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#14-6204 (Smart Carte, Inc.) - No BCC Chairman Signature
115 L _t JUL 1 Q c! 4 J By U r lIL- 14-6204 LOCKER CONCESSION AGREEMENT This Agreement is made this_ -.day of V-,ww . , 2014 by and between Collier County, Florida, with an address at 15000 Livingston .Road, Naples, Florida("Owner") and Smarte Carte, Inc., with offices at 4455 White Bear Parkway, St. Paul MN 55110 ("Smarte Carte"). Recitals: Whereas, Owner operates the water park which is known as Sun-N-Fun Lagoon located in Naples,FL (the"Water Park");and Whereas, Smarte Carte desires to operate a self-service electronic storage locker concession (the "Concession") at the Water Park and Owner desires to engage the services of Smarte Carte; Now, Therefore, in consideration of the premises and the mutual covenants contained herein, the parties agree as follows: 1. Equipment. Smarte Carte will install and maintain lockers and associated rental stations (the "Equipment") at the Water Park's locker area in the locations described on Exhibit A. Owner will, at its expense, provide standard electrical power to the paypoints, in accordance with the Locker Specifications set forth on Exhibit B. The Owner will pay the monthly costs associated with the power lines. Upon the expiration or earlier termination of this Agreement, Smarte Carte will, at its expense, remove, without damage to the premises, the Equipment from the Water Park within thirty (30) days. On Smarte Carte's failure to do so, the Owner may remove and store the Equipment at the cost and expense of Smarte Carte, and the Owner shall have a continuing lien thereon in the amount of the cost and expense of such removal and storage until paid, and Owner may sell such personal property and reimburse itself for such costs and expense,plus all expenses of the sale. 2. Exclusive Supplier. Smarte Carte will be the exclusive supplier of locker services in the Water Park, and no other locker service or supplier will be allowed to install or operate in the Water Park regardless of whether such lockers are provided on a rental or complimentary basis,during the term of this Agreement. 3. Operation. 3.1. Hours of Operation and Services. Smarte Carte will operate the Concession during the days and hours that the Water Park is open for business. In accordance with Exhibit C, Smarte Carte will furnish a local service manager, at no additional cost, who will be responsible for collecting and depositing receipts, training Owner's personnel on basic operations and troubleshooting the Equipment, and supervising any other Smarte Carte employees necessary to perform these duties. 9 3.2. Locker Rental. The rental price to locker users for all-day multiple entry use is five dollars ($5.00). Forms of payment accepted at the Concession are MasterCard, Visa, American Express and Discover credit cards and cash in denominations of$1.00 and $5.00 bills. Any change in the locker rental price will be mutually agreed upon in writing by the parties. 3.3. Customer Service. Owner's guest services staff will provide customer service support to the Water Park patrons, and will,on a daily basis,remove and store items from overdue lockers all as more particularly set forth on Exhibit C. Smarte Carte will provide during the Water Park's business hours, on-call service via cell phone or pager for response to service requests. 3.4. Locker Facility and Access. The Owner agrees that Smarte Carte is entitled to use of and access to the Water Park areas, as follows: (i) the facility at which the Concession is operated; (ii) adjacent areas to the Equipment as may be necessary for the operation and maintenance of the Concession; and (iii) common ways and areas within the Water Park for loading and unloading supplies, and installation, repair and maintenance of the Equipment, and other elements related to the Concession. 3.5. Expansion and Relocation. If the Concession averages more than 0.80 rentals per day per door, the parties may mutually agree to increase the number of lockers. If the Concession averages less than 0.45 rentals per day per door, the parties may mutually agree to remove or relocate sections of the Equipment to improve rental usage. The removal and/or relocating of any Equipment will be the sole responsibility of Smarte Carte. Any modifications, increases, decreases or relocations of the Equipment will be agreed upon by the parties in writing. 3.6. Employees. Owner will provide Smarte Carte's employees with access to enter the Water Park, including employee parking areas, during business hours to be used in the performance of their duties. 4. Not a Lease. The subject space is being licensed to Smarte Carte and Smarte Carte shall be a concessionaire and not a lessee. Smarte Carte's right to operate the Concession shall continue only so long as the Concession complies with the undertakings, provisions, agreements, stipulations and conditions of this Agreement. 5. No Partnership or Agency. Nothing herein contained shall create or be construed as creating a partnership between the Owner and Smarte Carte. Smarte Carte is not an agent of the Owner. 6. Permits, Licenses,Taxes. Smarte Carte agrees to obtain and pay for all permits and licenses necessary for the conducting of business and agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Smarte Carte. Smarte Carte shall also be solely responsible for payment of any and all taxes levied on the concession operation. In addition, Smarte Carte shall comply with all existing and future applicable rules, regulations and laws of Collier County, the State of Florida,or the U.S. Government. a 7. Term. 7.1. Initial Term. The initial term of this Agreement will commence on or before March 1, 2014 (the "Commencement Date"), and will continue until February 28, 2019 (the"Term"). 7.2. Owner's Options to Renew. The Owner may at its discretion, subject to the consent of Smarte Carte, renew the Agreement under all of the terms and conditions contained in this Agreement for three (3) additional periods of one (1) year each. The Owner shall give Smarte Carte written notice of the Owner's intention to extend the term not less than sixty (60) days prior to the end of the then current term. The Owner may also, at its sole discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred eighty (180) days. The Owner shall give Smarte Carte written notice of the Owner's intention to extend the Agreement term not less than thirty (30) days prior to the end of the then current term. 8. Accounting and Payment. On or before the fifteenth (15th) day following the end. of each calendar month, Smarte Carte shall submit to the Owner a true and correct statement setting forth the Net Revenues received by Smarte Carte during the immediately preceding calendar month. Along with said statement, Smarte Carte shall remit to the Owner an amount (the "Percentage Commission")calculated as: 15%of the first$25,000 in Net Revenues per Contract Year; and 50%of the next$25,000 in Net Revenues per Contract Year; and. 60%of all Net Revenues in excess of$50,000 per Contract Year. The Owner is to receive the Percentage Commission net, free and clear of all costs and charges arising from,or related to, Smarte Carte's obligations under this Agreement. As used in this Agreement "Net Revenues" means the sum of all income collected, accrued or derived by Smarte Carte under the privileges granted by this Agreement, minus(i)all Federal, State or other taxes collected by Smarte Carte from customers and required by law to be remitted to the taxing authority, and (ii) any refunds or reimbursements paid to users of the lockers for customer service-related complaints. "Contract Year" means each twelve-month period (or shorter period with respect to the first and last years that this Agreement is in effect) that this Agreement is in effect, commencing on or before March 1 of each year and ending on the last day of February of the following year. The monthly Percentage Commission will be payable to "Collier County Board of County Commissioners"and sent,with the monthly statement,to Owner at the following address: North Collier Regional Park 15000 Livingston Road Naples,FL 34109 Attn: Richard DeGalan CA Upon request, Smarte Carte shall also provide Owner with a copy of Smarte Carte's monthly Florida State Sales and Use Tax remittance for the Concession at the Water Park. In the event the Smarte Carte fails to pay the Percentage Commission by the due date, there shall be a late charge of Fifty Dollars($50.00) for such late payment, in addition to interest at the rate of 1.5%per month. If the payment of consideration and accumulated daily penalties are not received within thirty (30) days after the normal monthly due date, then the County may take possession of the Smarte Carte's assets on Owner's property and may cancel this Agreement. 9. Default. If either party fails to perform a material term of this Agreement, the other party may terminate this Agreement by giving fifteen(15) days prior written notice or such longer period as may be consented to by the parties in writing if the default is not capable of being cured within fifteen(15)days; provided, further, if the defaulting party timely remedies the breach within the cure period, such notice shall be null and void. In the event that the Agreement is terminated, Smarte Carte's recovery against the Owner shall be limited to that portion of the Net Revenues earned through the date of termination. Smarte Carte shall not be entitled to any other or further recovery against the Owner, including, but not limited to, any damages or any anticipated profit on portions of the services not performed or materials not provided. 10. Termination for Convenience. Either party may terminate this Agreement for convenience, at any time, with sixty(60)days prior written notice. 11. Records, Audit. Smarte Carte agrees to establish and maintain such records as now exist and may hereafter be prescribed by the Owner in the future to provide evidence that all terms of this Agreement have been and are being observed. All financial records are to be maintained during the entire term of this Agreement and for a period of three (3) years following the termination of this Agreement. Smarte Carte grants to the Owner the right and authority to audit all records, documents, and books pertaining to the Concession operation. Such audit will be conducted at locations and at a frequency determined by the Owner and communicated to Smarte Carte. Smarte Carte agrees to provide all records for the audit at the designated place within five(5)business days after the Owner's notice to do so is received. 12. Force Majeure. If closure of the Water Park or loss of equipment is due to unforeseeable causes beyond the control of Smarte Carte, and not due to its own fault or neglect, including but not restricted to, acts of nature or of public enemy, acts of government or of the County, fires, floods, epidemics, quarantine regulations, strikes or lock-outs, the Owner will allow pro rata adjustment of monthly payments up to the time such damage is repaired. 13. Waiver of Interference. Smarte Carte hereby waives all claims for compensation for loss or damage sustained by reason of any interference with the Concession operation by any public agency or official in enforcing their duties or any laws or ordinances. Any such interference shall not relieve the Smarte Carte from any obligation hereunder. Cq 14. No Liens. Smarte Carte agrees that it will not suffer or through its actions or by anyone under its control or supervision, cause to be filed upon the property any lien or encumbrance of any kind. In the event any lien is filed, the Smarte Carte agrees to cause such lien to be discharged within ten (10)days of written notice to do so from the Owner. 15. No Improper Use. Smarte Carte will not use, nor suffer or permit any person to use in any manner whatsoever, the concession facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, or County law, ordinance, rule, order or regulation, or of any applicable governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of any violation of this Agreement by Smarte Carte, or if the Owner or its authorized representative shall, acting reasonably, deem any conduct on the part of Smarte Carte to be objectionable or improper, as noted on any Concession Inspection Report, the Director of Parks and Recreation shall have the right to summarily suspend the operation of the Concession should Smarte Carte fail to promptly correct any such violation, conduct, or practice to the reasonable satisfaction of the Director. Smarte Carte shall not resume operation of the Concession during such suspension until the violation has been corrected to the reasonable satisfaction of the Owner. 16. Indemnification. Each party agrees to indemnify, defend and hold harmless the other, its officers, board members, agents and employees from and against any and all fines, suits, claims, demands,penalties,liabilities, costs or expenses, losses, settlements,judgments and awards and actions of whatever kind or nature, including attorney's fees and costs (and costs and fees on appeal), and damages (including, but not limited to, actual and consequential damages) arising from any negligent, willful or wrongful misconduct,knowing misrepresentation or breach of this Agreement by such party, its officers, board members, agents or employees. This paragraph shall not be construed in any way to alter the State's waiver of sovereign immunity or extend the party's liability beyond the limits established in Section 768.28,Florida Statutes. 17. Insurance. Smarte Carte shall provide insurance as follows: A. Commercial General Liability. Coverage shall have minimum limits of$1,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability. Coverage shall have minimum limits of$1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership. C. Workers' Compensation. Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers'Liability with a minimum limit of$500,000 for each accident. Collier County Government shall be listed as the Certificate Holder and included as an additional insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirements herein identified shall be maintained by Smarte Carte during the Term. Smarte Carte shall provide Owner with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the Owner ten (10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Smarte Carte shall also notify Owner, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non- renewal or material change in coverage or limits received by Smarte Carte from its insurer, and nothing contained herein shall relieve Smarte Carte of this requirement to provide notice. 18. Confidentiality. This Agreement and all information regarding the business operations, policies, and practices of the parties acquired or learned in connection with the activities conducted under this Agreement are confidential and proprietary and shall be kept in strictest confidence under appropriate safeguards, except for information that is or becomes generally available to the public other than as a result of disclosure in violation of this Agreement. This Section shall survive the expiration or termination of the Agreement. Confidentiality of information contained in this agreement is subject to the requirements of the Florida Public Records Act, Chapter 119, Fla. Stat., and the Florida Sunshine Law, Chapter 286, Fla. Stat. 19. Assignment. Smarte Carte shall not assign this Agreement or any part thereof, without the prior consent in writing of Owner. Any attempt to assign or otherwise transfer this Agreement or any part herein, without the Owner's consent, shall be void. If Smarte Carte does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Smarte Carte all of the obligations and responsibilities that Smarte Carte has assumed toward Owner. 20. Notice. All notices provided under this Agreement shall be in writing and personally delivered or sent by courier, or registered or certified mail, postage prepaid, return receipt requested, and additionally by e-mail, addressed as follows: to Owner: North Collier Regional Park 15000 Livingston Road Naples, FL 34109 E-mail: Richard DeGalan @colliergov.net Attention: Richard DeGalan to Smarte Carte: Smarte Carte, Inc. 4455 White Bear Parkway St. Paul, MN 55110 E-mail: Carr.1@smartecarte.com Attention: General Counsel ,CA( or to such other persons or places as either party may designate. 21. Governing Law. This Agreement will be governed exclusively by the laws of the State of Florida. 22. Dispute Resolution and Venue. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Smarte Carte with full decision-making authority and by Owner's representative. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 23. Entire Agreement. This Agreement, including all exhibits and schedules, constitutes the entire agreement between the parties and supersedes all previous understandings of the parties. The failure or refusal by either party to exercise any option, right or remedy contained herein, shall not be construed as a waiver or relinquishment for the future of such term, provision, option, right or remedy, but the same shall continue and remain in full force and effect. If any provision of this Agreement is held invalid, the remainder of this Agreement will remain in full force and effect. This Agreement may be modified only in writing executed by the parties. [The remainder of this page is intentionally left blank..! CAC 1 1 I i IN WITNESS WHEREOF, the parties have each, respectively, by an authorized person or agent,executed this Agreement on the date indicated below. OWNER: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA By' \`----- • ne Markie iez 1 .4 Interim Purchasing/General Services Director First Witness: SMARTE CARTE. INC. By: (-- a A ''(. A-10--Ct3 I . ( C3-asae- f ,Su-ra.__ By: fraiiil - ...—..e.! Print Name Date: /446r/ GARR Print Name and Title Second Witness: By: 8 aAk .4._ a..e._...,,A.. Eiit..s. b A.te•it, 0,5 I It.A.e Print Name Name Approved as to Form and Legality: 41,0 f Assistant County County Attorney EXHIBIT A EQUIPMENT Location Number of Lockers and Paypoints In front of changing rooms 4 paypoints and 160 lockers At EXHIBIT B LOCKER SPECIFICATIONS General Reference Information -Locker height: 6' —3" -Locker depth: 18" -Power source: 120 VAC 60 HZ -Electrical draw per access station: 1.5 AMP -Installation options -against existing wall -back to back against another bank of lockers To Be Provided By Owner - Accessible AC Power outlet(NEMA 5-15R)above each access station; -GFCI protected outlet(according to local code); -bottom of AC outlet should be installed 6'-5"above floor/locker pad level; -multiple access stations can operate on a dedicated electrical circuit. -For outdoor installations, a protective canopy, roof or awning is required; -constructed from non-porous material; -bottom to be installed 7'-4"above the locker pad; -extending 32"beyond the front face of lockers; and -extending 24"beyond the side end of the lockers. t:tit. EXHIBIT C DUTIES AND RESPONSIBILITIES Owner Operational Responsibilities Daily Operations: Resetting of locker doors. General cleaning of interior&exterior of lockers. Primary customer service point of contact. Removal of overdue items. Reporting and usage log. Equipment Repair and Maintenance: Primary response/clear observable obstructions: -Coin Acceptor -Credit Card Reader -Jammed locker doors Contact Smarte Carte's location manager with unresolved repair issues or the need for additional parts or specialized service. Smarte Carte Operational Responsibilities Bi-Weekly Operations: Collections of receipts. Equipment testing and trouble shooting. Training of Water Park staff on equipment and operations(as needed). Communicate with Water Park staff on general operation of the business. Monthly Operations: Usage and revenue reporting. Payment of rent. Equipment Repair and Maintenance to be provided at Smarte Carte's expense: Provide technical phone support regarding repair and maintenance. Order any additional parts or specialized service for the proper functional use of the equipment. Replacement of components, included but not limited to the following: -Credit Card Reader -Door actuator motor -CPUs and monitors -Interface electrical board Make on-site repairs,as needed, to ensure lockers are in working condition. AC"°® IY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYY) 01 ke..►'�. /1 512 01 4 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 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 i certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Match USA Inc. NAME:__.�_..�._—_......_..._____.___... ..._.—. _._.__.._...__....__........__—.. PHONE FAX - — 333 South 7th Street,Suite 1400 ,4At C-11.2..EaU:........................................—......_.--......-----_.__._......_.__ I T IA/C.No); Minneapolis,MN 55402-2400 EMAIL ADDRESS: INSURERMAFFORDING.COVERAGE...._..............___....._.._......__.......-...__.._NAIL R 402974-STND-GAW-13-14 LNA 14-620 Naples INSURER A:National Union Fire Ins Co Pittsburgh PA 19445 INSURED TE CARTE,INC. INSURER B:New Hampshire Insurance Company 23841 ATTN:JILL EHRMAN INSURER c:N/A N/A 4455 WHITE BEAR PARKWAY INSURER 0 WHITE BEAR LAKE,MN 55110 --._....._.._.........__._._......................_._......._.-_.........._....___..._._._....__._..._._. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-004842508-01 REVISION NUMBER:1 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. INSR TYPE OF INSURANCE D'$UBR POLICY EFF POLICY EXP LIMITS LTR INSR MD POLICY NUMBER IMMlDD1YYYY1 IMMlDp/YYYY1 A GENERAL LIABILITY GL 1929610(AOS) 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GL192683(MA) 1213112013 1113112014 _PREMISES(Ea occurrence)- $ 1,000'000 — CLAIMS-MADE [ X OCCUR MED EXP(My one person) $ 10900 PERSONAL 8 ADV INJURY S. 1,000900 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS.COMP/OP AGG $ 2,000,000 PR X POLICY JECT LOC $ A AUTOMOBILE UABILITY CA0934873 12/31/2013 12131/2014 COMBINED SINGLE LIMIT 2,000900 ANY AUTO BODILY INJURY(Per person) '$ -- ALL OWNED —SCHEDULED BODILY AUTOS BODILY INJURY(Per student) S .._.._ AUTOS X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS x AUTOS .lar r e R1?____— X COMP$1000 X COLL$1000 $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ ............ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION WC015684253(AOS) 12/31/2013 12/3112014 X WC STATU- 1 IOTH- AND EMPLOYERS'LIABILITY TORY LIMITS.L..........j._.E.a. B ANY PROPRIETOR/PARTNERlEXECUTIVE Y l N WC 015684250(KY,OH,WA,WY,MA,WI) 12/31/2013 12/31/2014 E.L.EACH ACCIDENT S 1,000'000 OFFICER/MEMBER EXCLUDED? N/A .___.._..._................_....___.........._...._._.._......_.._.._ B (Mandatory in NH) WM5684251(CA) 12/31/2013 12/31/2014 E.L.DISEASE-EA EMPLOYEE $ 1.000,000 It yes.describe under —,...__...__.._.........................1...............__. DESCRIPTION OF OPERATIONS below eddlbonal page. I E,L DISEASE-POLICY LIMIT $ 1'0000'0000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Re:Contract#14.6204"Locker Concession Agreement" Collier County Board of County Commissioners are included as additional insured for General Liability(Public Liability)coverage as respects contract agreement with the named insured. CERTIFICATE HOLDER CANCELLATION Collier County Board SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3327 Tamiami Trail East ACCORDANCE WITH THE POLICY PROVISIONS. Naples,FL 34112-4901 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Manashi Mukherjee -- .v JAcsi` -c. .,,,,o - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD j _ AGENCY CUSTOMER ID: 402974 LOC#: Minneapolis ACRE ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. SMARTE CARTE,INC. ATTN.JILL EHRMAN POUCY NUMBER 4455 WHITE BEAR PARKWAY WHITE BEAR LAKE,MN 55110 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 _ FORM TITLE: Certificate of Liability Insurance Workers Compensation Cont: Carrier The Insurance Company of the State of Pennsylvania Policy Number:WC 015684252(FL) Effective Date:12/31/2013 Expiration Date_12/31/2014 Limits Refer to Workers Comp limits on certificate Carrier:New Hampshire insurance Company Policy Number:WC 038238308(NJ,PA) Effective Date:1213112013 Expiration Date:12/31/2014 Limits:Refer to Workers Comp limits on certificate Carrier New Hampshire Insurance Company Policy Number:WC 038238305(AK,AZ,GA,VA) Effective Date:12/31/2013 Expiration Date:12/3112014 Limits:Refer to Workers Comp limits on certificate Carrier:New Hampshire Insurance Company Policy Number:WC 038238310(IL,NC,NH,UT) Effective Date:12/31,12013 Expiration Date:12/31/2014 Limits:Refer to Workers Comp limits on certificate ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I' _