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HomeMy WebLinkAboutSUPPLEMENTAL AGREEMENT BETWEEN AUGUSTA, GEORGIA AND STARK PLUMBING FOR SANITARY SEWER CONNECTION SERVICES TASK ORDER PROGRAM, PHASE II NOTICE OF AWARD G E' O R G 1 A Contractor: Stark Plumbing Date: 2/14/2017 Address: 1026 Hampton Terrace North Augusta,SC.29841 Project: SSCP Phase 2-Group 1 J Project No: AUD_2015-02 At a meeting of the Augusta, Georgia Commission held on 10/18/2016 , you were awarded the contract for the following project: Sanitary Sewer Connection Service Phase 2 - Group 1 Enclosed please find 4 copies of the Contract Documents for your execution. Please complete the pages, affixing signatures, dates, notary and/or corporate seals, etc. where necessary and return to this office within 10 days from the date of this letter, excluding Legal Holidays. The Certificate of Insurance must be complete. Power of Attorney must be submitted in triplicate; an original and two copies is permissible. Very truly yours, Sylvester Rosier- Project Manger Receipt of this NOTICE OF AWARD is hereby acknowledge this 9 day of n'n2ca , 411P- . _ S7 40/c ,01/.44,4/.✓ei LL e "ces--/ e^rr Co actor By Title Please sign and return one copy of this Notice of Award Acknowledgement to: Augusta Utilities Department Attn: Sylvester Rosier/Marie Corbin,P.E. 360 Bay Street, Suite 180 Augusta, GA 30901 Engineering Division 360 Bay Street,Suite 180-Augusta,GA 30901 (706)312-4132—Fax(706)312-4133 W W W.AUGUSTAGA.GOV This SUMPLEMENTAL AGREEMENT,made on the day of ,20 ,to the AGREEMENT,made on the 19th day of JANUARY,2017 by and between AUGUSTA, GEORGIA,BY AND THROUGH THE AUGUSTA-RICHMOND COUNTY COMMISSION,party of the first part,hereinafter called the OWNER, and Stark Plumbing, party of the second part,hereinafter called the CONTRACTOR. WITNESSETH, that the Contractor and the Owner, for the considerations hereinafter named, agree as follows: ARTICLE I-SCOPE OF THE WORK- The Contractor hereby agrees to furnish all of the materials and all of the equipment and labor necessary, and to perform all of the work shown on the plans and described in the specifications for the project entitled: SANITARY SEWER CONNECTION SERVICE—PHASE 2—GROUP 1 and in accordance with the requirements and provisions of the Contract Documents as defined in the General and Special Conditions hereto attached,which are hereby made a part of this agreement. ARTICLE II-TIME OF COMPLETION The work to be performed under this Contract shall be commenced within 5 business days after the date of written notice by the Owner to proceed.All work shall be substantially completed within 28 business days with all such extensions of time as are provided for in the General Conditions. Substantial completion shall be defined as all lots awarded connected to the city sewer system, all septic tanks abandoned. Final completion shall be 9 days after substantial completion. Final completion shall be defined as a representative of each property has signed off on the completeness and acceptance of work,example included. It is hereby understood and mutually agreed,by and between the Contractor and the Owner,that the date of beginning, rate of progress and the time for completion of the work to be done hereunder are ESSENTIAL CONDITIONS of this contract.Contractor agrees that said work shall be prosecuted regularly, diligently,and uninterruptedly at such rate of progress as will ensure full completion thereof within the time specified.It is expressly understood and agreed by and between the Contractor and the Owner,that the time for completion of the work described herein is a reasonable time for completion of the same, taking into consideration the average climatic range and construction conditions prevailing in this locality. 11Page ARTICLE III—PAYMENT (A)The Contract Sum The Owner shall pay to the contractor for the performance of the Contract the amount as stated in the BID FORM and Schedule of Items. No variations shall be made in the amount except as set forth in the specifications attached hereto. (B) Progress Payment On no later than the fifth day of every month,the Contractor shall submit to the Owner's Engineer an estimate covering the percentage of the total amount of the Contract which has been completed from the start of the job up to and including the last working day of the preceding month, together with such supporting evidence as may be required by the Owner and/or the Engineer.This estimate shall include only the quantities in place and at the unit prices as set forth in the Bid Schedule. On the vendor run following approval of the invoice for payment,the Owner shall after deducting previous payments made,pay to the Contractor 90%of the amount of the estimate on units accepted in place.The 10%retained percentage may be held by the Owner until the final completion and acceptance of all work under the Contract. ARTICLE IV-ACCEPTANCE AND FINAL PAYMENT (A) Upon receipt of written notice that the work is ready for fmal inspection acceptance,the Engineer shall within 10 days made such inspection, and when he finds the work acceptable under the Contract and the Contract fully performed,he will promptly issue a fmal certificate,over his own signature,stating that the work required by this Contract has been completed and is accepted by him under the terms and conditions thereof. The contract shall then submittal a final payment request for the entire balance found to be due the Contractor including the retained percentage. This payment shall be paid to the Contractor by the Owner within 30 days after the date of the receipt of the final payment request. (B) Before final payment is due,the Contractor shall submit evidence satisfactory to the Engineer that all payrolls, material bills, and other indebtedness connected with work have been paid, except that in case of disputed indebtedness of liens of evidence of payment of all such disputed amounts when adjudicated in cases where such payment has not already been guaranteed by surety bond. (C) The making and acceptance of the final payment shall constitute a waiver of all claims by the Owner, other than those arising from unsettled liens,from faulty work appearing within 12 months after fmal payment, from requirements of the specifications,or from manufacturer's guarantees.It shall also constitute a waiver of all claims by the Contractor except those previously made and still unsettled. (D) If after the work has been substantially completed, full completion thereof is materially delayed through no fault of the Contractor, and the Engineer, so certifies, the Owner shall upon certification of the Engineer,and without terminating the Contract,make payment of the balance due for that portion of the work fully completed and accepted. Each payment shall be made under the terms and conditions governing final payment,except that it shall not constitute a waiver of claims. 2IPage IN WITNESS WHEREOF,the parties hereto have executed this Agreement in three(3)counterparts, each of which shall be deemed an original, in the year and day first mentioned above. OWNER: AUGUSTA,GEORGIA t ATTEST: „+0"""""`t I SEAL By: ill-Z.: Atil 4,7 i /A; e a The Honorable Hardie Davis,Jr. I Levi toe '�3 � :' �;71, re 1 Mayor 1 Cle cof�,th ' r,a nab c' : Date: k Dat v 4 yC d 1: °s 444 APPROVED AS TO FORM: DEPAR L . ' „SAL: By: ,4, 1X4%keivi { ,. Thomas D. Wiedmeier Attorney Director,Augusta Utilities Department Date: 3721.0 7 Date: 1 /Z s I ' 7 CONTRACTOR: ATTEST: SEAL By: 4,z7Adz- By: dal k_a_G1Ca. - Name: G 6m2Tis t,..?, .5rhzrc.._ Name:LC sS O. S\QC\C- Title: ,6.�esa› r- Title: '\C 5\ •Cn\' Date: 9 tidAez .o/1 Date: S,t1pCc'e' cA/2 c ,q „"IluIiIirii,,� ` e Aj4 .a: Bond No.71886852 PERFORMANCE BOND (NOTE: THIS BOND IS ISSUPT)SIMULTANEOUSLY WITH PAYMENT BOND ON PAGE 6, IN FAVOR OF OWNER CONDITIONED FOR THE PAYMENT OF LABOR AND MATERIAL.) KNOW ALL MEN BY THESE PRENSENTS: 1026 Hampton Terrace That Stark Plumbing LLC North Augusta, SC 29841 as Principal, hereinafter called Contractor,and WESTERN SURETY COMPANY ,a corporation organized and existing under the laws of the State of South Dakota ,with its principal office in the City of Sioux Falls ,State of South Dakota , as Surety, hereinafter called Surety, are held and firmly bound unto AUGUSTA, GEORGIA BY AND THROUGH THE AUGUSTA COMMISSION as Obligee,herein after called the Owner, Sixty-Six Thousand in the penal amount of Four Hundred Twenty and 00/100 Dollars ($ 66,420.00 ) for the payment whereof Contractor and Surety bind themselves,their heirs,executors,administrators,successors,and assigns,jointly and severally,firmly by these presents for the faithful performance of a certain written agreement WHEREAS,Contract has by said written agreement dated January 19,2017 entered in to a contract with Owner for the Sanitary Sewer Connection Services Task Order Program in accordance with the drawings and specifications issued by the Augusta Utilities Department and the Augusta Richmond County Commission, which contract is by reference made a part hereof, and is hereinafter referred to as the CONTRACT. NOW,THEREFORE,the condition of this obligation is such that,if Contractor shall promptly and faithfully perform said CONTRACT,then this obligation shall be null and void;otherwise it shall remain in full force and effect. The Surety hereby waives notice of any alteration or extension of time made by the Owner. 4(rage Whenever Contractor shall be, and declared by Owner to be in default under the CONTRACT, the Owner having performed Owner's obligations thereunder, the Surety may promptly remedy the default,or shall promptly (1) Complete the CONTRACT in accordance with its terms and conditions,or (2) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination by Surety of the lowest responsible bidder,or,if the Owner elects, upon determination by the Owner and the Surety jointly of the lowest responsible bidder, arrange for a contract between such bidder and Owner, and make available as Work progresses(even though there should be a default a succession of defaults under the contract or contracts of completion arranged under this paragraph)sufficient funds to pay the cost of completion less the balance of the contract price;but not exceeding,including other costs and damages for which the Surety may be liable hereunder,the amount set forth in the first paragraph hereof. The term"balance of the contract price,"as used in this paragraph,shall mean the total amount payable by Owner to Contractor under the Contract and any amendments thereto,less the amount properly paid by Owner to Contractor Any suit under this bond must be instituted before the expiration of two(2)years from the date on which final payment under the CONTRACT falls due. No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or the heirs,executors,administrators or successors of the Owner. Signed and sealed this 16th day of March A.D.20 17. Witness c ,c,1/4.a ( \L Stark Plumbing LLC (Seal) (Contractor) Attest By d-2� (Seal) (Title) Witness WESTERN SURETY COMPANY (Seal) (Surety) N. 7—P41 W itnes_s1, t 1WBy A a/ ,�tl•.� ' lam!u .1v J- kN a tianlcs,Attorney-in SIP- age Bond No. 71886852 LABOR AND MATERIAL PAYMENT BOND (NOTE: THIS BOND IS ISSUED SIMULTANEOUSLY WITH PERFORMANCE BOND ON PAGE 4,IN FAVOR OF THE OWNER CONDITIONED FOR THE PAYMENT OF LABOR AND MATERIAL) KNOW ALL MEN BY THESE PRENSENTS: 1026 Hampton Terrace That Stark Plumbing LLC North Augusta, SC 29841 as Principal, hereinafter called Contractor,and WESTERN SURETY COMPANY ,a corporation organized and existing under the laws of the State of South Dakota ,with its principal office in the City of Sioux Falls .State of South Dakota , as Surety, hereinafter called Surety, are held and firmly bound unto AUGUSTA, GEORGIA BY AND THROUGH THE AUGUSTA COMMISSION as Obligee,herein after called the Owner, Sixty-Six Thousand for the use and benefit of claimants as herein below defined in the amount of Four Hundred Twenty and 0011 ooDollars (5 66,420.00 ) for the payment whereof Contractor and Surety bind themselves,their heirs,executors, administrators,successors,and assigns,jointly and severally,firmly by these presents. WHEREAS,Contract has by written agreement dated January 19,2017 entered in to a contract with Owner for the Sanitary Sewer Connection Services Task Order Program in accordance with the drawings and specifications issued by the Augusta Utilities Department and the Augusta Richmond County Commission, which contract is by reference made a part hereof, and is hereinafter referred to as the CONTRACT. NOW, THEREFORE, the condition of this obligation is such that,if the Contractor shall promptly make payment to all claimants as hereinafter defined,for all labor and material used or reasonably required to use in the performance of the CONTRACT,then this obligation shall be void;otherwise it shall remain in full force and effect,subject,however,to the following conditions: (1) A claimant is defined as one having a direct contract with the Contractor or with a subcontractor of the Contractor for labor,material,or both,used or reasonably required for use in the performance of the contract,labor and material being construed as to include that part of water,gas,power,light,heat,oil,gasoline,telephone service or rented of equipment directly applicable to the CONTRACT. (2) The above named Contractor and Surety hereby jointly and severally agree with the Owner that every claimant as herein defined,who has not been paid in full before the expiration of a period of ninety(90)days after the date on which the last of such claimant's work or labor was done or performed,or materials were furnished by such claimant,may sue on this bond for the use of such claimant,prosecute the suit to final judgment for such sum or sums as may be justly due claimant,and have execution thereon. The Owner shall not be liable for the payment of any costs or expenses of any such suit. 61Page (3) No suit or action shall be commenced hereunder by any claimant, (a) Unless claimant,other than one having a direct contract with the Contractor,shall have given written notice to any two of the following:The Contractor,the Owner,or the Surety above named, within ninety (90) days after such claimant did or performed the last of the work or labor, or furnished the last of the materials for which said claim is made,stating with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished,or for whom the work or labor was done or performed. Such notice shall be served by mailing the same by registered mail or certified mail,postage prepaid,in an envelope addressed to the Contractor,Owner or Surety,at any place where an office regularly maintained for the transaction of business,or served in any manner in which legal process maybe served in the state in which the aforesaid project is located, save that such service need not be made by a public officer. (b) After the expiration of one(I)year following the date on which Contractor ceased work on said CONTRACT, it being understood, however, that if any limitation embodied in this bond is prohibited by any law controlling the constriction hereof, such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law. (c) Other than in a state court of competent jurisdiction in and for the county or other political subdivision of the state in which the project,or any part thereof,is situated, or in the United States District Court for the district in which the project,or any part thereof is situated,and not elsewhere. (4) The amount of this bond shall be reduced by and to the extent of any payment or payments made in good faith hereunder,inclusive of the payment by Surety of mechanics'liens which may be filed of record against said improvement,whether or not claim for the amount of such lien be presented under and against this bond. Signed and sealed this 16th day of March A.D.20 17. Witnca� g - Stark Plumbing LLC (Seal) (Contractor) Attest By - er. (Seal) itle) Witness WESTERN SURETY COMPANY (Seal) (Surety) Witrtess 0 (Title) 7 1 p a g e - ey Wayne Banks,Attorney-in- Stark Plumbing Awarded Lots-SSCP Phase 2 Group 1 Description -- Stark 6 2517 Sand Ridge Ct, Hephzibah, GA, 30815 1 LS 7 2524 Sand Ridge Ct, Hephzibah, GA, 30815 1 LS 9 2557 Spirit Creek Rd, Hephzibah, GA, 30815 1 LS 11 2572 Spirit Creek Rd, Hephzibah, GA, 30815 1 LS 13 2602 Whittier PI, Hephzibah, GA, 30815 1 LS 15 2610 Whittier PI, Hephzibah, GA, 30815 1 LS 16 2614 Sadie Ct, Hephzibah, GA, 30815 1 LS 18 2666 Carrington Dr, Hephzibah, GA, 30815 1 LS 19 2801 Harwood Dr, Hephzibah, GA, 30815 1 LS 21 2805 Harwood Dr, Hephzibah, GA, 30815 1 LS 22 2825 Pepperdine Dr, Hephzibah, GA, 30815 1 LS 23 2841 Harwood Dr, Hephzibah, GA, 30815 1 LS 24 2842 Pepperdine Dr, Hephzibah, GA, 30815 1 LS 25 2843 Harwood Dr, Hephzibah, GA, 30815 1 LS 27 2920 Arrowwood Cir, Hephzibah,GA, 30815 1 LS 28 2922 Arrowwood Cir, Hephzibah, GA, 30815 1 LS 31 2953 Arrowwood Cir, Hephzibah,GA, 30815 1 LS 38 3714 Fairington Dr, Hephzibah, GA, 30815 1 LS 47 3787 Fairington Dr, Hephzibah, GA, 30815 1 LS 49 3805 Crest Dr, Hephzibah, GA, 30815 1 LS 50 3807 Fairington Dr, Hephzibah, GA, 30815 1 LS 55 3846 Crest Dr, Hephzibah, GA, 30815 1 LS 56 3852 Fairington Dr, Hephzibah, GA, 30815 1 LS 57 3863 Crest Dr, Hephzibah, GA, 30815 1 LS 61 3912 Fairington Dr, Hephzibah, GA, 30815 1 LS 66 4125 Country Ln, Hephzibah,GA, 30815 1 LS ■ Total- $66,420.00 Western Surety Company POWER OF ATTORNEY-CERTIFIED COPY Bond No. 71886852 Know All Men By These Presents,that WESTERN SURETY COMPANY,a corporation duly organized and existing under the laws of the State of South Dakota,and having its principal office in Sioux Falls,South Dakota(the"Company"),does by these presents make, constitute and appoint Jeffrey Wayne Banks its true and lawful attorney(s)-in-fact,with full power and authority hereby conferred,to execute,acknowledge and deliver for and on its behalf as Surety,bonds for: Principal: Stark Plumbing LLC Obligee: Augusta—Richmond County Amount: $1,000,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President,sealed with the corporate seal of the Company and duly attested by its Secretary,hereby ratifying and confirming all that the said attorney(s)-in-fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds,policies, undertakings,Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President or by such other officers as the Board of Directors may authorize. The President,any Vice President,Secretary,any Assistant Secretary,or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds,policies,or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." All authority hereby conferred shall expire and terminate,without notice,unless used before midnight of May 15 2017 ,but until such time shall be irrevocable and in full force and effect. sli4$14 I +M` Western Surety Company has caused these presents to be signed by its Vice President,Paul T.Bruflat,and its co v e+ieelltrbe. this 16th day of March , 2017 :- t 04 " .: --- 0 WEST: R ►. SURE COMPANY 'Emit itzi SRA -SCJ �A Paul T. at,Vice President CO �� ti',' �`` ss On this 16th day of March ,in the year 2017 ,before me,a notary public,personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and deed of said corporation. t40.4.4•4.4.4.4.aba...%%.,%%%%rra•.+.+ s J. MOHR p J sF NOTARY PUBLIC� �$ Notary Public-South Dakota SOUTH DAKOTA %3 s +tig00000 oovtoo oebb4A oo + My Commission Expires June 23, 2021 I the undersigned officer of Western Surety Company,a stock corporation of the State of South Dakota,do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable,and furthermore,that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof,I have hereunto set my hand and seal of Western Surety Company this 16th day of March 2017 WEST ` Rh - ' SUREjCOMPANY / Paul T. at,Vice President To validate bond authenticity,go to www.enasurety.com >Owner/Obligee Services>Validate Bond Coverage. Form F5306-1-2016 R e AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY) �*�^'' 11/3/2016 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 NAMEACT JoyPhillips Sanford,Brulaer,Banks&Tabb,Inc PHONE 706 724 2452 FAX 931 Broad St (ac,No,at): (A/c,No):706.724.4097 Augusta,GA 30901 MAIL s: jphitlips@sbbinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Auto-Owners 18988 INSURED Stark Plumbing,LLC INSURER B: Guard GRD 1026 Hanpton Terrace INSURER C: RLI RLI North Augusta,SC 29841 INSURER D: 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 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. LTRINSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LIMITS A ✓ COMMERCIAL GENERAL LIABILITY 48567272 08/07/2016 08/07/2017 EACH OCCURRENCE $ 1,000,000 GE TO RENTED CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- V POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 1,0�,000 JECT OTHER: $ A AUTOMOBILE LIABILITY 49567272 08/08/2016 08/08/2017 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION STWC70043402/10/2016 02/10/2017 ✓ PER OTH AND EMPLOYERS'LIABILITY Y/NANY STATUTE ER O FF ICER/MEMBEERRE)CLUDED? NIA PARINERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) F es,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Augusta Richmond Bond LSM0525095 8/7/2016 8/7/2017 15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Augusta Richmond County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 9270 Augusta,GA 30916 AUTHORIZED REPRESENTATIVE T- C. y ,f LtK- 1 4 t ,,,,„„,,,,,,,,,.„„a____ 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD