liab 1,000,000 City of Carlsbad has been added as Additional Insured in regards to Commercial General Liability and Professional Liability. City of Carlsbad 1200 Carlsbad Village Dr. Carlsbad, CA 92008 (SRP) Printed by SRP on 06/30/2023 at 03:35PM ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOSHIREDNON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: AC844E99-8167-4A 11 -AB78-F26E81 E6A8A 1 ACORD® I ~ I ~ □ □ ~ ~ Fl □ □ ~ f--~ ~ ~ f--f-- ~ H I I I I I □