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HomeMy WebLinkAbout4164 +--------------------------------------------------------------------------+ tEnter Search Criteria, Press Esc Key to Transmit t tpress Del Key to Terminate Delete Mode t t CHANGE Contract Transactions t t Contract Number 4164 t t t tVendor Name CONVERGENCE TECHNOLOGIES INC t tSubject CHERYL STREET SITE t tDepartment ADMIN SVCS t tStatus Code TEL t t Amount $3600.00 t t Begin Date 03/15/2001 t t Insurance End Date 12/31/2005 t t Type Amount Review Date 02/15/2007 t t GL $2000000.00 t + t t t t Insurance Total $2000000.00 t t Insurance Review Date 10/01/2005 + + t t Comments NON-RENEWAL LTR SENT 10/05 TO RENEW OR REMOVE EQUIPMENT t t VAULT 01/01/2007 t t t +--------------------------------------------------------------------------+ PUBLIC WORKS & UTILITIES Administration VIA CERTIFIED U.S. MAIL October 11, 2005 Mr. John Stockwell Convergence Technologies, Inc. 245 4th Street Suite 209 Bremerton, W A 98337 Re: Communications Lease Agreement Dear Mr. Stockwell: Repeated attempts have been made by the City of Bremerton to receive formal notification of your intent to renew your lease with the City at the tower site on Cheryl Street. Despite these attempts which have been by both US. Mail and e-mail, you have failed to respond as requested. You were notified of the requirement to provide formal notification of your intent to renew in June of 2004, November of 2004 and again in May of 2005. In each instance, you failed to respond as required by Section 5 of the lease. Therefore, since you are in default of the lease due to failure to comply with Section 5 of the lease, and in accordance with Section 12 the lease is hereby terminated and you are directed to remove your equipment from said tower no later than 45 days from receipt of this letter. Should you fail to do this, the City will effect removal and you will be billed for the cost of such removal. You may avoid this termination and removal of your equipment by simply complying with Section 5 of the lease and provide a letter notifying the City of your intent to renew. Sincerely, 62/c:?~ Paul R. Lucas Administrative Manager (Contract Administrator) C: City Attorney City Auditor +Browse: Next Previous First Last Update Delete Restart X - Exit +Retrieve the Next record +Found: 10 Record(s) MAINTAIN Contract Transactions + Contract Number 4164 + +Vendor Name CONVERGENCE TECHNOLOGIES INC +Subject CHERYL STREET SITE +Department ADMIN SVCS +Status Code TEL + Amount $3600.00 + Begin Date 03/15/2001 + Insurance End Date 03/14/2004 + Type Amount Review Date 11/01/2003 + GL $1000000.00 + + + Insurance Total $1000000.00 + Insurance Review Date 04/01/2003 + + Comments 2 THREE YR OPTIONS TO RENEW W/60-120 DAYS WRITTEN + NOTICE PRIOR TO EXPIRATION-CPI + LEASE AGREEMENT City Owned Tower THIS LEASE AGREEMENT entered into by and between the City of Bremerton, a municipal corporation duly organized and existing under the laws of the State of Washington, as Lessor (hereinafter referred to as "Lessor") and Convergence Technologies, Inc., (hereinafter referred to as "Lessee"). Whereas, Lessor is the owner of property housing a telecommunications tower and shelter at the site commonly known as the Cheryl Street Site and hereafter referred to as the "Premises". The Premises is more fully described on Exhibit "A" attached hereto and made a part of this Agreement. In consideration of the mutual covenants contained herein and for good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: 1. LEASE. Lessor agrees to lease to Lessee approximately 1' x 5' (5) square feet of space on the Lessor's telecommunication tower and space in the adjacent shelter for associated antenna and radio equipment cabinet hereafter referred to as the "Equipment" more fully described on Exhibit "B" attached hereto and made a part of this Agreement. Any change to the Equipment described in Exhibit "B" shall result in renegotiation of the lease rent amount and require prior approval by the Lessor. 2. USE OF PREMISES. a. Lessee agrees to use the Premises for the installation, operation and maintenance of equipment and associated antenna for the purpose of transmission and reception of telecommunication and signals in any and all frequencies described in Exhibit "B" attached hereto and made a part of this Agreement. All of Lessee's equipment or other property attached to or otherwise brought onto the Premises shall at all times remain personal property and are not considered fixtures, and at Lessee's option may be removed by Lessee at any time during the term hereof or any renewal terms. Upon expiration or termination of this Agreement, Lessee agrees to repair any damage to the Premises caused by Lessee during the term of the Agreement, ordinary wear and tear and damage from the elements excepted. In connection therewith, Lessee shall have the right, at its sole cost and expense, to obtain electrical and telephone service from the servicing utility company, including the right to install a separate meter and main breaker, where required. Lessee shall be responsible for the electricity it consumes for its operations at the normal rate charged by the servicing utility company. Lessee and Lessor agree that if an easement is required to obtain telephone service, Lessor and the servicing utility company will agree to an acceptable location. LEASE AGREEMENT - Page 1 Convergence Technologies - 2/7/01 b. This lease is contingent upon the Lessee obtaining all necessary permits, approvals and licenses for the proposed facilities. In the event that the Lessee is unable to obtain all such permits, approvals and licenses, it may cancel this lease, and obtain a pro rata refund in any rents paid, without further obligation by giving thirty (30) days prior written notice to the City. Lessee agrees to restore City property to original condition if cancellation is requested. In the event that the holder of a lease determines that the City property is unsuitable for its intended purpose, the Lessee shall have the right to cancel the lease upon thirty (30) days written notice to the City. c. Lessee shall have the right to mn transmission lines from the equipment area to the antenna location and to mn power fi.om the main feed to the equipment, which improvements shall be at Lessee's sole cost and expense. Further, Lessee agrees to perform all improvements in a good and workmanlike manner. d. Lessor agrees to provide twenty-four (24) hours, seven (7) days a week access to the Premises without charge to Lessee, Lessee's employees or any subcontractors or agents. Lessor acknowledges that the Lessee has such access, which shall remain unimpeded throughout the initial term and any renewal term of this Agreement. e. Notwithstanding any other provisions herein, the Lessee shall not enter into any sublease of the Premises or any portion thereof, and shall not enter into any assignment of any interest in this agreement, whether long or short term in nature, and shall not engage in any activity with respect to or on the Premises other than the express use(s) and purpose(s) stipulated herein, without obtaining prior written authorization therefore from the Lessor. 3. SITE TESTING. Lessor acknowledges that Lessee, at its option following full execution of this Agreement, may perform engineering surveys, structural analysis reports, or any other testing which may be required in order for Lessee to occupy the Premises as more fully described in Paragraph 2 (a), (b) and (c) above. Any materially adverse test results may entitle Lessee to terminate this Agreement under Paragraph 2 (b). 4. INTERFERENCE. a. Lessee agrees not to cause interference to the radio frequency communication operations of Lessor, Lessor's tenants, or anyone holding an agreement with Lessor to operate on the Property during the site testing phase. b. A~er the execution of this Agreement, Lessee shall not install or permit the installation of any equipment interfering with or restricting the operations of Lessor, Lessor's tenants, or anyone holding an agreem~nt with Lessor. Such interference shall be deemed a material breach of this Agreement by Lessee. Should such interfer~mce occur, LEASE AGR~EEMENT - Page 2 Convergence Technologies - 2/7/01 Lessee shall promptly take all necessary action, at no cost to Lessor, to elimiffate the cause of said interference, including, if necessary removing equipment creating said interference. c. In the event that any other tenant's activities interfere with the Lessee's use of the City property, and the Lessee cannot resolve this interference with the other tenants, the Lessee may, upon thirty (30) days notice to the City, terminate this lease. d. Lessee shall operate its equipment in compliance with all Federal Communications Commission (FCC) regulations and in compliance with the applicable standards for this site as established by the Western Washington Cooperative Interference Committee (WWCIC) Engineering Standard #6 Rev. C (09-97) for Radio Transmitting and Receiving Devices and FM Broadcast, hereinat~er incorporating future amendments. 5. TERM. The initial term of this Agreement shall be for a period of three (3) years ("Term") commencing upon March 15, 2001, ("Commencement Date") and shall terminate on the third anniversary of the Commencement Date, unless otherwise provided in Paragraph 11. Lessee shall have the right to renew the Agreement for two (2) successive three (3) year periods ("Renewal Terms"), upon the same terms and conditions in effect during the Term except as to rent which may be re-negotiated. Lessee shall exercise its renewal rights by providing written notice to Lessor of its intention to renew not more than one hundred twenty (120) days nor less than sixty (60) days prior to the expiration of the Term or any Renewal Term. 6. RENT. a. Lessee agrees to pay to Lessor as rent the sum of One Hundred and No/100 Dollars ($100.00) ($50/antenna and $50/transmitter) per month ("Rent") within ten (10) business days following the Commencement Date. Should the Commencement Date occur on a day other than the first day of the month ("Due Date") during the Term or Renewal Terms, Rent shall be prorated. Rent payments shall be payable to Lessor. b. At the beginning of each successive year thereafter the monthly rent shall automatically be adjusted based upon the CPI for all urban consumers, Seattle-Tacoma index (1982-84=100) as published by the Bureau of Labor Statistics for the last month for which statistics are posted prior to the effective date above. However, rent shall not, in any case, decrease. c. Any payments received after ten (10) business days following the Due Date shall include a late payment penalty of 2% of the annual rental fee for each day or part thereof past the due date. 7. TAXES. LEASE AGREEMENT - Page 3 Convergence Technologies - 2/7/01 Lessee agrees to pay any portion of personal property taxes which may be assessed upon the Premises as a direct cause of Lessee's Installation. Lessor shall provide evidence of such assessment within a timely manner. 8. INSURANCE. The Lessee shall, as a condition of the Lease, secure and maintain the following liability insurance policies insuring both the Lessee and Lessor and its elected and appointed officers, officials, agents, employees, representatives, engineers, consultants, and volunteers against claims for injuries to persons or damages to property which may arise from or in connection with the exercise of the rights, privileges, and authority granted to the Lessee: a. Comprehensive general liability insurance, written on an occurrence basis, with limits not less than: (1) $1,000,000.00 for bodily injury or death to each person; (2) $1,000,000.00 for property damage resulting from any one accident; and O) $1,000,000.00 for all other types of liability. b. The liability insurance policies required by this Section shall be maintained by the Lessee throughout the term of the Lease, and such other period of time during which the Lessee is operating without a Lease hereunder, or is engaged in the removal of its telecommunications facilities. The Lessee shall provide an insurance certificate, together with an endorsement designating the Lessor and its elected and appointed officers, officials, agents, employees, representatives, engineers, consultants, and volunteers as additional insureds, to the Lessor prior to the commencement of any work or installation of any facilities pursuant to said Lease. Any deductibles or self-insured retentions must be declared to and approved by the Lessor. Payment of deductibles and self-insured retentions shall be the sole responsibility of the Lessee. The Lessee's insurance shall be primary insurance as respects the Lessor, its officers, officials, employees, agents, consultants, and volunteers. Any insurance maintained by the Lessor, its officers, officials, employees, consultants, agents, and voltmteers shall be in excess of the Lessee's insurance and shall not contribute with it. The Lessor shall be provided thirty (30) days advance notice of cancellation of any coverages required above; e. Within thirty (30) days after receipt by the Lessor of said notice, and in no event later than fifteen (15) days prior to said cancellation or intent not to renew, the Lessee shall obtain and furnish to the Lessor replacement insurance policies meeting the requirements of this Section. 9. GENERAL INDEMNIFICATION. LEASE AGREEMENT - Page 4 Convergence Technologies - 2/7/01 Lessee covenantg not to bring suit against the Lessor and hereby agrees to defend, indemnify, and hold harmless the Lessor, its appointed and elected officers, employees, agents and volunteers fi.om and against any and all liability, loss, costs, damage, and expense, including costs and attorney fees in defense thereof, and including claims by the Lessee's own employees to which the Lessee might other~vise be immune under Title 51 RCW, because of actions, claims or lawsuits for damages resulting from personal or bodily injury, including death at any time resulting therefi'om, sustained or alleged to have been sustained by any person or persons, and on account of damage to property, arising or alleged to have arisen directly or indirectly out of or in consequence of the performance of this Agreement, whether such injuries to persons or damage to property is due to the negligence of the Lessee, its agents, employees, representatives or assigns. This provision shall be inapplicable to the extent such damage or injury is judicially found to be caused by the sole negligence of the Lessor. This provision waiving immunity for claims arising out of Title 51 RCW was specifically negotiated by the parties. Lessee assumes the risk of damage to its facilities located in the Lessor's public ways, rights-of-way, easements and property from activities conducted by the Lessor, its officers, employees, agents, and volunteers. The Lessee releases and waives any and all claims against the Lessor, its officers, employees, agents, and volunteers for damage to or destruction of the Lessee's facilities except to the extent any such damage or destruction is caused by the willful and malicious action of the Lessor, its officers, employees, agents, or volunteers. 10. RIGHTS GRANTED. This Lease does not convey any right, title or interest in the City Property, but shall be deemed to convey only the right to use and occupy the City Property for the limited purposes and term stated in the Lease. Further, this Lease shall not be construed as any warranty of title. 11. TERMINATION. Lessee may terminate this Agreement without further liability on prior written notice to Lessor, which shall become effective sixty (60) days after the date notice is mailed 12. DEFAULT AND RIGHT TO CURE. Lessor shall have the right to terminate this Agreement by written notice to take effect immediately if Lessee fails to make its rental payment when due and does not cure such failure within ten (10) days of Lessor's notice thereof. In addition either party shall have the right to terminate this Agreement on written notice to take effect immediately if the other party (i) fails to perform any other covenant for a period of forty-five (45) days after receipt of notice in accordance with Paragraph 14; or (ii) commits a material breach of this Agreement and fails within forty-five (45) days of the first party's notice thereof to commence curing the breach and continuously and diligently pursues such cure to its completion. 13. NOTICES. LEASE AGREEMENT - Page 5 Convergence Technologies - 2/7/01 Unless otherwise provided herein, any notice or demand required to be given herein shall be given by certified or registered mail, return receipt requested or reliable overnight courier to the address of Lessee and Lessor as set forth below: LESSOR: LESSEE: City of Bremerton Convergence Technologies, Inc. Administrative Services Director Right of Access - Coordinator 239 Fourth Street 1202 Sheridan Road Bremerton, WA 98337 Bremerton, WA 98310 Lessee and Lessor may designate a change of notice address by giving written notice to the other party. 14. AMENDMENT. No amendment or modification to any provision of this Agreement shall be valid unless made in writing and agreed to and signed by the appropriate parties who have attested and executed this Agreement. 15. GENERAL CONDITIONS. a. Entire Agreement: This Agreement constitutes the entire agreement between the parties and both parties acknowledge that there are no other agreements, written or oral, that have not been fully set forth in the text of this Agreement. b. Waiver: Failure to insist upon strict compliance with any terms, covenants or conditions of this Agreement shall not be deemed a waiver of such, nor shall any waiver or relinquishment of such right or power at any time be taken to be a waiver of any other breach. e. Applicable Law & Venue: This Agreement shall be construed and interpreted in accordance with the laws of the State of Washington and, in the event of dispute, the venue of any action brought hereunder shall be in Kitsap County Superior Court. d. Severability: If any provision of this Agreement is deemed invalid or nonenforceable, the remainder of this Agreement shall remain in force and to the fullest extent as permitted by law. // LEASE AGREEMENT - Page 6 Convergence Technologies - 2/7/01 CONVERGENCE TECHNOLOGIES, INC. JO~ STO¢ WELL, President CITY OF BREMERTON Date: ,.:~-~sf-O! BY: ~ :d/~"~ LYNN S. HORTON, Mayor DEPARTMENTAL APPROVAL: E~G~, Director Public Works & Utilities DAVID B. ST.'PIE~RRE, Assistant City Attorney REC~V~..F/Iq : - ~1 KEY, City Clerk / Attachments: Exhibit A: Description of Premises Exhibit B: Description of Equipment II II II LEASE AGREEMENT - Page 7 Convergence Technologies - 2/7/01 State of Washington ) ) SS. County of Kitsap ) On this ~t9~'''-uay o .. _&,cC/~m.2 ,20 D t , before me, the undersigned Notary Public in and for,the State of Wasllington,~ duly commissioned and sworn, p~rsonally appeared ~ ~ ~-/~/~t.(,(. , /~F~ 54~ of~.~rV/~r~r~c~_"'~z~ot/~}~ the organizatidfi that executed the within and' foregoing instrument, and acl~nowledged said/ instrument to be the free and voluntary act and deed of said organization, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to execute said instrument. In witness wh~e~h~ve hereunto set my hand and affixed my official seal the day and year first above v~ll~.._ I ~ _~I~I. IG. i ~ N*ta]y mu]~lic i~'an~ ;or life)State of- Washington ~~77 My commission expires: State of Washington ) ) SS. County of Kitsap ) On this ~a~day of~.,~, 20 OI , personally appeared Lynn S. Horton to me known to be the MaS, or of the City of Bremerton, a municipal corporation, that executed the within and foregoing instnunent, and acknowledged said instrument to be the free and voluntary act and deed of said municipal corporation, for the uses and purposes therein mentioned, and on oath stated that she was authorized to execute said instrument. In witness whereof I have hereunto set my hand and affixed my official seal the day and year first above written. Notary Pt~lic ~nand for the Stata(of Washington Residing at _~$,o~,,~_t.l. at-,~.) My commission expires: ~/,,~__ LEASE AGREEMENT - Page 8 Convergence Technologies - 2/7/01 EXHIBIT "A" WITNESS TH: 1. Premises. The C£=y is =he legal o~er of the following A parcel of land located in the N.W. 1/4 of =he $.w. 1/4 of =he N.E. 1/4 of Sec=ion i Tuwnship N., ~ange i East of the Willamette Meridian. K~own . and olympus Avenue in East Bremert?n;. ALSO: A 40' x 80' parcel of land located in =he $.W. 1/4 cf ~hs N.E. 1/4 of Section X, T. 24 N., 1 E. of =he Willamette Mer£d£an. Parcel is within ~he boundaries of · ten acre parcel (660' x 660') ~'~.ed by the City of bounded by Cheryl Street on the North and Forest Drive on =he East, more particularly described by City of Bremar~on Survey Plat, Exhibit "A" which is attached hereto and made · a par~ hereof by this reference. AST BREMERTON Feb- 12-01 06: 37P ~ ~ P.02 SITE: BREMERTON-CIIERYI, SCHEDULE B ....... LESSEE'S ANTENNA AND EQUIPMENT SPECIFI(.~ATIONS Frequency: Transmit 2.4000-2Ag35Ghz Receive: 2.4000-2.4835Ghz Antenna: Type Quaatity Product No. Dimension (Approx) Bi-direction I HG2415U Weight 1,16 kg Length 1.78 m Width 2.5cm ~_~b!g: Amphenol Coaxial TWB 400 or Equiv, Diameter I cm Eouioment: 1) 19" relay rack equipped with shelf Air Conditioning: Existing air conditioning equipment will support this equipment St!bst_itu_tj. gn: Convergence Technologies, Inc. reserves the right to substitute similar model and style of antenna or equipment. Initials EXHIBIT "B" HyperGain ~M Model HG24f5U 2.4 GHz 15 dBi Omnidirectional Antenna Electrical Characteristics Frequency 2400 - 2483.5 MHz Gain 15 dBi Impedance 50 Ohm VSWR 1: 1.5 max Maximum Input Power 100 W Vertical Pattern (dB) Mechanical Characteristics Weight 1.16 kg Length 1.78 m Radome Material Fiberglass Finish Powdercoat Mounting 2.5" diameter mast max. E~{IBIT "B" 3erGain HG2415U Mount antenna on west leg of tower CONVERGENCE TECHNOLOGIES, INC. Wireless Access Antenna Bremerton-Coast Guard Tower Cheryl Avenue Antenna Schematic- SIZE FSC~4 NO DWG NOorgREV. Elevation East Elevation J. Stockwell Jan. 30, 2001 SCALE lin =2Oft Oinl ISHEET I OF 1 I I — I CONVTEC-01 KEWAR ACORD' �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 9/2912022 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 -E: FourOrchard PHONE F Four Orchard St. W. (A/C, No, Ext): (366) 373-4100 5712 University Place, WA 98467 ADoRIL . requests@fourni INSURED Convergence Technologies,lnc. PO Box 2307 Bremerton, WA 98310-2307 rnvFoer_Gc CFR7IFICATF NIIMRFR� .com REVISION NUMBER: 792-2454 v 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 IADDLISUBR NSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR 1 BKS57503678 10l14/2022 10/14/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISESEa occurrence) 1,000,000 $ MED EXP (Any oneperson) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY jRo LOC OTHER: PRODUCTS - COMP/OP AGG 2,0001000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BAS57664008 12/1/2021 12/1/2022 COMBINED SINGLE LIMIT Ea accident) 1,000,000 $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PeorracEcidentDAMAGE $ rA UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A BKS57503678 10/14/2022F10/14/2023 STATUTEOTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Operations of the named insured CFRTIFICATF Hnl_r)FR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cityof Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th St Ste 600 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE 7 1 r? ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD