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HomeMy WebLinkAboutContract #: 1548 - From: 09-08-2022 To: 09-08-2023 - Environmental Partners Group, Inc. - DPW AGREEMENT FOR PROFESSIONAL ENGINEERING SERVICES BETWEEN THE TOWN OF NORTH ANDOVER,MASSACHUSETTS AND ENVIRONMENTAL PARTNERS GROUP,LLC THIS AGREEMENT made this Z day of September,2022 between Environmental Partners Group,LLC,a Massachusetts corporation with a usual place of business at 1900 Crown Colony Drive, Suite 402, Quincy, MA 02169, hereinafter called the "ENGINEER," and the Town of North Andover, MA,acting by its Select Board,with a usual place of business at 120 Main Street,North Andover, MA 01845 hereinafter called the "TOWN". The ENGINEER and the TOWN,for the consideration hereinafter named, agree as follows: 1. Scope of Work The ENGINEER shall perform the work set forth in the Scope of Services attached hereto as Exhibit A. 2. Contract Price The TOWN shall pay the ENGINEER for services rendered in the performance of this Agreement a lump sum of$41,850.00.The amount to be paid to the ENGINEER shall not exceed$41,850.00 without the prior written consent of the TOWN. j 3. Commencement and Completion of Work A. This Agreement shall commence on September 8,2022 and shall expire on September 8,2023,unless terminated sooner in accordance with this Agreement. B. Progress and Completion; ENGINEER shall commence work promptly upon execution of this Agreement and shall prosecute and complete the work regularly, diligently and uninterruptedly at such a rate of progress as will insure completion in a timely manner. 4. Performance of the Work The ENGINEER shall supervise and direct the Work,using his best skills and attention, which shall not be less than such state of skill and attention generally rendered by the engineering/design profession for projects similar to the Project in scope, difficulty and location. A. Responsibility for the Work (1) The ENGINEER shall be responsible to the TOWN for the acts and omissions of his employees, subcontractors and their agents and employees,and other persons performing any of the Work under a contract with the ENGINEER. Consistent with the standard of care referenced above,the ENGINEER shall be responsible for the professional and technical accuracy for all work or services furnished by him or his consultants and subcontractors. The ENGINEER shall perform his work under this Agreement in such a competent and professional manner that detail checking and reviewing by the TOWN shall not be necessary. (2) The ENGINEER shall not employ additional consultants,nor sublet, assign or transfer any part of his services or obligations under this Agreement without the prior approval and written consent of the TOWN. Such written consent shall not in any way relieve the ENGINEER from his responsibility for the professional and technical accuracy for the work or services furnished under this Agreement. (3) All consultants must be registered and licensed in their respective disciplines if registration and licensor are required under the applicable provisions of Massachusetts law. (4) The ENGINEER and all consultants and subcontractors shall conform their work and services to any guidelines, standards and regulations of any governmental authority applicable to the type of work or services + covered by this Agreement. (5) The ENGINEER shall not be relieved from its obligations to perform the work in accordance with the requirements of this Agreement either by the activities or duties of the TOWN in its administration of the Agreement, or by inspections, tests or approvals required or performed by persons other than the ENGINEER (6) Neither the TOWN's review, approval or acceptance of,nor payment for any of the work or services performed shall be construed to operate as a waiver of any rights under the Agreement or any cause of action arising out of the performance of the Agreement. B. Deliverables, Ownership of Documents: One(1)reproducible copy of all drawings,plans,specifications and other documents prepared by the ENGINEER shall become the property of the TOWN upon payment in full therefor to the ENGINEER. Ownership of stamped drawings and specifications shall not include the ENGINEER's certification or stamp. Any re-use of such documents without the ENGINEER's written verification of suitability for the specific purpose intended shall be without liability or legal exposure to the ENGINEER or 2 to the ENGINEER's independent professional associates,subcontractors or consultants. Distribution or submission to meet official regulatory requirements or for other purposes in connection with the Project is not to be construed as an act in derogation of the ENGINEER's rights under this Agreement. C. Compliance With Laws: In the performance of the Work, the ENGINEER shall comply with all applicable federal, state and local laws and regulations,including those relating to workplace and employee safety. 5. Site Information Not Guaranteed; Contractor's Investi ag t The TOWN shall furnish to the ENGINEER available surveys, data and documents relating to the area which is the subject of the Scope of Work. All such information, including that relating to subsurface and other conditions,natural phenomena,existing pipes, and other structures is from the best sources at present available to the TOWN. All such information is furnished only for the information and convenience of the ENGINEER and is not guaranteed. It is agreed and understood that the TOWN does not warrant or guarantee that the subsurface or other conditions,natural phenomena, existing pipes, or other structures will be the same as those indicated in the information furnished, and the ENGINEER must satisfy himself as to the correctness of such information. If,in the opinion of the ENGINEER,such information is inadequate,the ENGINEER may request the TOWN's approval to verify such information through the use of consultants or additional exploration. In no case shall the ENGINEER commence such work without the TOWN's prior written consent. Such work shall be compensated as agreed upon by TOWN and ENGINEER. 6. Payments to the Contractor A. Cost incurred on this project shall be billed monthly on an hourly basis as outlined in the attached Scope of Services. Payment shall be due 30 days after receipt of an invoice by the TOWN. B. If there is a material change in the scope of work,the TOWN and the ENGINEER shall mutually agree to an adjustment in the Contract Price. C. If the TOWN authorizes the ENGINEER to perform additional services,the ENGINEER shall be compensated in an amount mutually agreed upon, in advance,in writing. Except in the case of an emergency,the ENGINEER shall not perform any additional services until such compensation has been so established. 7. Reimbursement Except as otherwise included in the Contract Price or otherwise provided for under this Agreement, the ENGINEER shall be reimbursed by the TOWN: (a)at 1.0 times the actual cost to the ENGINEER of consultants retained to obtain information pursuant to Article 5 hereof or otherwise. No such reimbursement shall be made unless the rates of compensation have been approved, in advance,by the TOWN; (b) at 1.0 times the actual cost of additional or specially authorized expense items, as approved by the TOWN. 3 8. Final Payment,Effect The acceptance of final payment by the ENGINEER shall constitute a waiver of all claims by the ENGINEER arising under the Agreement. 9. Terms Required By Law This Agreement shall be considered to include all terms required to be included in it by the Massachusetts General Laws, and all other laws, as though such terms were set forth in full herein. 10. Indemnification A. General Liability: The ENGINEER shall indemnify and hold harmless the TOWN from and against any and all claims, damages,losses, and expenses, including attorney's fees,to the extent arising out of the performance of this Agreement and to the extent the same relate to matters of general commercial liability,when such claims,damages,losses, and expenses are caused, in whole or in part,by the negligent or wrongful acts or omissions of the ENGINEER or his employees, agents, subcontractors or representatives. B. Professional Liability: The ENGINEER shall indemnify and hold harmless the TOWN from and against any and all claims, damages, losses, and expenses, including attorney's fees, arising out of the performance of this Agreement and to the extent the same relate to the professional competence of the ENGINEER's services,when such claims,damages, losses, and expenses are caused,in whole or in part,by the negligent acts,negligent errors or omissions of the ENGINEER or his employees, agents, subcontractors or representatives. 11. Insurance A. The ENGINEER shall at his own expense obtain and maintain a Professional Liability Insurance policy for errors,omissions or negligent acts arising out of the performance of this Agreement in a minimum amount of$1,000,000,00, B. The coverage shall be in force from the time of the agreement to the date when all construction work for the Project is completed and accepted by the TOWN. If, however, the policy is a claims made policy, it shall remain in force for a period of six(6)years after completion. Since this insurance is normally written on a year-to-year basis,the ENGINEER shall notify the TOWN should coverage become unavailable. C. The ENGINEER shall, before commencing performance of this Agreement, provide by insurance for the payment of compensation and the furnishing of other benefits in accordance with M.G.L, c.152, as amended,to all its employees and shall continue such insurance in full force and effect during the term of the Agreement. 4 D. The ENGINEER shall carry insurance in a sufficient amount to assure the restoration of any plans, drawings, computations, field notes or other similar data relating to the work covered by this Agreement in the event of loss or destruction until the final fee payment is made or all data are turned over to the TOWN. E. The ENGINEER shall also maintain public liability insurance, including property damage,bodily injury or death, and personal injury and motor vehicle liability insurance against claims for damages because of bodily injury or death of any person or damage to property, F. Evidence of insurance coverage and any and all renewals substantiating that required insurance coverage is in effect shall be filed with the Agreement. Any cancellation of insurance, whether by the insurers or by the insured, shall not be valid unless written notice thereof is given by the party proposing cancellation to the other party and to the TOWN at least fifteen days prior to the intended effective date thereof,which date shall be expressed in said notice. G. Upon request of the ENGINEER,the TOWN reserves the right to modify any conditions of this Article. 12. Notice All notices required to be given hereunder shall be in writing and delivered to, or mailed first class to,the parties'respective addresses stated above. In the event that immediate notice is required, it may be given by telephone or facsimile, but shall, to the extent possible, be followed by notice in writing in the manner set forth above. 13. Termination A. Each party shall have the right to terminate this Agreement in the event of a failure of the other party to comply with the terms of the Agreement. Such termination shall be effective upon seven days'notice to the party in default and the failure within that time of said party to cure its default. B. The TOWN shall have the right to terminate the Agreement without cause,upon ten(10)days'written notice to the ENGINEER. In the event that the Agreement is terminated pursuant to this subparagraph,the ENGINEER shall be reimbursed in accordance with the Agreement for all work performed up to the termination date. 14. Miscellaneous A. Assignment: The ENGINEER shall not assign or transfer any of its rights, duties or obligations under this Agreement without the written approval of the TOWN. B. Governing Law: This Agreement shall be governed by and construed in accordance with the law of the Commonwealth of Massachusetts. 5 IN WITNESS WHEREOF,the parties hereto have set their hands and seals,the TOWN by its authorized representative who,however, incurs no personal liability by reason of the execution hereof or of anything herein contained, as of the day and year first above written. THE TOWN THE CONTRACTOR Environmental Partners Group, LLC I Division/&"parlment Head Company Naive 8-31-2022 o anager Date Si Date Ryan J. Trahan, President Print Name&Title APPROVED AS TO FORM: Town Counsel Date i CERTIFICATION AS TO AVAILABILITY OF FUNDS: 7 To n ccountant Date 6 CERTIFICATIONS CERTIFICATE OF NON-COLLUSION The undersigned certifies under penalties of perjury that our bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person, As used in this certification, the word "person" shall mean natural person, business, partnership, corporation, committee,union, club or other organization,entity, or group of individuals. Signature Date 8-31-2022 Ryan J. Trahan, President Environmental Partners Group, LLC Print Name&Title Company Name CERTIFICATE OF TAX COMPLIANCE Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49A(b), I Ryan J. Trahan authorized signatory for Environmental Partners Group, LLC Name of individual Name of contractor do hereby certify under the pains and penalties of perjury that said contractor has complied with all laws of the Commonwealth of Massachusetts, and the Town of North Andover, relating to taxes, permit or other fees, reporting of employees and contractors, and withholding and remitting child support. 8-31-2022 SigkauKj Date 7 CERTIFICATE OF VOTE At a duly authorized meeting the Board of Directors of the Environmental Partners Group, LLC held on 7-23-2021 it was VOTED,THAT Ryan J. Trahan President (Name) (Officer) of Environmental Partners Group,LLC be and hereby is authorized to execute contracts and bonds in the name and on behalf of said Environmental Partners Group,LLC , and affix its corporate seal hereto; and such execution of any contract or obligation in the name of Environmental Partners Group,LLC on its behalf by such officer under seal of Environmental Partners Group,LLC , shall be valid and binding upon Environmental Partners Group,LLC I hereby certify that I am the clerk of the above named Environmental Partners Group,LLC and that Ryan J.Trahan is the duly elected officer as above of said i Environmental Partners Group,LLC and that the above vote has not been amended or rescinded and remains in full force and effect as the date of this contract. 8-31-2022 ~ (Date) (Cleric) --- 8 EXHIBIT A ENVIRONMENTAL k PARTNERS ,.-- An Apex Company --- August 10, 2022 Mr.Timothy Willett Operations Manager Department of Public Works 384 Osgood Street North Andover, MA 01845 RE: Proposal for Engineering Services Ferncroft Circle Water Main Improvements Design, Permitting,and Bidding Assistance Dear Mr,Willett: Environmental Partners, LLC (Environmental Partners) prepared the following proposal for engineering services for the design,permitting and bidding phases associated with the Ferncroft Circle Water Main Improvements project.Environmental Partners prepared the proposed scope of services based upon our discussions with Town staff and recent experience working in Town. We have provided our Project Understanding below, Project Understanding Based on our discussions with you, we understand that the Town is requesting Environmental Partners to complete the design, permitting and bidding assistance work for the replacement of the existing water main on Ferncroft Circle,The proposed work to be included under this contract includes the replacement of approximately 800 linear feet of existing 6" CI water main with new 8" cement lined ductile iron water main, The project also includes new fire hydrants,valves, replacing service connections with new services from the new main to the curb stop,and trench pavement, Ferncroft Circle-Existing Conditions TS 1i 1 -x 22 Page 2 of 5 Based on sewer record drawings provided by the Town and information collected from MassGIS,it is anticipated that the project will require permitting through the Town's Conservation Commission in the form of a Request for Determination(RDA)due to the proximity to known wetland resource areas. All proposed work will occur within the existing limits of development (generally within limits of existing paving), which includes work within the 100-foot wetland resource area buffer zone along several portions of the water main alignment, No temporary or permanent impacts to the resource areas are anticipated. Environmental Partners confirmed with the Town's Conservation Agent that an RDA Is the appropriate filing for this project.The Town has also requested Environmental Partners to provide bidding services as part of this scope of services, We have prepared the following Scope of Services and Budget based on our understanding of the above project information. Scope of Service Environmental Partners proposes the following scope of services for the above referenced project. Task 1 - Field Survey and Design Underthis Task,Environmental Partners will conduct an in-house field survey of the project limits and complete the design of the new water main. The scope of services under Task 1 will include the following: A. The field survey will be performed by Environmental Partners staff and will include survey of the following: a. Roadway(centerline,edges of pavement,sidewalks,curbing). b. Underground utilities(based on visible utility features and road paint by others). c. Additional ground surface points to establish topography. d. Visible surface utility features such as drain manhole covers,catch basins,gas boxes, and electrical and telephone utilities. e. invert measurements for existing drainage and sewer infrastructure. f. Property lines and right-of-way limits will be obtained from information available through MassGIS. Property line surveys are not included in this scope of services. B. The water main engineering design services and activities shall include the following: a. Preparation of preliminary design plans utilizing the survey completed under this task to be reviewed and discussed with you and your distribution staff. b. One(1)meeting to review the Town's comments on the preliminary design drawings. c. Preparation of an Opinion of Probable Construction Cost(OPCC)based on recent bids for similar type projects. d. Preparation of engineering design plans and specifications for public bidding. e. Deliverables: Electronic (PDF format) and two hard copies of Bid Documents (Plans, Specifications and OPCC). empartners.com Page 3 of 5 Task 2- Permitting Under this Task, Environmental Partners will complete the permitting work associated with the Ferncroft Circle water main improvements described in Tasks 1 above. The permitting task shall include the following: A. Conservation Commission Permitting a. Coordinate with the North Andover Conservation Commission Agent to conduct a site walk of the project area prior to filing an application with the Commission. b. Retain the services of a Wetland Specialist to delineate all wetland resource areas within 200 linear feet of edge of pavement. The subconsultant shall provide a memorandum describing the resource areas and a sketch Identifying the location of the wetland flags. c. Prepare filing with the Conservation Commission and MassDEP assuming a Request for Determination of Applicability (RDA) is required and submit RDA to the Conservation Commission for review,comment, and approval. d. Attend a total of one (1) Conservation Commission hearing to present the project's RDA. Address comments required by the Conservation Commission and Incorporate in final design documents. Task 3- Bidding Assistance Under this Task, Environmental Partners will assist the Town with the public bidding process for the proposed water main project.The Bidding Assistance task shall include the following: A. Coordinate and complete public bidding advertising requirements including the Central Register and newspaper advertisement. B. Provide textfor the Client to advertise the project in CommBuys and to post the invitation to bid publicly at Town Hall. C. Obtain state wage and labor rates. D. Prepare and distribute public bid documents electronically through an on-line bidding service(ProjectDog). Bids will be received electronically through ProjectDog. E. Coordinate and attend a pre-bid meeting with the Town and prospective contractors. F. Respond to Contractor questions and prepare bid addenda. Environmental Partners assumes up to 2 addenda will be prepared. G. Review and evaluate public bids to identify the lowest responsible and eligible bidder. Prepare a recommendation of award memorandum. H. Assist with the approval and award of construction contracts. I. Prepare contracts for execution by the Town and the selected Contractor. empartners.com Page 4 of 5 Assumptions Environmental Partners developed the proposed scope of services based upon the following assumptions: A. Boring information from the Sewer Record Drawings provided by the Town will be utilized.A subsurface investigation program,including soil borings,is not included In this scope of services, B. A property line and right-of-way survey is not included in this scope of services, C. The proposed water main will be installed within a separate trench adjacent to the existing water main.Therefore,the existing water main will remain in service during construction and the use of a temporary bypass system will not be required. D. The water services will be replaced from the water main to the property line.Water services on private property will not be replaced.The Town provided water service tie cards to Environmental Partners for reference, E. The Town will provide front end format for procurement, and content of general conditions and special conditions. F. Permitting is limited to an RDA and attendance of one(1) hearing through the North Andover Conservation Commission,A Notice of Intent filing is not included In this scope of services.Additional permitting support if needed can be provided to the Town on a time and materials basis, G. Opinions of Probable Costs will be based on best available information and will include contingencies based on the level of design. H. Construction Phase services would be the subject of a separate scope of services. Fee and Schedule Environmental Partners proposes to perform the indicated Scope of Services for Tasks 1 through 3, previously described for a lump sum fee of Forty-One Thousand and Eight Hundred and Fifty Dollars($41,850),A breakdown of the fee by task and duration is presented in the table below. Task Fee Duration Task 1: Field Survey and Design $ 25,765 8 weeks Task 2: Permitting $ 9,160 6 weeks Task 3: Bidding Assistance $ 6,925 6 weeks Total $ 41,850 5 Months(') 1) Tasks 1 and 2 schedule will overlap. envpartners.com Page 5 of 5 Invoices will be issued to the Town on a monthly basis and will be based upon percentage complete per task.A status report documenting the work performed each month will be provided with each invoice. Summary if this proposal is. acceptable to the Town we will coordinate with you for a formal agreement. Environmental Partners looks forward to working with you and your colleagues on this Important project for the Town of North Andover. Please feel free to contact us directly with any questions or concerns. Sincerely, Robert j. Rafferty, P.E. Eric A. Kelley, P,E, Principal Principal/Project Manager P:617.657,0277 P: 617.657.0282 E:rjr@envpartners.com E: eak@envpartners.com Cc: Jim Stanford, DPW Director John Borgesi,P.E.,Assistant DPW Director/Town Engineer Ben Mangan,P.E., Environmental Partners envpartners,com DATE(MM/Dtl ) p® CERTIFICATE OF LIABILITY INSURANCE 8/31/2022 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 have ADDITIONAL INSURED provisions or 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 NA"EcT John Kil arriffJBrett Nealls The Graham Company PHONE FAX N 215 701-5291 c The Graham Building E-MAIL 1. 1 Penn Square West ADDRESS: KILGARRIFF UNIT rahamco.com Philadelphia PA 19102— INSURERS AFFORDING COVERAGE NAIC N _ INSURER A:Starr Surplus Lines Insurance Com an 13604 INSURED �~ APEXCOM-01 INSURER B:Libeq Insurance Cor oration 42404 Environmental Partners Group, LLC 1900 Crown Colony Drive,Ste 402 INSURER C:Tokio Marine America insurance Com art 10945 Quincy,MA 02169 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:149563382 REVISION NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD/YYYY A X COMMERCIALGENERALLIABILITY Y 1000065707221 7/31/2022 7/31/2023 EACH OCCURRENCE $1,000.000 CLAIMS-MADE EKIOCCUR PRMAGE EMISES -R ocam®nce $300,000 _� MED EXP Any one porsan} $25,000 PERSONAL SADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY®JET 0LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ASS-Z51-294467-022 7/31/2022 7/31/2023 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $pR AUTOS ONLY AUTOS " HIRED NON-OWNED OPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident _ X $2.500 Comp X $2,500 Coll $ A UMBRELLA LIAR X OCCUR 1000336571221 7/31/2022 7131/2023 EACH OCCURRENCE $25,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $26,000,000 OED RETENTION$ $ B WORKERSCOMPENSATION WC7-ZS1^294467-012 7131/2022 7/31/2023 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOPJPARTHERIEXECUTIVE N NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,00%000 If yS describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professlonal/PollutionLiability 1000065707221 7/31/2022 7/31/2023 PerdainVAggr eta 1M12M C Contractors Equipment CPP6411631 7/31/2022 7/31/2023 Leased/Rentedquip 325.000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks schedule,may be attached If more space Is required) " Property Policy-Toklo Marine America Insurance Company Policy#CPP6411631;Policy Period 7/31/2022-7/31/2023 RE:Ferncroft Circle Water Main Improvements,.Design,Permitting and Bidding Assistance Town Of North Andover Is additional Insured on the above General Liability Policy if required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of North Andover 120 Main Street AUTHORIZED REPRESENTATWE North Andover MA 01845 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD