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09-0408
New Hanover County Contract # 09-0408A kDDF *SDI NI M AC ItF:F MIEN f of "Imll) irz lt1 vi+~~,tli~ii3fT? "o ifiv t.Aci:t.lcd LeiLsc Ag!CC11',ent (1ll <1gCs:t cnt, dated tilt` _'50) sLl „1 al"d llelsa Ccll ' L v, I tally LT t OU; 'ft ~l Xid i :ill[11111 '"'rt,'r% !C'C o1por.'kI on. dated tiIa4 i 1. 24'09 for U,-.s tiPk ,i - SitciI oxcr S.,,stcl, v, I uIptI"clit at file s,oIIJ1lkv er Cou tit, Land iiii 111 WiIititInvton, 111 ;bddcfililllll ,er-\ CS al,, a.li allicndl?lCliI taI t~'1C i"CC a~ Icx{ii. Av z: ~itGtltit?lt.'{i ~'iitlli)1llClil It onlh* '\~i~t;lil2a"f ~1~ t~iltitrllai ~fl[1 i'ICC:ETi'S1ih ~~i~C''~'~`itCltl .C ~i!!ft tNt i)~`I~ ilttlttih~ ii±yjtti iitil"IJlllltl41 la,a ,S C'al tl"ttt', ~e71 ittti itl(1 ltt iltit` It ei=, I~~Cltt)'tiir t_ oulll~ I andt.ill. Ii'i6tszCtlt t4}r. !.r Silo ;111 tUl mlcnil',' Stl?lc'Pti1~Cl" ! Should ~ c%w i{~tI1 5lir l UlYt" dk-~I'C tilt' addillolt 1)t thcC Sllo lie S%. ,I lit, tm of ii- 's1 )4! itt ,tdIUstcd upon LANDFILL SERVICE C ORPOR.-%, FION NF AN Fi itiOVF.R C OU, V1 Joel V, I.aru, President Approved as to fomXclunty Attorney ORIGINAL _ New Hanover County Contract # 09-0408 ACcpj?" ® DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/1/2009 PRODUCER' (607) 754-1411 FAX: (607) 754-6463 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Partners Insurance & Financial Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 825 Vestal Pkwy W ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Vestal NY 13850 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Everest Indemnity Insurance Landfill Service Corporation INSURER B: Cincinnati Insurance Company 2183 Pennsylvania Ave INSURER C: INSURER D: Apalach' n NY 13732 I 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 OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATION'. LIMITS LTR N RD TYPE FIN RANCE DATE MMID ATE MMIDDIYYYY GENERAL LIABILITY 'i -EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A X CLAIMS MADE ~I OCCUR F4ML00397-091 7/14/2009 7/14/2010 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY ~i$ 1 000 , 000 GENERALAGGREGATE 2 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO UD CTS -COMP/OP AGG 2 000 , 000 _I 1 X POLICY PRO- LOC - - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO B ALL OWNED AUTOS 5128035 9/27/2009 9/27/2010 I $ BODILY INJURY I SCHEDULED AUTOS ~fe, person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN ACC - $ AUTO ONLY: AGG $ EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE _ OCCUR CLAIMS MADE $ DEDUCTIBLE is RETENTION $ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN T RY LIMIT R _ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ _ OFFICER/MEMBER EXCLUDED? ~i (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under i SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER T DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES/ EXCLUSIONSADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Holder is listed as additional insured per the automatic Additional Insured Endorsement IE0036 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION New Hanover County Landfill DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 5210 US Highway 421 North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Wilmington, NC 28401 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD New Hanover County Contract # 09-0408 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 This Certificate of Insurance 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. ACORD 25 (2009/01) INS025 (200901) New Hanover County Contract # 09-0408 ADDITIONAL COVERAGES dition Date Ref # Description Coverage Code Form No. E Pollution Liability POLUT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 10,000 Ref # Description Coverage Code Form No. Edition Date Underinsured motorist combined single limit UNCSL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref # Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 50,000 $174.00 Ref # Description Coverage Code Form No. Edition Date Uninsured motorist combined single limit UMCSL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 $477.00 Ref # Description Coverage Code Form No. Edition Date Additional Insured ADDIN Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $25.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. Ne over County Routing 71~Cb Contract # Department Acct. U itials Date In I-A To: Risk Manager Grants Coordinator Finance Director County Manager j Commission Chairman Clerk to the Board - County Attorney From: Legal Dept. Date ~ - 3 Re: Contract for/Dept. ` A18001110. Landfill Service PRICE GUARANTEE SUPPLIER: CUSTOMER: LANDFILL SERVICE CORPORATION NEW HANOVER COUNTY (LANDFILL) 2183 Pennsylvania Avenue 5210 US Hwy 421 N Apalachin, NY 13732 Wilmington, NC 28401 Telephone: (607) 625-3050 Telephone: (910) 798-4400 Facsimile: (607) 625-2689 Facsimile: (910) 341-4371 ISSUE DATE: May 15, 2009 TERRITORY: New Hanover County Landfill Wilmington, North Carolina SUPPLY ITEMS: PRICE: PSM-200TM Setting Agent; 1000-1b Bulk Saks $330.00 ea. PSM-20OTM Setting Agent; 50-1b Bags $16.50 ea. Posi-PaO P-100 Fibers; 15-1b Bags $36.00 ea. Brown Coloring; Powder; 5-lb Bags $15.00 ea. Above Supply Item prices guaranteed for I year from Agreement Date. Delivery charges additional and not included in above stated prices. A11 prices in US dollars and FOB source. TERMS: Net 30 days STANDARD CONDITIONS: 1) Term and Termination. This Agreement shall take effect upon the Issue Date above. The term shall automatically renew for successive one (1) year terms unless either party provides a written notice of non-renewal to the other party at least sixty (60) days prior to the expiration of the then-current term. a. Prior to the expiration date of this Agreement as set forth in this Agreement, the Supplier may, at its option, terminate this Agreement if the Customer: (a) fails to make any payment required under this Agreement; or (b) fails to perform any other obligation required under this Agreement within 30 days after receiving notice of any such failure by the Supplier; or (c) commits a non-curable breach of this Agreement. b. In the event that this Agreement is terminated as provided herein, no amounts paid under this Agreement shall be refunded to the Customer. 2) Price and Payment. Customer shall pay Supplier the per unit price specified above. Said price is exclusive of all delivery charges and all city, state, and federal sales taxes, which may be added to the invoice as separate charges to be paid by Customer. An interest charge of 1.5% per month will be assessed on unpaid balances. 3) Dues and Taxes. Customer shall pay all dues, taxes and other expenses imposed by any Government or Government Agency. 4) Attorneys' Fees. Customer shall pay Supplier's reasonable attorneys fees and other costs incurred in connection with enforcement (including collection of past due amounts) of this Agreement. 5) Notice. Any notices, requests, statements, submissions or other communications required or permitted by this Agreement shall be given in writing and, for all purposes, shall be deemed given and effective on carriers verified delivery date, or after 10 days of mailing, if dispatched by air mail (which shall be certified or registered, with postage pre-paid), and properly addressed to either party as designated above. 6) Returns. Returns will be accepted with prior return authorization only. A 25% restocking charge will apply to all returns. Product must be unused and undamaged. Only full pallet product may be returned. Partial pallets will not be accepted. Customer assumes the shipping and responsibility of returning product to landfill Service Corporation. Posi-Shell® and Posi-Paks® are registered trademarks of landfill Service Corporation. Customer agrees to the above terms and conditions of doing business with Landfill Service Corporation. SUPPLIER: CUSTOMER: LANDFILL SERVICE CORPORATION NEW HANOVER COUNTY (LANDFILL) By: By: J `~E. Lanz, reside AUTHORIZED TIVE T. Date: 15 /7'1 N- 009 Name: Title: 0j flu huula BSI-She Date: / ! `7 VER SYSTE RIGINAL ~ t !QTR 1 0 lb' IJ d 1~,~,.•, ,,,AOJ Approved as to fiorm/Coun~ q l1MENT HAS BEENPRE-Alinrmn ~~11V ~V l~~co 3 REQUIRED BY THE 11 NI Page 1 of 1 „r LOCAL OM22, ~,r. _ ACORD~ CERTIFICATE OF LIABILITY INSURANCE 5/18i2o 9 ' PRODUCER (607) 754-1411 FAX: (607) 754-6463 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Partners Insurance & Financial Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 825 Vestal Pkwy W ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Vestal NY 13850 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Evanston Insurance 35378 Landfill Service Corporation INSURER B: Cincinnati Insurance 10677 2183 Pennsylvania Ave INSURER C: INSURER D: Apalachin NY 13732 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN 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 MAY HAVE REDUCED PAID rA INADD'L SRD TYPE OF INSURANCE POLICY NUMBER PDATEYMM/DDTIVE PDATE MM/DD TON LIMITS 1YYi GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ccrrnce $ 50 , 000 X COMMERCIAL GENERAL LIABILITY PRMMG ESO RENTED X CLAIMS MADE a OCCUR OBPKGO1953 7/14/2008 7/14/2009 MEDEXP An one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AG $ 2,000,000 X POLICY PRO L 0 C Pollution Liability 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 8 ALL OWNED AUTOS CAA5128035 9/27/2008 9/27/2009 BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accidenQ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN A A $ AUTO ONLY: AGG $ EXCESSA MBRELLA LIABILITY EAC H OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION WORKERS COMPENSATION AND WC STATURY ER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT is OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ A OTHER DESCRIPTION OF OPERATIONS/LOCATK)NSfVEHK LESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Holder is listed as additional insured per the automatic Additional Insured Endorsement IE0036 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE New Hanover County Landfill EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 5210 US Highway 421 North 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Wilmington, NC 28401 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHOR12ED REPRESENTATIVE ~i Phil Wiles/KAM "goo. w ACORD 28 (2001108) ® ACORD CORPORATION 1988 IN4A9R,n~noi no pone 1,49 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. ACORD 28 (2001/08) INS025 (oioeywa Page 2 012 06-05-'09 11:46 FROM-NBC Environmental +9107984408 T-888 P002 F-037 Nov York State Insurance Fund Wo ei • Cox eww1na ktabfliSip p t' y7ta Specialistra Slrece 1914 2001 PERIMETER ROAD CAST, BUILDING 16, ENDICOTT, NEW YORK 13780-7390 Phone: JWTI741-W35 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 'AAA AAA LANDFILL SERVICE CORP 2183 PENNSYLVANIA AVENUE APALACHIN NY 13732 POLICYHOLDER CERTIFICATE HOLDER LANDFILL SERVICE CORP NEW HANOVER COUNTY LANDFILL 2183 PENNMVANIAAVENVE 5210 HWY'421N APALACHIN NY 13732 WILMINGTON NC 28401 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE BATE E 890 510-0 770293 10/31/2006 TO 10/31/2010 8/3!2009 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 090.510-0 UNTIL 1013112010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS " OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY I$ CANCELLED, OR CHANGED PRIOR TO 10/81/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL 80 ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. TH8 NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIASILrrY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER., THIS CERTIFICATe DOES NOT AMEND, EXTGND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. A NEW YORK STATE INSURANCE FUND dam- DIRECTOR JNSURANCE FUND UNDERWRITING This certificate can b6 validated an our web site at htlps:l/~.nysif.oomicart/certvoi.asp or by calling (888) 875-5790 _ VALIDATION NUMBER. 17938621 V-218.3 qor r 2 s 2009 s _ I NEW HANOVER COUNTY CONTRACT REQUEST CHECKLIST In order to process your request for a contract, this form must be completed, signed and sent to Legal with all required documentation attached for processing. PLEASE NOTE THAT IT IS EACH DEPARTMENT'S RESPONSIBILITY, PRIOR TO REQUESTING A CONTRACT, FOR THE FOLLOWING ACTIONS: Bids (Informal and formal) Verify insurance requirements with Risk Management Verify funds availability for this contract with Finance/Budget By signing this form, you are acknowledging that all of the actions listed above have been completed by you or your department. Please furnish ALL of the information listed below. Please attach required documentation and/or information to this form. Incomplete forms will be returned. Please check off that the following information is included or indicate N/A r / Name of Contractor (Legal name) )Li nl'I ^C Address of Contractor and name of contact person n Mr h1 _ Scope of Service - 01 tt0ehcz Contract cost or a "not to exceed" amount $ Vol. i p us i Exhibits -a tta-F t~~~ r _i Time of Performance days, ~y~ar(sj; dates to If a Renewal or Amendment (Please state original contract Certificates of Insurance (must be attached) Account Number (from which Contractor will be paid) /1C D~),2 ~ 7DI ja Once completely executed (Contractor and County), the original contract will stay in Legal, a duplicate original will be returned to the Contractor and a copy sent to the requesting department. Other instructions: Date: 5 Elv Signature of Requesting Party Requesting Department 14 ~t~" Phone Number Depa ment Head Please allow two weeks for contract processing. Routing times will vary. Completed forms and attachments must be submitted to Legal, Attn: Diane Morgan. 0- Q- New Hanover County Contract Request Form n Drafted 0110512009 dm u ~L~N11 ~ rye? i Z ~ 2 F .Z I •f.I t1FlI11111;\ NEW HANOVER COUNTY WANDA M. COPLEY County Attorney KEMP P. BURPEAU SHARON J. HUFFMAN Deputy County Attorney Assistant County Attorney June 17, 2009 Landfill Service Corporation 2183 Pennsylvania Avenue Apalachin, NY 13732 RE: New Hanover Contract # 09-0408 Dear Sirs: Enclosed please find your copy of the above referenced contract. Thank you for your assistance in this matter. If you have any questions please give us a call. Sincerely, ,ffa49m& k Dtudap Margaret R. Dunlap Administrative Support Specialist Office of the County Attorney Enclosure 230 Government Center Drive - Suite # 125 - Wilmington, NC 28403 Phone: 910-798-7153 - Fax: 910-798-7157 www.nhcgov.com New Hanover County Routing Slip Contract # Department Acct. # Initials Date To: Risk Manager.. r` Grants Coordinator Finance Director h'~,._ (J { County Manager Commission Chairman Clerk to the Board County Attorney From: Legal Dept. Date Re: Contract for/Dept. t