Backup Documents 12/11-12/2012 Item #16A35 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
16A35
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper.Attach to original document.Original documents should be hand delivered to the Board Office.The completed routing slip and original
documents are to he forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines#1 through#4 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#4,complete the checklist,and forward to Ian Mitchell(line#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1.
2.
3.
4. Scott R.Teach, Deputy County Attorney County Attorney SRT 12/13/12
5. BCC Board of County Commissioners
6. Minutes and Records Clerk of Court's Office V
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval.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,including Ian Mitchell needs to contact staff for additional or missing
information.All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Scott R. Teach,Deputy County Attorney Phone Number 252-8400
Contact
Agenda Date Item was 12/11/12 J Agenda Item Number 16-A-35
Approved by the BCC
Type of Document Retention Agreement with FEMA Law Number of Original One
Attached Associates,PLLC Documents Attached
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. Original document has been signed/initialed for legal sufficiency. (All documents to be SRT
signed by the Chairman,with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions,etc. signed by the County Attorney's Office and signature pages from
contracts,agreements,etc.that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's SRT
Office and all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the SRT
document or the final negotiated contract date whichever is applicable.
4. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's SRT
signature and initials are required.
5. In most cases(some contracts are an exception),the original document and this routing slip SRT
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified.Be aware of your deadlines!
6. The document was approved by the BCC on 12/11/12 and all changes made during SRT
the meeting have been incorporated in the attached document.The County Attorney's }_
Office has reviewed the changes,if applicable.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,^wised 2.24.05
08-MGR-00132/33
16A35 5
MEMORANDUM
Date: December 17, 2012
To: Scott Teach, Deputy County Attorney
County Attorney's Office
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: A Retention Agreement with FEMA Law Associates, PLLC
for legal services concerning the de-obligation of FEMA funds
Attached for your records is a copy of the agreement referenced above (Item #16A35)
approved by the Board of County Commissioners on Tuesday December 11, 2012.
As requested, a copy was also provided to the Coastal Zone Management Department.
If you have any questions, please call me at 252-8406.
Thank you.
Attachment
16A35
RETENTION AGREEMENT WITH
FEMA LAW ASSOCIATES, PLLC
This Retention Agreement is made by and between the Board of County Commissioners
of Collier County, Florida (the "County"), and the law firm of FEMA Law Associates, PLLC
("FLA") whose principal place of business is located at 1725 I Street, NW, Suite 300,
Washington, D.C. 20006.
Whereas, FLA has special expertise and resources in representing public agency clients on
issues arising under the laws, regulations, and policies of the Federal Emergency Management
Agency ("FEMA"), including but not limited to matters seeking to reverse the deobligation of
FEMA assistance grants; and
Whereas, the County wishes to retain counsel to provide legal services which are
particularly within the expertise of FLA;
Now, therefore, in consideration of the premises contained herein, the County hereby hires
and retains FLA and FLA hereby agrees to provide legal services to County.
ARTICLE 1
COMPENSATION; METHOD OF PAYMENT
1.1 Compensation shall be paid to FLA in accordance with the terms set forth in Exhibit "A"
attached hereto and made a part hereof Requirements for reimbursable expenses are set
forth in Exhibit `B," attached hereto and made a part hereof Expenses other than
automobile expenses must be documented by copies of paid receipts or other evidence of
payment. The Certificate contained in Exhibit "C" must be included with every invoice
submitted for payment.
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1.2 The rates set forth in Exhibit "A" shall remain in effect without change for a minimum of
two (2) years from the effective date of this Agreement. In any subsequent years of the
Agreement, upon the request of FLA, the County Attorney is authorized to negotiate to
increase the hourly rate up to a maximum of ten (10) percent without approval by the
Board of County Commissioners. In the negotiation process, FLA must substantiate the
reason the request is being made (i.e. market conditions, increase in CPI, etc.)
1.3 Multiple Attorney Assignments.
FLA agrees that all legal services will be primarily provided for the County by its
Principal, Ernest B. Abbott, with assistance from his designated paralegal staff, and by any
other FLA attorney (either currently in FLA's employ or subsequently hired) as designated
by Mr. Abbott.
1.4 FLA may submit invoices for hourly work assignments pursuant to Exhibit "A" only after
the services for which the invoices are submitted have been completed or expenses
incurred. An original invoice plus one copy is due within fifteen (15) days of the end of
the month, except the final invoice which must be received no later than sixty (60) days
after the work is completed or the expiration of this Agreement.
1.5 To be deemed proper, all invoices must comply with the requirements set forth in this
Agreement and must be submitted on the form and pursuant to the instruction prescribed
by County. Payment may be withheld for failure of FLA to comply with a term, condition,
or requirement of this Agreement.
1.6 Payment shall be made to FLA at:
FEMA Law Associates, PLLC
Suite 300
1725 I Street, NW
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16A35
Washington, D.C. 20006
ARTICLE 2
INSURANCE
2.1 FLA shall as a minimum, provide, pay for, and maintain in force at all times during the
term of this Agreement, professional liability insurance in an amount no less than Two
Million Dollars ($2,000,000.00) per occurrence, Combined Single Limits. If any liability
insurance obtained by FLA to comply with the insurance requirements contained herein is
issued on a "claims made" form as opposed to an "occurrence" form, the retroactive date
for coverage shall be no later than the commencement date of the assigned work to which
this Agreement applies, and such insurance shall provide, in the event of cancellation or
non-renewal, that the discovery period for insurance claims (tail coverage) shall not be less
than three years following the completion of the assigned work and acceptance by the
County.
2.2 Such policy or policies shall be issued by an insurance company with at least an "A" rating
from the A.M. Best Company, Inc.
2.3 FLA shall furnish to the Risk Management Director Certificates of Insurance or
endorsements evidencing the insurance coverages specified by this Article prior to
beginning performance of work under this Agreement.
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16A35
ARTICLE 3
TERM AND TIME OF PERFORMANCE
3.1 The term of this Agreement shall be for a period of two (2) years to begin November 13,
2012 and to end on November 12, 2014, unless terminated earlier in accordance with the
provisions of this Agreement. Absent notice of intent to terminate, the Agreement may be
renewed upon mutual consent of the parties for three (3) additional terms of one (1) year
each. (In the event the term of this Agreement extends beyond a single fiscal year of
County, the continuation of this Agreement beyond the end of any fiscal year shall be
subject to the availability of funds from County in accordance with Chapter 129, Florida
Statutes.)
3.2 Time shall be deemed to be of the essence in performing the duties, obligations and
responsibilities by this Agreement.
3.3 Any amendments, alterations, variations, modifications or waivers of provisions of this
Agreement shall only be valid when they have been reduced to writing, duly signed by
both parties hereto, and attached to the original of this Agreement.
ARTICLE 4
TERMINATION
4.1 This Agreement may be terminated by either party for cause upon ten (10) days' notice or
by either party for convenience upon no less than thirty (30) days' advance written notice
in accordance with the "NOTICES" section of this Agreement.
4.2 Termination of this Agreement for cause shall include, but not be limited to, failure to
suitably perform the work, failure to continuously perform the work in a manner
calculated to meet or accomplish the objectives of County as set forth in this Agreement,
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16A35
or multiple breach of the provisions of this Agreement notwithstanding whether any such
breach was previously waived or cured.
4.3 In the event this Agreement is terminated for convenience, FLA shall be paid for any
services performed to the date the Agreement is terminated; however, upon notice by
•
either party to terminate, FLA shall refrain from performing further services or incurring
additional expenses under the term of this Agreement. FLA acknowledges and agrees that
Ten Dollars ($10) of the compensation to be paid by County, the adequacy of which is
hereby acknowledged by FLA, is given as specific consideration to FLA for County's right
to terminate this Agreement for convenience. FLA's obligations to the County as
provided for hereunder shall cease upon termination, except for participating in an orderly
and professional transfer of such responsibilities and files or copies of files to the County
or its designee,
ARTICLE 5
RECORD AUDIT AND INSPECTION
5.1 County shall have the right to audit the books and records of FLA pertinent to the funding
under this Agreement. FLA shall preserve and make available, at reasonable times for
examination and audit by County, all financial records, supporting documents, and other
documents pertinent to this Agreement for a period of three (3) years after termination of
this Agreement or, if any audit has been initiated and audit findings have not been resolved
at the end of the three years, the books and records shall be retained until resolution of the
audit findings.
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16A3 rs
5.2 If the Florida Public Records Act (Chapter 119, Fla. Stat.) is determined by County to be
applicable to FLA's records, FLA shall comply with all requirements thereof.
ARTICLE 6
CONFLICT OF INTEREST
6.1 FLA states that it is familiar with and will comply with the terms and conditions of
Chapter 112, Part III, Florida Statutes (Code of Ethics).
6.2 It is important that FLA be independent and impartial in order to properly conduct its
services to the County. FLA shall not act as counsel in any lawsuit or other adversary
proceeding in which County is named as an adversary party or in which FLA takes an
adverse position to the County.
6.3 Neither FLA nor its employees shall have or hold any continuing or frequently recurring
employment or contractual relationship that is substantially antagonistic or incompatible
with FLA's loyal and conscientious exercise of judgment related to its performance under
this Agreement.
6.4 In the event FLA is permitted to utilize subcontractors, herein, to perform any services
required by this Agreement, FLA agrees to prohibit such subcontractors, by written
contract, from having any conflicts as within the meaning of this section.
6.5 If at any time FLA's firm represents a client in matters having to do with the Collier
County government, be it before the Board of County Commissioners or any other agency
or division of Collier County government, FLA will contact the County Attorney's Office
before undertaking such representation so that it can be determined whether a conflict of
interest exists.
Page 6 of 16
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ARTICLE 7
OWNERSHIP OF DOCUMENTS
7.1 Any and all documents provided or created in connection with this Agreement are and
shall remain the property of County. In the event of termination of this Agreement, any
documents prepared by FLA, whether finished or unfinished, shall become the property of County
and shall be delivered by FLA to the County within seven (7) days of termination of this
Agreement by either party. Any compensation due to FLA shall be withheld until all documents
are received as provided herein.
ARTICLE 8
INDEPENDENT CONTRACTOR
8.1 FLA is an independent contractor under this Agreement. Services provided by FLA shall
be subject to the supervision of FLA, and such services shall not be provided by FLA as officers,
employees, or agents of the County. The parties expressly acknowledge that it is not their intent
to create any rights or obligations in any third person or entity under this Agreement.
ARTICLE 9
NONDISCRIMINATION, EQUAL OPPORTUNITY
AND AMERICANS WITH DISABILITIES ACT
9.1 FLA shall not unlawfully discriminate against any person in its operations and activities in
its use or expenditure of the funds or any portion of the funds provided by this Agreement and
shall affirmatively comply with all applicable provisions of the Americans with Disabilities Act
(ADA) in the course of providing any services funded in whole or in part by County, including
Page 7 of 16
16A35
Titles I and II of the ADA (regarding nondiscrimination on the basis of disability), and all
applicable regulations, guidelines, and standards.
9.2 FLA's decisions regarding the delivery of services under this Agreement shall be made
without regard to or consideration of race, age, religion, color, gender, sexual orientation national
origin, martial status, physical or mental disability, political affiliation, or any other factor which
cannot be lawfully or appropriately used as a basis for service delivery.
9.3 FLA shall comply with Title I of the Americans with Disabilities Act regarding
nondiscrimination on the basis of disability in employment and further shall not discriminate
against any employee or applicant for employment because of race, age, religion, color, gender,
sexual orientation, national origin, marital status, political affiliation, or physical or mental
disability. In addition, FLA shall take affirmative steps to ensure nondiscrimination in
employment against disabled persons. Such actions shall include, but not be limited to, the
following: employment, upgrading, demotion, transfer, recruitment or recruitment advertising,
layoff, termination, rates of pay, other forms of compensation, terms and conditions of
employment, training (including apprenticeship), and accessibility.
9.4 FLA shall take affirmative action to ensure that applicants are employed and employees
are treated without regard to race, age, religion, color, gender, sexual orientation, national origin,
marital status, political affiliation, or physical or mental disability during employment. Such
actions shall include, but not be limited to, the following: employment, upgrading, demotion,
transfer, recruitment or recruitment advertising, layoff, termination, rates of pay, other forms of
compensation, terms and conditions of employment, training (including apprenticeship), and
accessibility.
Page 8 of 16
16 35
9.5 FLA shall not engage in or commit any discriminatory practice in performing the Scope of
Services or any part of Scope of Services of this Agreement.
ARTICLE 10
NOTICES
10.1 Whenever either party desires to give notice to the other, such notice must be in writing,
sent by registered or certified United States Mail, postage prepaid, return receipt requested, or by
hand-delivery, addressed to the party for whom it is intended at the place last specified. The place
for giving notice shall remain the same as set forth herein until changed in writing in the manner
provided in this section. For the present, the parties designate the following:
FOR COLLIER COUNTY:
Jeffrey A. Klatzkow, County Attorney
Government Center
3299 Tamiami Trail East
Suite 800
Naples, Florida 34112
FOR FEMA LAW ASSOCIATES, PLLC:
Ernest B. Abbott, Esq.
FEMA Law Associates, PLLC
Suite 300
1725 I Street, NW
Washington, D.C. 20006
ARTICLE 11
MISCELLANEOUS
11.1 WAIVER OF BREACH AND MATERIALITY
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Failure by County to enforce any provision of this Agreement shall not be deemed a
waiver of the provision or modification of this Agreement. A waiver of any breach of a
provision of this Agreement shall not be deemed a waiver of any subsequent breach and
shall not be construed to be a modification of the terms of this Agreement.
11.2 COMPLIANCE WITH LAWS
FLA shall comply with all federal, state, and local laws, codes, ordinances, rules, and
regulations in performing its duties, responsibilities, and obligations related to this
Agreement.
11.3 SEVERANCE
In the event a portion of this Agreement is found by a court of competent jurisdiction to
be invalid, the remaining provisions shall continue to be effective unless County and FLA
elect to terminate this Agreement. The election to terminate this Agreement based upon
this provision shall be made within seven (7) days after the finding by the court becomes
final.
11.4 APPLICABLE LAW AND VENUE
This Agreement shall be interpreted and construed in accordance with and governed by
the laws of the State of Florida. Venue for litigation concerning this Agreement shall be in
Collier County, Florida.
11.5 PRIOR AGREEMENTS
This document supersedes all prior negotiations, correspondence, conversations,
agreements, and understandings applicable to the matters contained herein and the parties
agree that there are no commitments, agreements or understandings concerning the
Page 10 of 16
16 A35
subject matter of this Agreement that are not contained in this document. Accordingly,
the parties agree that no deviation from the terms hereof shall be predicated upon any
prior representations or agreements, whether oral or written. It is further agreed that no
modification, amendment or alteration in the terms or conditions contained herein shall be
effective unless contained in a written document in accordance with Article 3 above.
11.6 INCORPORATION BY REFERENCE
The truth and accuracy of each "Whereas" clause set forth above is acknowledged by the
parties. The attached Exhibits "A," "B" and "C" are incorporated into and made a part of
this Agreement.
DATE: December 11, 2012 BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORID
ATTEST:
DWIGHT E. BROCK, CLERK
lAtt 3446irtV*10 BY� 1_ �. FRED W. COYLE, CHAIR(A
i y,aititi
Approved as to°form And
le fficien
4.. i.......iL
Scott R. Teach
Deputy County Attorney
Remit la t65'.
Agenda I2I'L
Date
Date
'ee'd
tIlk
Page 11 of 16
16 A35
FEMA Associate LLC
N� 12-
DATE:
By:
Ernest B. Abbott, Esq.
Its: ;
CITY OF WASHINGTON
DISTRICT OF COLUMBIA
The foregoing Retention Agreement was acknowledged before me this 04' day of
AidfrenfiA. , 2012, by Erhesl g Aeloolras 'C,';,c_,c di of FEMA Law Associates,
PLLC, on behalf of Ernest B. Abbott. He/she is personally known to me or produced
C)ii v r'i L 1 c e,,u as identification.
Signature of Notary Public
Fcc a-
Name of Notary Public typed, printed or
My Commission Expires:
i 1 I
BRIAN FRIEDMAN p�'�..����hj,�
Notary Public District of Columbia ��'.• �''a"''�•`�,
My Commission Expires July 14,2013 : 4 it
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41414.4. ;%
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Page 12 of 16
16 A35
EXHIBIT A
For professional services rendered, FEMA Law Associates PLLC's fee shall be based on the
hourly rate as follows:
Ernest B. Abbott $400.00 per hour
Other Attorneys $200.00 per hour
Law Clerks & Paralegals $80.00 per hour
FEMA Law Associates' fee shall not exceed $100,000.00 without the prior approval of the Board
of County Commissioners. Any expenditure beyond the initial $100,000.00 approval by the
Board of County Commissioners must have Board approval prior to work being performed.
(Where appropriate a "not to exceed" sum shall be agreed to when each assignment is made to
FEMA Law Associates.)
In the event that FEMA Law Associates is required or requested to perform any additional or
extraordinary services not herein contemplated, FEMA Law Associates shall be entitled to apply
for additional compensation, the amount of which shall be subject to the approval of County and
no such additional compensation in excess of the amount herein stated shall be paid unless
specifically authorized in advance by County in its sole discretion.
FEMA Law Associates shall provide, at no cost to County, the annual response to County's
auditors regarding pending or threatened litigation. The auditors typically request information
regarding all litigation, claims and assessments considered to be material. The response should
include the nature of the litigation, the progress of the case to date, an estimate of the amount or
range of potential loss, and any other information considered necessary to explain the case.
FEMA Law Associates shall provide said response within 30 days of receipt of the request.
NOTES:
• Divisions, or departments within such divisions, shall be responsible and pay for legal
counsel services relating to litigation and outside counsel specifically for cases, matters or
issues relating to such division or department, as determined by the County Attorney in
coordination with the County Manager.
Page 13 of 16
16 A 35
EXHIBIT B
1. In addition to the charges for professional fees set forth in Exhibit "A," and the
Schedules attached hereto, County shall reimburse FEMA Law Associates for out-of-
pocket expenses reasonably incurred in the course of rendering such legal services,
including costs of long distance calls, printing, costs of reproduction, and necessary
travel expenses incurred in accordance with the requirements of Chapter 112, F.S.
FEMA Law Associates shall not charge for travel of attorneys between its offices so
that it can provide the best available and most appropriate lawyer in any of its office
locations for the issues involved.
2. FEMA Law Associates shall submit invoices on a monthly basis for the payment of
out-of-pocket expenses. Each invoice shall include a signed certificate listing all costs,
expenses, vouchers, invoices and other documentary evidence that will describe in
reasonable detail the basis for expenditures for which reimbursement is sought as set
forth below.
3. REQUIREMENTS
The following represents Collier County's payment requirements for legal costs
➢ Your federal employee identification number must be on all invoices submitted.
➢ The applicable Purchase Order number must be on all invoices submitted.
➢ No service, interest, or other charge of like nature is to be imposed with regard to
any item, invoice, or request. All firms doing business with Collier County must
have a current W-9 "Request for Taxpayer Identification Number and
Certification" on file.
➢ Services rendered must be specifically and concisely identified-
➢ Names of persons performing services, hourly rates, and dates must be listed. The
County agrees to reimburse FEMA Law Associates for retention and utilization of
sub-consultants.
Page 14 of 16
➢ Reimbursable expense must be verified by attached receipts or copies thereof
➢ Claims for mileage and meals cannot exceed statutory allowance as provided for
under Chapter 112, F.S. Meals and mileage cannot be charged unless the
professional has traveled outside the county of the principal business location.
➢ Claims for lodging at single rate (actual cost) must be substantiated by paid bill or
charge, with a cap of no more than $150.00 per night.
➢ Car rentals required for travel should include compact or standard-size vehicles
only.
➢ Common carrier travel shall be reimbursable at tourist or coach class fares only.
➢ Accounting Division requires original receipts, or copies of receipts which have
been individually certified to be true copies of the originals. In addition the
Certificate contained in Exhibit "C" must accompany each invoice. The certifying
person must sign the Certification form and a description provided of the items,
which are certified.
➢ Faxes shall not be reimbursed
➢ Legal Research costs (Lexis-Nexis, Westlaw, etc.) shall not be reimbursed
Page 15 of 16
16 A35
EXHIBIT C
CERTIFICATE
IT IS HEREBY CERTIFIED that:
1. has been duly designated as special counsel to
render legal services or provider of services for or on behalf of Collier County;
2. Each of the documents hereinafter identified and attached is a true and correct copy of the
original record;
3. Expenditure(s) enumerated represent costs necessarily incurred during the course of official
business for which payment has not been received and for which documentation is not
available or reasonably retrievable;
4. Claims are in compliance with the applicable statutes and administrative orders, and with
the express provision that all other parties are barred from entitlement to any part of these
costs.
RE: Invoice No. , Dated
Period Covered: , Amount
IN-HOUSE CHARGES:
Photocopies: copies @ $0.15/each $
Mileage: miles @ /mile $
OTHER (Copies of invoices required):
Long Distance Calls $
Other: $
TOTAL: $
FOR THE FIRM
Signed:
Print Name:
Title:
Date:
04-00A-01158/2897
Page 16 of 16
darw LLawyers Professional Liability Insurance
Policy Declarations
Darwin National Assurance Company Policy Number: 0306-9790
Main Administrative Office Address: Corporate Address:
9 Farm Springs Road 1807 North Market Street
Farmington, CT 06032 Wilmington, DE 19802
THIS IS A CLAIMS MADE POLICY WHICH APPLIES ONLY TO CLAIMS FIRST MADE DURING THE
POLICY PERIOD OR ANY EXTENDED REPORTING PERIOD, AND REPORTED IN ACCORDANCE
WITH SECTION IV.I. OF THE POLICY. THE LIMIT OF LIABILITY AVAILABLE TO PAY DAMAGES
WILL BE REDUCED AND MAY BE EXHAUSTED BY CLAIMS EXPENSES AND CLAIMS EXPENSES
WILL BE APPLIED AGAINST THE RETENTION AMOUNT. IN NO EVENT WILL THE INSURER BE
LIABLE FOR CLAIMS EXPENSES OR DAMAGES IN EXCESS OF THE APPLICABLE LIMIT OF
LIABILITY. PLEASE READ THE ENTIRE POLICY CAREFULLY.
Item 1. Name and Mailing Address of Named Insured:
FEMA Law Associates, PLLC
1725 Eye Street, NW, Suite 300
Washington, DC 20006
Item 2. Policy Period:
Inception Date: October 12, 2012
Expiration Date: October 12, 2013
At 12:01AM Standard Time at the Mailing Address shown above
Item 3. Limit of Liability(inclusive of Claims Expenses):
(a) $2,000,000 maximum limit of liability per CLAIM
(b) $2,000,000 maximum aggregate limit of liability for all CLAIMS
Item 4. Retention:
$10,000 each and every CLAIM
Item 5. Notices required to be given to the Insurer must be addressed to:
For Notice of Claims and Circumstances: For All Other Notices:
noticeofloss(a�darwinpro.com 9 Farm Springs Road
Farmington, CT 06032
Item 6. Premium:
Total Premium: $2,080
DRWN E4405 (9/2008)
16A3
Item 7. Retroactive Date:
None-Prior Acts Coverage Provided
Item 8. Endorsements Attached at Issuance:
1. e1091 (09/2008) District of Columbia Amendatory
2. v2671 (01/2011) Omnibus Endorsement
3. v2741 (05/2012) Prior Knowledge Date
THESE DECLARATIONS, THE POLICY FORM, ANY ENDORSEMENTS AND THE APPLICATION
CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE INSURER AND THE INSURED RELATING
TO THIS INSURANCE.
In Witness Whereof,the Insurer has caused this Policy to be executed by its authorized officers.
N37%*1-7 /0/44,41(/ /1/".
SECRETARY PRESIDENT
/ f7747-.717
AUTHORIZED SIGNATURE
Licensed Agent License Number
If the policyholder wishes to present inquiries or obtain information about coverage or to provide
assistance in resolving complaints, please contact Darwin Professional Underwriters at(860)284-
1300.
DRWN E4405 (9/2008)