Backup Documents 02/14/2012 Item #16D 1160 i
MEMORANDUM
Date: February 23, 2012
To: Diana De Leon, Contract Technician for Jack Curran
Purchasing Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Contract #12 -5799
"Senior Food Services"
Contractor: GA Food Service of Pinellas County /d.b.a
GA Foods, Inc.
Attached, is an original copy of the contract referenced above (Item #16D1),
approved by the Board of County Commissioners on Tuesday, February 14,
2012.
The second original will be held on file with the Minutes and Record's
Department in the Board's Official Records.
If you have any questions, please contact me at 252 -7240.
Thank you.
i��M. I�E-_.m_
Memorandum
Subject: Contract No. #12 -5799 "Senior Food Services"
Date: February 14, 2012
160
Purchasing Department
3327 Tamiami Trail East
Naples, Florida 34112
Telephone: (239) 252-8949
FAX: (239) 252-6594
Email: KelseyWardea colliergov.net
www.colliemov.net/purchasing
From: Diana DeLeon for Kelsey Ward, Contract Administration Manager
To: Ray Carter, Manager Risk Finance
This Contract was approved by the BCC on February 14, 2012 agenda item 16.D.1.
El
The County is in the process of executing this contract with GA Food Service of Pinellas County d.b.a. GA Foods,
Inc.
Please review the Insurance Certificate(s) for the referenced Contract.
• if the insurance is not in order please contact the vendor /insurance company to obtain a proper
certificate. Once you receive the proper certificate(s), please acknowledge your approval and send to the
County Attorney's office via the attached Request for Legal Services.
Q ,
• /f the insurance is in order please acknowledge your approval and send to the County Attorney's office via
the attached Request for Legal Services.
If you haye.aQ� questiWs, please contact me at the above referenced information.
k Finance Signature
RECEIVED
R16K MANAGEMEW
(Please route to County Attorney via attached Request for Legal Services)
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G/ Acquisitions` /AgentFo rmsandLetters /RiskMgmtReviewofl nsura nce4/15/2010/16/09
16D i
A G R E E M E N T 12-5799
for
Senior Food Services
THIS AGREEMENT, � made and entered into on this ay of - - fqO12, by and
between GA Food Service of Pinellas County, d.b.a. G.A. Food Service, Inc., aithorized to do
business in the State of Florida, whose business address is 12200 32nd Court, North, St.
Petersburg, FL 33716, hereinafter called the "Contractor" and Collier County, a political
subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County ":
WITNESSETH:
1. COMMENCEMENT. The Contractor shall commence the work upon the issuance of a
Purchase Order. The contract shall be for a one (1) year period, commencing on the date
of Collier County Board approval, and terminating on December 31, 2012.
The County may, at its discretion and with the consent of the Contractor, renew the
Agreement under all of the terms and conditions contained in this Agreement for three
(3) additional one (1) year periods in accordance with the grant requirements. The
County shall give the Contractor written notice of the County's intention to extend the
Agreement term not less than ten (10) days prior to the end of the Agreement term then
in effect.
2. STATEMENT OF WORK. The Contractor shall provide Senior Food Services in
accordance with the terms and conditions of Bid #12 -5799, specifically including
Exhibit I: Scope of Work, and Exhibit IA: Additional Grant Requirements and the
Contractor's proposal referred to herein and made an integral part of this agreement.
This Agreement contains the entire understanding between the parties and any
modifications to this Agreement shall be mutually agreed upon in writing by the
Contractor and the County contract manager or his designee, in compliance with the
County Purchasing Policy and Administrative Procedures in effect at the time such
services are authorized.
3. COMPENSATION. The County shall pay the Contractor for the performance of this
Agreement the aggregate of the units actually ordered and furnished at the unit price, as
per Exhibit A, Price Schedule, attached herein and incorporated by reference.
Contractor shall be responsible for all other costs and expenses associated with activities
and solicitations undertaken pursuant to this Agreement.
Page 1 of 9
160 1
Payment will be made upon receipt of a proper invoice and upon approval by the
Contract Manager or his designee, and in compliance with Chapter 218, Fla. Stats.,
otherwise known as the "Local Government Prompt Payment Act ".
3.1 Payments will be made for services furnished, delivered, and accepted, upon
receipt and approval of invoices submitted on the date of services or within six (6)
months after completion of contract. Any untimely submission of invoices beyond
the specified deadline period is subject to non - payment under the legal doctrine of
"laches" as untimely submitted. Time shall be deemed of the essence with respect to
the timely submission of invoices under this agreement.
4. SALES TAX. Contractor shall pay all sales, consumer, use and other similar, taxes
associated with the Work or portions thereof, which are applicable during the
performance of the Work.
5. NOTICES. All notices from the County to the Contractor shall be deemed duly served
if mailed or faxed to the Contractor at the following Address:
G.A. Food Service, Inc.
Attn: James J. LoBianco, President
12200 32nd Court, North
St. Petersburg, FL 33716
Telephone: (727) 573 -2211
Facsimile: (727) 571 -1652
All Notices from the Contractor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department
3327 Tamiami Trail, East
Naples, Florida 34112
Attention: Steve Carnell, Purchasing/ GS Director
Telephone: 239 -252 -8371
Facsimile: 239 - 252 -6584
The Contractor and the County may change the above mailing address at any time upon
giving the other party written notification. All notices under this Agreement must be in
writing.
Page 2 of 9
160 1
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Contractor or to constitute the Contractor as
an agent of the County.
7. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits
necessary for the prosecution of the Work shall be obtained by the Contractor. Payment
for all such permits issued by the County shall be processed internally by the County.
All non - County permits necessary for the prosecution of the Work shall be procured
and paid for by the Contractor. The Contractor shall also be solely responsible for
payment of any and all taxes levied on the Contractor. In addition, the Contractor shall
comply with all rules, regulations and laws of Collier County, the State of Florida, or the
U. S. Government now in force or hereafter adopted. The Contractor agrees to comply
with all laws governing the responsibility of an employer with respect to persons
employed by the Contractor.
8. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to
use in any manner whatsoever, County facilities for any improper, immoral or offensive
purpose, or for any purpose in violation of any federal, state, county or municipal
ordinance, rule, order or regulation, or of any governmental rule or regulation now in
effect or hereafter enacted or adopted. In the event of such violation by the Contractor
or if the County or its authorized representative shall deem any conduct on the part of
the Contractor to be objectionable or improper, the County shall have the right to
suspend the contract of the Contractor. Should the Contractor fail to correct any such
violation, conduct, or practice to the satisfaction of the County within twenty -four (24)
hours after receiving notice of such violation, conduct, or practice, such suspension to
continue until the violation is cured. The Contractor further agrees not to commence
operation during the suspension period until the violation has been corrected to the
satisfaction of the County.
9. TERMINATION. Should the Contractor be found to have failed to perform his
services in a manner satisfactory to the County as per this Agreement, the County may
terminate said agreement for cause; further the County may terminate this Agreement
for convenience with a thirty (30) day written notice. The County shall be sole judge of
non - performance.
10. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as
to race, sex, color, creed or national origin.
11. INSURANCE AND BONDS. The Contractor shall provide insurance as follows:
A. Commercial General 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 Premises and Operations; Independent
Contractors; Products and Completed Operations and Contractual Liability.
Page 3 of 9
16D Y
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 of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits.
The coverage must include Employers' Liability with a minimum limit of $500,000 for
each accident.
D. Umbrella Liability: $2,000,000 Limit to apply in excess of underlying Employer
Liability, Commercial General Liability and Automobile Liability
E. BONDS. For projects in excess of $200,000, bonds shall be submitted with the
executed contract by Contractor, and written for 100% of the Contract award amount,
the cost borne by the Contractor. The Performance and Payment Bonds shall be
underwritten by a surety authorized to do business in the State of Florida and otherwise
acceptable to the County; provided, however, the surety shall be rated as "A-" or better
as to general policy holders rating and Class V or higher rating as to financial size
category and the amount required shall not exceed 5% of the reported policy holders'
surplus, all as reported in the most current Best Key Rating Guide, published by A.M.
Best Company, Inc. of 75 Fulton Street, New York, New York 10038.
Special Requirements: 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 requirement herein identified shall be
maintained by Contractor during the duration of this Agreement. Renewal certificates
shall be sent to the County ten (10) days prior to any expiration date. There shall be a
thirty (30) day notification to the County in the event of cancellation or modification of
any stipulated insurance coverage.
Contractor shall insure that all subContractors comply with the same insurance
requirements that he is required to meet. The same Contractor shall provide County
with certificates of insurance meeting the required insurance provisions.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the
Contractor shall indemnify and hold harmless Collier County, its officers and
employees- from any and all liabilities, damages, losses and costs, including, but not
limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the
negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone
employed or utilized by the Contractor in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce any other
Page 4 of 9
16D 1
rights or remedies which otherwise may be available to an indemnified party or person
described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of Collier
County.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of
the County by the Housing, Human and Veterans' Services (HHVS) Department.
14. CONFLICT OF INTEREST: Contractor represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Contractor further represents that
no persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the attached
component parts, all of which are as fully a part of the contract as if herein set out
verbatim: Contractor's Proposal, Insurance Certificate, Performance and Payment
Bonds, ITB #12 -5799 Specifications/ Scope of Services specifically including Exhibit I:
Scope of Work, and Exhibit IA: Additional Grant Requirements and any Addenda, and
attached Exhibit A. Price Schedule.
16. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between
the parties herein that this agreement is subject to appropriation by the Board of County
Commissioners.
17. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or
individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee,
service or other item of value to any County employee, as set forth in Chapter 112, Part
III, Florida Statutes, Collier County Ethics Ordinance No. 2004 -05, and County
Administrative Procedure 5311. Violation of this provision may result in one or more of
the following consequences: a. Prohibition by the individual, firm, and/or any
employee of the firm from contact with County staff for a specified period of time; b.
Prohibition by the individual and/or firm from doing business with the County for a
specified period of time, including but not limited to: submitting bids, RFP, and/or
quotes; and, c. immediate termination of any contract held by the individual and/or
firm for cause.
18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement,
the Contractor is formally acknowledging without exception or stipulation that it is fully
responsible for complying with the provisions of the Immigration Reform and Control
Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either
may be amended. Failure by the Contractor to comply with the laws referenced herein
shall constitute a breach of this agreement and the County shall have the discretion to
unilaterally terminate this agreement immediately.
Page 5 of 9
16D 1
19. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful proposer extending the pricing, terms and
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement
shall remain in effect.
21. ADDITIONAL ITEMS /SERVICES. Additional items and/or services may be added to
this contract in accordance with the Purchasing Policy.
22. DISPUTE RESOLUTION. 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 Contractor with full decision - making authority and by
County's staff person who would make the presentation of any settlement reached
during negotiations to County for approval. Failing resolution, and prior to the
commencement of depositions in any litigation between the parties arising out of this
Agreement, the parties shall attempt to resolve the dispute through Mediation before an
agreed -upon Circuit Court Mediator certified by the State of Florida. The mediation
shall be attended by representatives of Contractor with full decision - making authority
and by County's staff person who would make the presentation of any settlement
reached at mediation to County's board for approval. Should either party fail to submit
to mediation as required hereunder, the other party may obtain a court order requiring
mediation under section 44.102, Fla. Stat.
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. KEY PERSONNEL/STAFFING: The Contractor's personnel and management to be
utilized for this project shall be knowledgeable in their areas of expertise. The County
reserves the right to perform investigations as may be deemed necessary to ensure that
competent persons will be utilized in the performance of the contract. The Contractor
shall assign as many people as necessary to complete the project on a timely basis, and
each person assigned shall be available for an amount of time adequate to meet the
dates set forth in the Project Schedule. The Contractor shall not change Key Personnel;
as identified in the Contractor's proposal, unless the following conditions are met: (1)
Proposed replacements have substantially the same or better qualifications and/or
experience. (2) that the County is notified in writing as far in advance as possible. The
Contractor shall make commercially reasonable efforts to notify Collier County within
seven (7) days of the change. The County retains final approval of proposed
replacement personnel.
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16D 1
24. ORDER OF PRECEDENCE: In the event of any conflict between or among the terms of
any of the Contract Documents, the terms of the ITB and/or the Contractor's Proposal,
the Contract Documents shall take precedence. In the event of any conflict between the
terms of the ITB and the Contractor's Proposal, the language in the ITB would take
precedence.
******* * *** * **** **********The rest of this page intentionally left blank * *** * * ***** * * * *** * **** ***
Page 7 of 9
16D 1
IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first
above written.
ATTEST:
Dwight E. Brock, Clerk of Courts
By.
Dated:
(SEAL) 4 06
Attlst in to pit ir' 0 , 41
004twe 4111%
First Witness
David Karpan
TType/ print witness na
Second Witness
Rosalind H. Dawson _
TType /print witness nameT
Approved as to form and
legal sufficiency:
Print Name
BOARD OF COUNTY COMMISSIONERS
COLLIER COTJNTY, FLORID
Rv-
Fred. W. Coyle, Chairman
Contractor
Page 8 of 9
James J. LoBianen, president
Typed signature and title
16D 1
Price Schedule
12 -5799 Senior Food Services
Note: Additional cash discount of 2.25% if payment is made within thirty (30) days.
Page 9 of 9
Bulk Food Program
Breakfast
$ 4.20
1
Bulk Food Program
Lunch
$ 4.40
2
Pre- packaged Site Specific Program
Breakfast
$ 4.36
3
Pre- packaged Site Specific Program
Lunch
$ 4.35
4
w/o all side items pre - packed i.e.,
bread /butter, dessert
Pre - packaged Site Specific Program
Lunch
$ 4.71
5
w all side items pre - packed i.e.,
bread /butter, dessert
6
Pre - packaged Home Delivery Program
Lunch
$ 5.58
TWO PACK
7
Pre - packaged Home Delivery Program
Lunch
$ 5.43
FIVE PACK
8
Pre - packaged Home Delivery Program
Lunch
$ 5.38
SEVEN PACK
9
Pre - packaged Home Delivery Program
Lunch
$ 5.38
FOURTEEN PACK
10
DRI Shelf Stable meal packs TWO
lunch
$ 4.84
PACK
11
DRI Shelf Stable meal packs THREE
lunch
$ 4.84
PACK
12
DRI Shelf Stable meal packs FIVE
lunch
$ 4.89
PACK
13
DRI Shelf Stable meal packs SEVEN
lunch
$ 4.94
PACK
14
C1 frozen meal
lunch
$ 4.79
15
C1 cold meal
lunch
$ 6.08
Note: Additional cash discount of 2.25% if payment is made within thirty (30) days.
Page 9 of 9
&D
A� ORO
CERTIFICATE OF LIABILITY INSURANCE DATE /YYY1�
1/2412012 24120a/zoiz
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 Lisa Rollin SWOrth
NAME: 9
Commercial Lines - (813) 639 -3000
PHONE N. E 813- 636 -5476 FAX Ne, 813- 636 -7192
C.
Wells Fargo Insurance Services USA, Inc.
ADDRESS: clw.certrequest@wellsfargo.com
' INSURER(S) AFFORDING COVERAGE
NAIC 0
2502 N. Rocky Point Drive, Suite 400
INSURER A : American Zurich Insurance Company
40142
Tampa, FL 33607
INSURED
INSURER 8: American Economy Insurance Co.
19690
G. A. Food Service of Pinellas County, Inc.
INSURER C ; North River Insurance Company
21105
DBA G.A. Food Service Inc
INSURER 0: Manufacturers Alliance Insurance Company
36897
12200 32nd Court, North
INSURER E:
St. Petersburg, FL 33716
INSURER F:
GENERAL AGGREGATE
COVERAGES CERTIFICATE NUMBER: 3846$$7 REVISION NUMBER: See helnw
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.
ILTR
TYPE OF INSURANCE
ODL
U
POLICY NUMBER
POLICY EFF
POOALI p EXP
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
CP09671871 -03
03/15/2011
03/15/2012
EACH OCCURRENCE
$ 1,000,000
NT MaGel
$ 700,000
MED EXP (Any one person)
$ 5,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
S 2,000,Q00
X POLICY PRO- LOC
S
B
AUTOMOBILE LIASILUY
02CE216187 -2
03/15!2011
03/15/2012
COMBINED SINGXL—IMrr
1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
X HIRED AUTOS X AUTOS NED
PROPER a DAMAGE
$
X HCPD - $70,0 X $1,000
Comprehenslvm Deductible
$ $1,000
C
X
UMBRELLALIAB
X
OCCUR
553- 094083 -8
03/15/2011
03/15/2012
EACHOCCURRENCE
$ 15,000,000
AGGREGATE
S 15,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTIONS 0
S
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNEPJFXECUTIVE ❑
OFFICERIMEMBER EXCLUDED7
N r A
201200-0298901
01 /01/2012
01101/2013
X WC STATU- OTH-
TORY LIMITS 7
E.L. EACH ACCIDENT
S 500,000
E.L. DISEASE - EA EMPLOYEE
$ 500,000
(Mandatory ht NH)
If yes, desorloe under
E.L. DISEASE - POLICY LIMIT
S 500,000
DESCRIPTION OF OPERATIONS below
I
__F
I
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (A11ach ACORD 101, Additional Remarks Schedule, If more space Is required)
REBID #08 -5037 RE: SOLICITATION 12 -5799 SENIOR FOOD SERVICE
SENIOR NUTRITION PROGRAM FOR HOUSING & HUMAN SERVICES COLLIER COUNTY BOCC ARE ADDITIONAL INSURED RE GENERAL
LIABILITY FOR ANY AND ALL WORK PERFORMED ON BEHALF OF COLLIER COUNTY.
Certificate holder will be given 30 days Notice of Cancellation In regards to the General Liability policy as per endorsement U- GL- 1446 -A-FL attached.
COLLIER COUNTY BOCC
ATTN:PURCHASING DEPARTMENT
3327 EAST TAMIAMI TRAIL
NAPLES FL 34112
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I ne AGUKU name ana logo are reglWarea marks of ACORD 01988.2010 ACORD CORPORATION. All rights reserved.
rta.Haft+„� Wk.araeusee:..mmrmrmrn
Notification to Others of Cancellation
160 1
19
ZURICHb
Policy No.
Eff. Date of Pot.
Exp. Date of Pol.
Eff. Date of End.
Producer No.
AddT Prem
Return Prem.
CP0967187103
/15/2011
/15/2012
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Liquor Liability Coverage Part
Products /Completed Operations Liability Coverage Part
A. If we cancel this Coverage Part(s) by written notice to the Named Insured for any reason other than nonpayment of
premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the Named Insured, or
the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part(s) by written notice to the Named Insured for nonpayment of premium, we will mail or
deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of
such notice.
SCHEDULE
Name and Address of Other Person(s) / I Number of Da s Notice:
r1m2nI79+inn1a %- Y .
I Performance Food Group, Inc. 1 30 1
to
All other terms and conditions of this policy remain unchanged.
U- GL -1448-A FL (05110)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.