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HomeMy WebLinkAboutL.K. McLean - Drainage Projects (FI Sewer Dist) =oOgUfFO(,yC3 RESOLUTION 2023-525 � ADOPTED DOC ID: 19203 A THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2023-525 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 6, 2023: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Service Agreement between the Town of Southold and L.K. McLean Associates, P.C., at a cost not to exceed $3,600.00 per year, in connection with Fishers Island Sewer District, subject to the approval of the Town Attorney. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Sarah E. Nappa, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell RECEIVED o�aSu�Fot,�Co Gym JUL 10 2023 Southold Town Clerk Office of the Town Attorney Town of Southold Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone : 631-765-1939 Facsimile: 631-765-6639 MEMORANDUM To: Denis Noncarrow, Town Clerk From: Melissa M Mirabelli Secretary to the Town Attorney Date: July 10, 2023 Subject: Agreement between Town of Southold and LKMA- Fishers Island Sewer District With respect to the above-referenced matter, I am enclosing the original Agreement together with the Resolution. If you have any questions regarding the enclosed, please do not hesitate to call me. Thank you. /mmm Enclosures cc: Accounting Engineer THIS AGREEMENT made and entered into this 10A--of July 2023, by and between Town of Southold (hereinafter referred to as "Town"), a municipal corporation organized and existing under and by virtue of the laws of the State of New York (mailing address: c/o Dennis Noncarrow, Town Clerk, P.O. Box 1179, Southold, New York 11971-0959), party of the first part,and Louis K McLean & Associates Engineers & Surveyors PC (hbreinafter referred to as "Consultant") with an address at 437 South Country Road, Brookhaven New York 11719, party of the second part. WITNESSETH: That the Town and Consultant, for the consideration named, hereby agree as follows: 1. PURPOSE. The Consultant shall provide various professional land surveying services in support of drainage projects throughout the Town of Southold. 2. SPECIFIC SERVICES. The Consultant shall perform all the tasks set forth in the Letter Proposal submitted to the Town dated March 21, 2023, a copy of which is attached hereto as Appendix A and made a part hereof. 3. TIME AND ATTENDANCE; COOPERATION BY THE TOWN. The services to be rendered under this Contract shall be completed within six months (6) months of execution of the contract. The Town agrees to cooperate with Consultant, as needed, and to provide Consultant with copies of any records, documents and other information needed for performance of this agreement on a timely basis. The Town further agrees to provide Consultant with access to appropriate officials and/or employees of the Town, as may be needed in the performance of the agreement Moreover, both parties understand and agree that mutual accountability and responsiveness is critical to the successful completion of the project, and therefore both shall always use their best faith efforts to be accountable and promptly responsive to each other. 4. COMPENSATION. In payment for the services to be performed hereunder by Consultant, the Town shall make payments to Consultant as follows: (a) For the services to be performed by Consultant pursuant to paragraph "2" hereof, the Town shall pay Consultant as set forth in the Proposals. Consultant shall submit an itemized voucher for work actually completed on a "monthly basis with the Town Comptroller and the Town will pay. Such voucher shall be due and payable within 45 days after receipt of such voucher, but such sum shall not be due and payable by the Town until the Town Board of the`Town has received such a voucher and has audited and approved for payment the signed voucher to be submitted by Consultant in connection therewith. (b) The Town Board shall process any vouchers received from Consultant as expeditiously as possible. (c) In the event that the Town disputes or objects to any portion of any voucher submitted by Consultant pursuant to this paragraph,the Town shall,within 30 days of the receipt of such voucher, notify Consultant in writing of such dispute or objection. (d) Consultant acknowledges that Consultant is familiar with the requirements of section 118 of the Town Law which, in effect, prohibits payment of any of Consultant's claims against the Town unless an itemized voucher therefore shall have been presented to the Town Board or Town Comptroller and shall have been audited and allowed by the Town Board or Town Comptroller. 5. TERM OF AGREEMENT; TERMINATION This agreement shall commence upon full execution hereof and shall terminate upon completion of, and payment for, all the tasks outlined in the Proposal, provided, however, that this agreement shall terminate immediately in the event that (a) Consultant dies; (b) Consultant incurs a disability which makes Consultant unable to perform the services which Consultant is required to perform hereunder; (c) Consultant files a Petition in Bankruptcy Court or a Petition is filed against Consultant in Bankruptcy Court, or Consultant is adjudged bankrupt or makes an assignment for the benefit of creditors; or (d) a Receiver or Liquidator is appointed for Consultant and/or Consultant's property and is not dismissed within 20 days after such appointment or the proceedings in connection therewith are not stayed on appeal within the said 20 days. In the event that Consultant refuses or fails to provide the services required hereunder with due diligence, or fails to make prompt payment to persons supplying labor for Consultant's services hereunder, or refuses or fails to comply with applicable statutes, laws or ordinances, or is guilty of a substantial violation of any provision of this agreement,the Town shall send Consultant written notice that Consultant has 20 days to cure said default;and if,at the end of said 20-day period,Consultant has not cured said default,the Town may then terminate this agreement on 7 days' prior written notice to Consultant. Except as prohibited by law, the Town and Consultant hereby waive trial by jury in any litigation arising out of, or connected with, or relating to this Agreement. 6. SKILLS OF CONSULTANT Consultant represents that Consultant has the requisite skills and experience to perform the services hereunder. 7. INDEPENDENT CONSULTANT STATUS OF CONSULTANT. Consultant and the Town agree that in the performance of Consultant's services hereunder, Consultant is an independent contractor and shall not be deemed to be an employee or agent of the Town for any purpose whatsoever. The Consultant shall assume all blame, loss and responsibility of any nature by reason of neglect or violation of any federal, state, county or local laws, regulations or ordinances. 8. CONSULTANT'S INSURANCE The Consultant shall not commence work under this Contract until it has obtained all insurance required under this paragraph and such insurance has been approved by the Town. (a) Compensation Insurance: The Consultant shall take out and maintain during the life of this Contract Workers' Compensation Insurance for its employees to be assigned to the work hereunder. (b) Liability Insurance: The Consultant shall take out and maintain during the life of this Contract such general liability, property damage, and commercial auto liability insurance as shall protect it from claims for damages for personal injury, including accidental death, as well as from claims for property damage which may arise from operations under this Contract. The amounts of such insurance shall be as follows: 1. General liability insurance in an amount not less than $1,000,000 for injuries, including wrongful death to any one person and subject to the same limit for each person, in an amount not less than $2,000,000 on account of any one occurrence. 2. Property damage insurance in an amount not less than $300,000 for damage on account of all occurrences. The Consultant shall furnish the above insurances to the Town and shall also name the Town as an additional named insured in said policies. (c) Any accident shall be reported to the office of the Town Clerk as soon as possible and not later than twenty-four (24) hours from the time of such accident. A detailed written report must be submitted to the Town as soon thereafter as possible, but not later than three (3) days after the date of such accident. 9. INDEMNIFICATION Consultant shall release, indemnify,defend and hold harmless the TOWN,its officers, employees, and representatives from and against any and all demands, liabilities, losses, damages,expenses (including attorney's fees) and judgments for any personal injuries, death, or property damage in any way relating to or arising from this Contract and the services to be performed under this contract. 10. PROHIBITION AGAINST ASSIGNMENT. Consultant is hereby prohibited from assigning, transferring, conveying, subletting or otherwise disposing of this agreement or his right, title or interest in this agreement without prior written consent of the Town. 11. COMPLIANCE WITH STATUTES. Consultant agrees that Consultant will comply with all statutes, ordinances, local laws, codes, rules and regulations which are or may be applicable to Consultant's services, activities and duties set forth in this agreement. 12. NOTICES. Any and all notices and payments required hereunder shall be addressed as follows, or to such other address as may hereafter be designated in writing by either party hereto: To Town: Dennis Noncarrow Town Clerk Town of Southold PO Box 1179 Southold, NY 11971-0959 To Consultant: Christopher F. Dwyer L.K. McLean Associates, P.C. 437 South Country Road, Brookhaven New York 11719 13. WAIVER. No waiver of any breach of any condition of the Agreement shall be binding unless in writing and signed by the party waiving said breach. No such waiver shall in any way affect any other term or condition of this Agreement or constitute a cause or excuse for a repetition of such or any other breach unless the waiver shall include the same. 14. APPLICABLE LAW. This Agreement and the rights and obligations of parties hereunder shall be construed in accordance with and be governed by the laws of the State of New York without regard to conflicts of laws and principles. Consultant hereby submits to the jurisdiction of the Courts of the State of New York for all disputes relating to this Agreement and agrees that venue for all disputes shall be in Suffolk County. 15. COMPLETE AGREEMENT; MODIFICATION. This Agreement constitutes the complete understanding of the parties. No modification of any provisions thereof shall be valid unless in writing and signed by both parties. IN WITNESS WHEREOF, the Town of Southold has caused its corporate seal to be affixed hereto and these presents to be signed by Scott A. Russell, its Supervisor, duly authorized to do so, and to be attested to by Dennis Noncarrow, Town Clerk, and the Consultant has caused its corporate seal to be affixed hereto and these presents to be signed by its President, the day and year first above written. Town of Southold By: Scott A. Russell, Supervisor Louis K. McLean & Associates Engineers & Surveyors PC By: Raymond G. DiBiase, PE. PTOE STATE OF NEW YORK) ) ss.. COUNTY OF SUFFOLK) On the I U�of July in the year 2023 before me,the undersigned,personally appeared Scott A.Russell, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his c acand that by his signature on the instrument,the individual or the person upon whose behalf of w 'ch the individual acted, executed the instrument. Richard D.Noncarrow Notary Public,State of New York No.01 N06224106 Notary Public Ouaiified in Suffolk County My Commission Expires June 2 .20,.... STATE OF NEW YORK) ) ss.. COUNTY OF SUFFOLK) On the of July in the year 2023 before me,the undersigned, personally appeared Raymond G. DiaBiase P.E., P.T.O.E., personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity and that by his signature on the instrument,the individual or the person upon whose behalf of which the individual acted, executed the instrument. CHRIP'"CiWIEGAND NOTAP'o State of New York No.Il ;!•• Suffolk County C +son"Pa as August 17 Notary Public CHRISTINE WIEGA� „ NOTARY PUBLIC,State of New York No.01 W16210359,Suffolk Coun Commission Expires August 17 Z5 L11AA , L. K. McLean Associates, P. C'. •:• 437 South Country Road • Brookhaven • Nety York • 11719 (631)286-8668 - FAX (631)286-6314 •:• 25 Newbridge Road • Suile 212 • Hicksr•ille • New York • 11801 https:hw\%,w,lkma.com RAYN'.OND G.DiBIASE,P.E.,PTOE,PTP,PRESIDENT and CEO Associates ROBERT A.STEELE,P.E..EXECUTIVE VICE PRESIDENT JAMES L DeKONING,P.E.,VICE PRESIDENT CHRISTOPHER F.DWYER STEVEN W.EISENBERG,P E ANDREW B.SPEISER MATTHEW C.JEDLICKA,LEED AP KEITH J.MASSERIA,P.E. VINCENT A.CORRADO,P.E, March ?1, 2023 TAMARA L STILLMAN.P.L.S. -Down of Southold Engineering Depalrtlnent 53095 Route 25 P.O. Box 1 179 SOLltllold, N.Y. 1 1971 ATT: Michael Collins P.E.. Civil Engineer Re: ";Measure & Report Scum and Septic Levels—Fishers Island Sewer District its 2023" Lump Sum Cost Proposal for Professional Services Dear N14r. Collins: In accordance with your request, L.K. McLean Associates, P.C. (i,KN/IA) is pleased to submit the following proposal :for professional surveying services In conjurictlon with die above mentioned project. We are familiar with the attachments provided in your email from ,lanuary 2014 and we understand the scope of services remains the same on Fisher's Island for the two (2) measuring and reporting periods (May and November) identified in your request. We understand our Scope 01'services to include the, f0ll0NN'i1)2: I. SCOPE OF SERVICES .C.1 U,-S ER S}YTEH N,leasure the scum and septage levels in the :inlet and outlet compartment of the septic tank lleport the liquid ]lcight in the septic tank and the first leaching pool. The covers for the three overflow leaching pools shown on the design dravving are not at grade CINI1114 SYS'TE14' MeaSLue the Scum and septage levels in the inlet and Outlet compartment of' the septic tank Report the liquid height in the septic tank and in both ends of each of the two leaching galleries C0A4.111_JV[T1'SI. TE,II Measure the scum and septage levels in the inlet and outlet compartments of each of the three septic tanks. .Report the liquid height in each of the three septic tanks and in both ends of each oto the fourteen leaching galleries. Assumin�g these conditions are acceptable Nve N4-ould recommend the folloNving fee: TODAY'S CHALLENGES I TOMORROW'S SOLUTIONS Since 1950 L11 A A L. K. McLean Ass®cautes, P. C'. 11. FEE AND PAYMENT Our fee estimate for the above services is as foilows: TASK A MEASURE &REPORT LF.,VELS (MAY 2023) $ 1,800.00 TASK B MEASURE &REPORT LEVELS (NOV 2023) S 1,800.00 ENGINEER-ING TOTAL: S 3,600.00 The above referenced lump sum includes all time, materials and transportation costs associated with the assignment. It is proposed that any additional authorized tivork be negotiated with the Town if and when necessary. No additional work will be performed without prior authorization. L.K. McLean Associates looks forward to working with you on this assignment. Thank you for the opportunity to provide this proposal for professional services; should you have an), questions or comments regarding this proposal.. please do not hesitate in contacting this office. Very truly yours, CFD:cfd Christopher F. Dwyer, Associate CC: LKMA File Copy LKMA Comptroller I.KMA Proposal-Measure&Report Levels{d:Fishers Island Sewer District in 2023 Page 2 o1'2 DATE(MM/DD/YYYY) .4co CERTIFICATE OF LIABILITY INSURANCE 01/26/2023 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(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements s. PRODUCER Keystone Risk Partners LLC CONTACT NAME: 604 East Baltimore Pike PHONE A/C No Ext):888-473-6398 FAX A/C No): Media,PA 19063 E-MAIL ADDRESS:Risk ExtensisGrou .com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Company of North 43575 INSURED INSURER B: Philadelphia Indemnity insurance Company 18058 Extensis,Inc.UC/F INSURER C: Louis K McLean Associates Engineers&Surveyors PC(Louis K McLean Associates Engineers&Surveyors PC) INSURER D: 900 US HWY 9 North,3rd Floor INSURER E: Woodbridge,NJ 07095 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 ADD'L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSRD WVD POLICY NUMBER MM/DD/YYYYI (MMIDDrrYYYI LIMITS GENERAL LIABILITY Not Applicable EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED $ PREMISESS Ea occurrence CLAIMS MADE ❑OCCUR I MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ COMED AUTOMOBILE LIABILITY Not Applicable Ea acBcide t SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR PHUB833392 09/30/2022 09/30/2023 EACH OCCURRENCE $ 10,000,000.00 B EXCESS LIAB CLAIMS MADE AGGREGATE $ 10,000,000.00 X DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY C51424098 09/30/2022 09/30/2023 TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBER EXCLUDED? Y/N N/A (Mandatory in NH) F-1E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 206744 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southland ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO Box 1179 AUTHORIZED REPRESENTATIVE Southold,NY 11791 Jay Peichel ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DATE(MM/DDrNW) AcoR>o• CERTIFICATE OF LIABILITY INSURANCE 01/26/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements s. PRODUCER Keystone Risk Partners LLC CONTACT NAME: 604 East Baltimore Pike PHONE A/C No Ext):888-473-6398 FAX Z.No): Media,PA 19063 E-MAIL ADDRESS:Risk ExtensisGrou .com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Company of North 43575 INSURED INSURER B: Philadelphia Indemnity Insurance Company 18058 Extensis,Inc.L/C/F INSURER C: Louis K McLean Associates Engineers&Surveyors PC(Louis K McLean Associates Engineers&Surveyors PC) INSURER D: 900 US HWY 9 North,3rd Floor INSURER E: Woodbridge,NJ 07095 INSURER R COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 ADD'L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSRD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY Not Applicable EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ COMAUTOMOBILE LIABILITY Not Applicable Ea acBcide t SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F7SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAR X OCCUR PHUB833392 09/30/2022 09/30/2023 EACH OCCURRENCE $ 10,000,000.00 B EXCESS LIAB CLAIMS MADE AGGREGATE $ 10,000,000.01) X DED I X RETENTION $ 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY C51424098 09/30/2022 09/30/2023 TORY LIMITS1 ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000.00 OFFICEWMEMBER EXCLUDED? Y/N N/A (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 206744 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southland ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO Box 1179 AUTHORIZED REPRESENTATIVE Southold,NY 11791 Jay Peichel ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD