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Backup Documents 06/10/2014 Item #16D8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 D 8 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. Colleen Greene County Attorney Office On& (0(4 I I 4. BCC Office Board of County Commissioners V N;5 L1V3 ik 5. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Natali Betanc a�+�.,31 � Phone Number 239-252-4 9 Contact/ Department Agenda Date Item was 06/10/14 Agenda Item Number 16D8 • Approved by the BCC Type of Document MOIL Number of Original 1 Attached Documents Attached PO number or account number if document is be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? NB 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be NB signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's -NB /Pc Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the NB document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NB signature and initials are required. 7. In most cases(some contracts are an exception),the original cument and this routing slip NW- should f f should be provided to the County Attorney Office at the tim the item is input into SIRE. 11 1 i Some documents are time sensitive and require forwarding o Tallahassee within a certain time frame or the BCC's actions are nullified. Be away f your deadlines! 8. The document was approved by the BCC on 06/10/1 and all changes made during the NB meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the NB BCC,all changes directed by the BCC have been made,and the document is ready for CAC Chairman's signature. 1:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 1608 MEMORANDUM Date: June 16, 2014 To: Natali Betancur, Operations Analyst Park & Recreation Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Memorandum of Understanding (MOU) with Naples BMX, Inc. for the use of facilities at Collier County's "Wheels" Park Attached for your records is a copy of the MOU referenced above, (Item #16D8) approved by the Board of County Commissioners on Tuesday, June 10, 2014. The original document will be held in the Minutes & Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment 1608 `oV 1ER Co ,Y FACILITY USE MEMORANDUM OF UNDERSTANDING Parks Recreation Plau(annerr.+Omalt, COLLIER COUNTY"WHEELS"BMX PARK This MEMORANDUM OF UNDERSTANDING is made by and between Collier County and NAPLES BMX, as Co-Sponsor Organization, and hereby entered on this IO+h day of :Yune , 2014. OVERVIEW The Collier County Parks and Recreation Department (CCPRD) is fortunate to have volunteers who execute youth and family sports programs on behalf of the County. In this unique partnership, the County provides resources to construct and maintain quality facilities. Youth and family Sports Organizations provide volunteer personnel, , to staff, organize, plan and administer outstanding sports programs. Together, this team ensures that wholesome, healthy and enjoyable recreation activities are available to literally thousands of youth in the County. Since the County provides valuable assets that are funded by taxpaying citizens and the County allows use of these assets to the Organizations, Organizations must be prepared to provide their services in compliance with existing County policies, ordinances and good business practices. In addition, there may be times when the County is asked to become involved in issues related to Organization operations. In these instances, the Organization must be prepared to cooperate with the CCPRD or the Board of County Commissioners to resolve issues in cases not specifically covered by this Memorandum of Understanding MOU. (This MOU which includes policies and procedures will apply to all approved park sites, as well as CCPRD approved school sites). I. GUIDELINES FOR BECOMING A CO-SPONSOR ORGANIZATION a. These guidelines are applicable to the above-named Organization as if specifically agreed to herein. b. A co-sponsored organization is defined as a group, designated as such by CCPRD sharing the basic objectives of CCPRD as stated above, and that requests either advertising assistance, or use of the Park and Recreation facilities for a program / league or event which the Department believes will be mutually compatible with its goals and will further the recreation needs of the Community in general. c. Co-sponsor organizations/ leagues must offer a recreational component. d. Organizations / leagues that co-sponsor with CCPRD must be not-for-profit, which is defined as being a Collier County community based or community serving organization not affiliated with or controlled by a for-profit entity. e. All co-sponsored organizations / leagues must have a total program membership with at least 90% being residents of Collier County. The determination of the 90% shall be based on the registration list submitted with the request for facility usage on the appropriate due date given by CCPRD. Co-sponsor status will not be granted to any organization as a short term relationship. A minimum term is one year. Page 1 of 7 16138 II. GENERAL a. The Organization agrees to provide a "Recreational" youth sports program as a service for the County. Recreational is defined in Paragraph II. e. In return for providing the youth and family sports program and for fulfilling the other requirements of this MOU, the County hereby waives all hourly field/facility rental fees, which are routinely charged to other non-affiliated organizations. Such fees may be levied, however, if it is determined that facilities are being used to subsidize individual income of paid or volunteer Organization staff, or that events that are not routine local events. b. The term of this MOU will be one year and will begin on the date of Board approval and continue for one year. The term of this MOU may be extended for one (1) additional year by approval of both parties with at least thirty days notice prior to expiration. Either party may terminate this MOU at any time with thirty (30) days written notice. Collier County may terminate for cause at anytime without notice. c. Naples BMX may use the WHEELS' facilities including the start gate on a non-exclusive basis to conduct a recreational BMX program at the following location(s): Collier County WHEELS Park d. This MOU includes the use of all support structures (i.e. bleachers and dugouts) and the BMX start gate at the above locations, unless otherwise specified by addendum to this MOU. e. For purposes of this MOU, a recreational program is designed as a non-competitive program where all participants who register under existing guidelines will be able to to participate in events with others of similar age and ability. Tryouts are acceptable only for the purpose of placing participants in the appropriate age and skill bracket. The Organization agrees to comply with The Americans with Disabilities Act (ADA) guidelines, which prohibit the discrimination against individuals with disabilities in any aspect of their program. The Act requires organizations to provide reasonable accommodations to enable participants with disabilities to play, unless doing so would impose an undue hardship on the organization. f. The Organization must provide to the CCPRD: 1. a list of Board of Directors and/or Organization Officers with contact information (annually); 2. Naples BMX Membership list including participant addresses (prior to start of Season); 3. current set of by-laws, with amendments if applicable (annually); 4. proof of liability insurance/certificate of insurance coverage: General Liability coverage of not less than $1,000,000 per occurrence (annually); 5. The liability insurance policy must include the Collier County Board of County Commissioners as a named additional insured (annually). g. The Parks and Recreation logo must be displayed prominently on all brochures, flyers, registration forms and other advertising materials, not to exclude advertisements in the news media. Page 2 of 7 9 1608 h. The Organization is empowered by the County to control the behavior of participants and spectators during the sporting event to the same extent the County is so empowered. The Organization or CCPRD representative can have an unruly or dangerous participant, coach, parent or spectator removed from the premises during sporting events. Any Organization, officer, coach, umpire / official, CCPRD representative can exercise this authority. The Organization, through these people, may contact the Collier County Sheriff's Office for assistance, if necessary. III. SCHEDULES a. The Organization agrees to provide CCPRD with a written schedule of local events at least 30 days in advance. Proposed scheduled effective 1/1/14 Mondays 5:30—8:30 pm Wednesdays 5:30—8:30 pm Fridays 5:30— 10:00 pm Saturdays— 3 Saturdays per month 9:00 am-3:00 pm b. The Organization will also provide written updates or changes to the original schedule. c. Once the Board of County Commissioners has approved the MOU, the schedule and the insurance, the Organization shall have exclusive use of the facility for all dates and times listed on the approved schedule. Note: The CCPRD site representative will make the final decision on whether or not a facility or field is usable during designated times. d. The Organization may hold two (2) organizational meetings per season at their respective park site building. This will be at no charge providing a reservation is booked with CCPRD. All other facility/building usage requests are handled as a facility rental and all fees will apply. IV. FACILITIES/SECURITY a. The Organization agrees to police all areas being used to ensure that trash and litter are cleaned up after use. These areas include any support structures at a facility used by the Organization. If cleanup for each event is not done in a reasonable amount of time and the County is required to do the cleanup, then the cost to the County may be charged to the Organization. b. The Organization should notify the CCPRD of any damage, vandalism, needed repairs and/or safety issues at their respective facility as soon as possible, not later than the next working day. If damage is a result of Organization members' negligence or failure to comply with accepted operational or security measures, the Organization may be held responsible for reimbursing the County for all or part of repair costs. c. The Organization is responsible for monitoring the facilities during the Organization's use. Hourly inspections of restrooms are required to ensure that their members are not purposely or inadvertently causing damage to the facilities. The Organization may_be Page 3 of 7 160 8 responsible for locking and unlocking Wheels access gates when staff isn't present. A Key Usage form is required for any keys received. d. The Organization shall not allow alcoholic beverages and/or illegal drugs to be on County property or in County facilities as it pertains to their organization. All Sport Organizations will comply with the Code of Laws and Ordinances of Collier County, Florida, Chapter 98, Parks and Recreation and applicable Florida Statutes. e. Co-sponsored Leagues or Organizations cannot display signs, banners or posters on County property (Community Parks/School approved sites) without prior approval by the CCPRD Director or designee, and then must remove them at the end of their regular season. Signs at Regional Parks can only be displayed during game play and must be removed after each game. All signage must comply with local zoning regulations. County zoning regulation may be obtained by contacting 239-252-5603. City of Naples zoning regulations may be obtained by contacting 239-213-5020. f. The Organization shall not allow vehicles in other-than designated parking areas, including concession buildings and office areas, unless specifically authorized by the CCPRD. The Collier County Sheriff's Office and/or the Collier County Park Rangers may issue citations for illegally parked vehicles, or for reckless operation(speeding, etc.) of vehicles on County property. g. The Organization shall not be allowed to alter, add, delete or improve the facilities without prior written consent by the CCPRD Director. Such alterations, additions or improvements shall meet existing applicable County codes, and become and remain County property. h. For events outside of routine recreational activities where large amounts of trash are expected, Organizations should rent adequately sized dumpsters for the duration of the activity, and ensure that trash bags are deposited in the dumpster(s). Dumpsters shall be removed from the site the last day of or the day after the tournament or activity. This will be coordinated and paid for by the Organization with the approval of the respective park site representative. i. The Organization will be required to complete a separate contract for every event hosted abo V e U11U UL•V U11i1 local ..V 4.11ts and VV ill UV required to pay U facility UJUUL rental fee. The Organization will also incur the cost of lighting the track if required. These fees are required whether it is a co-sponsored organization/program or a non-cosponsored orizan1LUtion U1Vt_1arn. he events are exempt Li*= -____ ___ ____ ________ _ ___-__ ___ _____ Olympic Day Race and the Bob Warnicke Race. These races are promotional races, some of which arc required by the USARMX, The revenue collected will he provided to the j. Any Organizations serving food must complete the Concession MOU and abide by its terms, maintenance program is required to preserve the life of the track, reduce long-term capital expenditures and ensure safe riding conditions. The County provides certain services in ..._..,._.1..__.... ._.'.L .L.. .._...:1.,L1.. L...1._... .._..1 L..__.-r i__ ........ EL.. d-._._.-_.:.....:..__ _....._.. supplement this maintenance effort either with materials, funding or other available resources at their disposal. The Organization agrees that no maintenance will he ::..riducted without prior approval from the CCPRD. I';lAP4nf7 Or 16D8 1. The Organization agrees to have a background check process in place for all adult volunteers involved with the Organization at their expense. The Organization may not engage any volunteer or coach who has not passed a background check that is compliant with USA/BMX rules and regulations. As per SB 150: Sports Coaches/Criminal History Screening, all organizations must sign an affidavit prior to the beginning of the season stating that all coaches have been screened. m. Waiver and Release Pertaining to the Use of Collier County Parks and Recreation Premises: Naples BMX ("ORGANIZATION"), agrees to release from liability, and to hold harmless the Collier County Board of Commissioners ("COUNTY"), its employees and agents against any and all claims brought by or on behalf of the ORGANIZATION, any person, or legal entity which may arise from the ORGANIZATION'S use of the County's property or premises. The ORGANIZATION agrees to indemnify and hold harmless the COUNTY from any act of negligence of the ORGANIZATION, its' agents, contractors or employees, from all costs, attorney's fees, expenses, and liabilities incurred as a result of any claim or proceeding brought thereon, all to the extent of the County's liability under general law. n. Other provisions not found in the MOU may be established in consultation with and written approval of the Parks and Recreation Director. Any additions or deletions will be attached to the MOU and be in force for the duration of the MOU. V. Naples BMX Obligations a. Naples BMX agrees that it shall run all USABMX sanctioned events and activities and that all eligible applicants will be authorized to participate. b. Naples BMX agrees that all Naples BMX activities shall be performed in strict compliance with USA BMX standards. c. Naples BMX agrees to provide the following positions during all Naples BMX operating times: (1) Certified, valid Track Operator, or(2) Certified, valid Naples BMX Inc. board member. d. Naples BMX agrees to provide the following positions as required by USA BMX in addition to (1)Certified, valid Track Operator or, (2) Certified,valid Naples BMX Inc. board member and a Certified,valid Teaching Coach. e. Naples BMX agrees that it shall be responsible for safe use of the start gate in accordance with Wheels Skate and BMX Standard Operating Procedures. f. Naples BMX agrees that it shall be responsible for any damage or vandalism occurring during usage or as a result of failing to adequately secure the start gate. g. Naples BMX agrees that it shall be responsible for tarping and untarping the track before and after use if applicable. h. Naples BMX agrees that it shall be responsible to provide manpower to assist with on-going maintenance.. i. Naples BMX agrees that it shall be responsible for all financial obligations to BMXUSA and Florida SSA for sanctioned activities and events. j. Naples BMX agrees that it shall be responsible to provide a monthly schedule of local events to the Parks and Recreation Director or his designee at least thirty days in advance. Page 5 of 7 CA ,; 1608 k. Naples BMX agrees that regional, state, and national events must be approved by the Parks and Recreation Director or designee at least four(4)months in advance. Some events may require Board of County Commissioners approval. 1. Naples BMX agrees that Collier County programming,repair and maintenance needs will supersede those of Naples BMX. VI. Collier County Obligations a. Collier County agrees that it shall be responsible for major track renovations subject to budget availability and Board approval as needed. b. Collier County agrees that it shall be responsible for the track and start gate when it is open to the general public during non-Naples BMX reserved hours. c. Collier County agrees that it shall be responsible to collect all funds associated with general public usage and Collier County sponsored programs. d. Collier County agrees that it shall be responsible to provide weekly maintenance with assistance from Naples BMX. VII. FINANCIAL a. The Organization must submit an annual financial report, including revenues and expenditures to the Parks and Recreation Department Director by January 15th of the prior year following the most recent facility request by the co-sponsor organization / league. b. A new co-sponsor request for the Organization will not be completed until the financial reports have been submitted and reviewed by the Parks and Recreation Director, or the assigned designee from the previous year. c. Audit: The County reserves the right to conduct an internal audit (conducted by County staff) of the Organization's financial records at any time. Audits can be conducted with no advance notice and the Organization should be prepared to produce the requested information or documentation. The County will absorb the cost of conducting these internal audits. Moreover, if warranted by the County based on results of the internal audit, an independent audit (on the cash basis of accounting) by a Certified Public Accounting firm may be required. The Organization will be responsible for the cost associated with this independent audit. d. For Organizations sharing facilities, following the conclusion of a season, the entire concession stand and storage area will be cleared for the next Organization's season. Should an Organization choose to sell another Organization remaining concession products, this transaction needs to take place prior to the beginning of the next Organization's season. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK SIGNATURE PAGE TO FOLLOW Page 6 of 7 CA 1608 This Memorandum of Understanding is signed and agreed by the parties this IOCl" day of Tore -, 2014. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, Clerk COLLIER COUNT/ , FLORIDA Ciitdp # I oc: By I - / Attes as. al i' iSty Clerk • HENNING, C' A IRMAN signature only Approved.as to form and legality: L C 60.1A1/1/1.2k olleen M. Greene, Assistant County Attorney WITNESSES: Naples BMX -(11Yl'JPS A (},1'-e By: A-7- 6 :------ Printed N. e: Printed Name: A74e-, / /-/ ,- ilte Title:%pre ,e4 Printed Name: ito c x`rra►j 4 ay,J STATE OF FLORIDA COUNTY OF COLLIER Signed and acknowledged on this 0 day of _ A , 2014, before me, the undersigned notary public, by �1%a Co/ f! i'%r , President of Naples BMX, a Florida corporation not-for-profit, on behalf of the corporation. He [] is personally known to me or [ ] produced \A , Li sf i v., as identification. A ilk ■ I No . "Folic Printed Name:AT.y\�� b /( My Commission Expires: 1/86 p�(�'7- iLa Item# MY COMMISSION N EE 870058 • ulu°' EXPIRES:January 30,2017 Agenda/„�{�,t N.ov c�oP°' Bonded Thru Budget Notary Services Date �J ICU Date Rec'd t , f Page7of7 Deputy C' Illp 0 , ,, 1 b Dom_____ Client#:1067930 AMERIBIC1 ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 2/21/2014 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 certificate holder in lieu of such endorsement{s). PRODUCER CONTACT US{Insurance Services LLC-CL NAME; (A/CC,No,Ex1):602-279-5800 rr 2201 E.Camelback Rd Suite 220A ((ac,No):602-Z79-5899 EMAIi Phoenix,AZ 85016 Mss, phx-certificates @usi.bix INSURER(S)AFFORDING COVERAGE i-- _� MAtC# INSURED INSURER A:Philadelphia Indemnity Insuranc 11805$ American Bicycle Association INSURER B: `— - DBA:USA BMX INSURER C: P.O.Box 718 INSURER O: Chandler,AZ 85244 INSURER E: INSURER F: ._ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD 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 ADDL SUER' POLICY EFF • POLICY EXP LTR TYPE OF INSURANCE IiJSFt WYD _-- POLICY NUMBER {MMtOD/YYYY}=(MM/DDNYYY) LIMITS A GENERAL LIABILITY Y Y PHPK1136495 03/01/2014:03/01/2015 EACH occuRRENCE 1s1,000,000 XI COMMERCIAL GENERAL LIABILITY { DAMAGET RENTED PREMISES ca occurrence) $100,000 I 'CLAIMS-MADE l Xi OCCUR ! j Ii MED EXP(Any one person) S Excluded ' ! PERSONAL&ADV INJURY S1,000,000 I I GENERAL AGGREGATE S5,000,000 GEM.AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGO S1,000,000 XI POLICY 1 i 5-r I-1 LOO.. ,_.--_-�� I Abuse/Molest $1,000,000 A AUTOMOBILE LIABILITY I PHPK1136495 03/01/2014 03/01/2015 coMBiNED SINGLE LIMIT (Eeacctdent) 51,000,000 X ANY AUTO (BODILY INJURY(Per S ALL OWNED + 1 SCHEDULED - person) � AUTOS AUTOS 'BODILY INJURY(Per accdent) S X HIRED AUTOS X -,NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) S 1 S A x:UMBRELLA Li 1 X OCCUR Y V PHUB450342 03/01/2014,03/01/2015 EACH OCCURRENCE ' 00 s4 0 000 i EXCESS LAB — .-.—._..._ r .� I I CLAIMS MADE DEC I X RETENTION$10,000 i AGGREGATE �4addds000,�.�,__.. WORKERS COMPENSATION I i S I AND EMPLOYERS'LIABILITY i WC TORY LIMITS I OTH-' Y/N ITORY LIMITS I ER ANY PROPRIETORIPARTU0RtEXECUTIVE k t OFFICER/MEMBER EXCLUDED? N/A j E.L EACH ACCIDENT _S .(Mandatory In NH) '{ If yes.describe under i E.L.DISEASE•EA EMPLOYEE S I DESCRIPTION OF OPERATIONS below i ! ss _�._....___..__.-., ! I E.L DISEASE-POLICY LIMIT I S I DESCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES(Abaci)ACORD 101,Additional Remarks Schedule,if more space is required) The General Liability policy includes a blanket automatic Additional Insured endorsement that provides Additional Insured and a Blanket Waiver of Subrogation status to the Certificate holder,only when there is a written contract or written agreement between the named insured and the certificate holder that requires such status,and only with regard to the above referenced on behalf of the named insured. The General Liability policy contains a special endorsement with"Primary and Noncontributory"wording. Re:Naples BMX Inc.Track#1916 CERTIFICATE HOLDER CANCELLATION SHOULD XP OVE DE THE EIRATION ANY OF THE DATABE THEREOFSCRIBED, NOTICE POLICIES WILL BE BE CANCELLED DELIVERED BEFORE IN BCC of Collier County - ACCORDANCE WITH THE POLICY PROVISIONS. 3299 Tamiami Tr. E. AUTHORIZED REPRESENTATIVE Naples, Fi. 34112 t/� 4 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S11714251/Ni11713223 CXTJD