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HomeMy WebLinkAboutXStream Creamery 6-27-16THIS AGREEMENT is made this.2_1 day of __,WpLe 2016 ("Effective Date"), by and between the CITY OF CAPE CANAVERAL, FLORIDA, a Florida municipal corporation, whose address is 105 Polk Avenue, Cape Canaveral, Florida, 32920 EXTREMERADS, LLC DBA XSTREAM CAR WASH AND CREAMERY, whose address is 7900 North Atlantic Avenue, Cape Canaveral, Florida, 32920 ("Vendor"). WHEREAS, the Vendor desires to offer COMMERCIAL BEACH MOBILE CART VENDING SERVICE OPERATION FRANCHISE FOOD AND NON ALCOHOLIC BEVERAGES ("Services") for the benefit of the public using the sand beach areas within the • ffl�� WHEREAS, the City desires to allow the Vendor to offer such Services to the public under the terms and conditions set forth in this Agreement. IN CONSIDERATION of the mutual covenants and provisions hereof, and other good, diverse and valuable considerations, the receipt and sufficiency all or which is hereby acknowledged, the parties desiring to be legally bound do hereby agree as follows: ARTICLE 1. 1.1 Engagement. The City hereby engages the Vendor for the stated fee arrangement and the Vendor agrees to perform the Services outlined in the Request for Proposal and Vendor submittal, attached hereto as EXHIBIT "A", which is fully incorporated herein by this reference. unless incorporated in this Agreement. 1.2 Due Diligence. The Vendor acknowledges that he/she has conducted an investigation prior to execution of this Agreement and satisfied himself/herself as to the conditions affecting the Services, the availability of materials and labor, the cost thereof, the requirements to obtain necessary insurance as set forth herein, and the steps necessary to complete the Services herein. The Vendor warrants unto the City that he/she has the competence and abilities to carefully and faithfully complete the Services set forth herein. The Vendor shall perform the Services with due and reasonable diliVace-co-n.-,i-stent--wiltL-sound professional practices. 1.3 Consultants Competitive Ne otiation Act Services. The Vendor warrants unto the City that the services being performed pursuant to this Agreement do not constitute professional services as defined by Section 287.055(2) (a), Florida Statutes. 2®1 Palment Terms. Annual payment of $500 per cart is due upon contract execution and at each annual renewal period thereafter. Franchise fee payments shall be sent to the parties at the following address: City of Cape Canaveral Culture & Leisure Services Director P.O. Box 326 Cape Canaveral, Fl. 32920 ARTICLE 3 3.1 Provision of Services is a Private Undertakin . With regard to any and all Services performed hereunder, it is specifically understood and agreed to by and between the parties hereto that the contractual relationship between the City and the Vendor is such that the Vendor is not an agent of the City. Nothing in this Agreement shall be interpreted to establish any relationship other than that of an independent contractor between the City and the Vendor during or after the performance of the Services under this Agreement. 3.2 Warranly of Services. The Vendor hereby warrants unto the City that he/she has sufficient experience to properly complete the Services specified herein or as may be performed pursuant to this Agreement. The Vendor shall comply with all laws, ordinances, rules and regulations in the performance of the Services. The Vendor shall pay all taxes, fees and license fees required by law, including but not limited to Local Business Tax Receipts and withholding taxes and assume all costs incident to the Services, except as provided herein. ARTICLE 4 4.1 Assi2nment and Subcontract . Unless otherwise specifically required by this Agreement, the Vendor shall not assign, sublet or transfer any rights or Services under or interest in (including, but without limitations, moneys that may become due) this Agreement without the written consent of the Citp exce(tt to the extent that ang assi�,4ment, sublet or transfer is mandated by law or the effect of this limitation may be restricted by law. Unless specifically stated to the contrary in any written consent to any assignment, no assignment shall release or discharge the assignor from any duty or responsibility under this Agreement, Further, the Vendor shall not subcontract any portion or all of the Services without the written consent of the City. Nothing under this Agreement shall be construed to give any rights or benefits in this Agreement to anyone other than the City and the Vendor, and all duties and responsibilities undertaken pursuant to this Agreement shall be for the sole and exclusive benefit of the City and the Vendor and not for the benefit of any other party. ARTICLE 5 MISCELLANEOUS PROVISIONS 5.1 Governin2 Law; Venue, This Contract shall be governed by the law of the State of Florida. Venue of all disputes shall be properly placed in Brevard County, Florida. The parties agree that the Agreement was consummated in Brevard County, and the site of the Services is Brevard County. If any dispute concerning this Contract arises under federal law, the venue shall 5.2 Notices. All notices, demands, requests, instructions, approvals, and claims shall be in writing. All notices of any type hereunder shall be given by U.S. mail or by hand delivery to an individual authorized to receive mail for the below listed individuals, all to the following City Manager City of Cape Canaveral P.O. Box 326 (105 Polk Avenue) Cape Canaveral, FL 32920 (321) 868-1220 (Phone) (321) 868-1248 (Fax) Name: Rachel or Scott Decamp_ Address: 7900 N Atlantic Avenue Cape Canaveral, FL 32920 Telephone: t3211403-7155____ Fax: (321) 868-1090 Notice shall be deemed to have been given and received on the date the notice is physically received if given by hand delivery, or if notice is given by first class U.S. Mail, then notice shall be deemed to have been given upon the date said notice was deposited in the U.S. Mail addressed in the manner set forth above, Any party hereto by giving notice in the manner set forth herein may unilaterally change the name of the person to who notice is to be given or the address at which notice is to be received. 5.3 Public Record. In accordance with section 119.0701, Florida Statutes, Contract(m agrees that all documents, transactions, writings, papers, letters, tapes, photographs, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to this agreement or in connection with any funds provided by the City pursuant to this Agreement may be considered public records pursuant to Chapter I 19, Florida Statutes. Contractor agrees to keep and maintain any and all public records that ordinarily and necessarily would be required by the City in order to perform the services required by this Agreement. Contractor also agrees to provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided by Chapter 119, Florida Statutes or as otherwise provided by law. Contractor shall also ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. In addition, Contractor shall meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of the Contractor upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt nts. All records stored electronicallgi must be �*rovided to the City in a format that is compatible with the information technology systerns of the City. If h a wrublic records re,.oiuest the CitpA shall have the right-tia-en-farce- the provisions of this Paragraph. In the event that Contractor fails to comply with the provisions of this Paragraph, and the City is required to enforce the provisions of this Paragraph, or the City 119, Florida Statutes due to Contractor' s failure to comply with the provisions of this Paragraph, the City shall be entitled to collect from Contractor prevailing party attorney's fees and costs, and any damages incurred by the City, for enforcing this Paragraph against Contractor. And, if applicable, the City shall also be entitled to reimbursement of any and all attorney's fees and damages which the City was required to pay a third party because of Contractor's failure to comply with the provisions of this Paragraph. This Paragraph shall survive the termination of this 5.4 Amendment of Ap-reement. Modifications or changes in this Agreement must be in writing and executed by the parties bound to this Agreement. 5.5 Severability. If a word, sentence or paragraph herein shall be declared illegal, unenforceable or unconstitutional, the said word, sentence or paragraph shall be severed from this Contract, and this Contract shall be read as if said illegal, unenforceable or unconstitutional word, sentence or paragraph did not exist. 5.6 Attorney's ees, Should any litigation arise concerning this Agreement between the parties hereto, the parties agree to bear their own costs and attorney's fees. 5.7 Entire Agreement. This Agreement represents the entire and integrated Agreement between the parties and supersedes all prior negotiations, representations or Agreements, either oral or written, and all such matters shall be deemed merged into this Agreement, 5.8 Sovereign Immunity. Notwithstanding any other provision set forth in this Agreement, nothing contained in this Agreement shall be construed as a waiver of the City's right to sovereign immunity under Section 768.28, Florida Statutes or other limitations imposed on the City's potential liability under state or federal law. As such, Vendor agrees that the City shall not be liable under this Agreement for punitive damages or interest for the period before judgment. FiriOxer- the Citv shall not be liable for anv claim or -iudement. or DOrtion thereo i to an i one j2erson or more man two nunarect tnous=t-ona—rs7r2U.#,=rl.,7)-,7r any cian-77 77-yq-uglmin, M pul LI'vil thereof, which., when totaled with all other claims or judgments paid by the State or its agencies and subdivisions arising out of the same incident or occurrence, exceeds the sum of three hundred thousand dollars ($300,000.00). ARTICLE 6 PROTECTION OF PERSONS AND PROPERTY' INSURANCE 6.1 Workers' Compensation. Upon the effective date of this Agreement, Vendor shall provide proof of workers' compensation insurance in the minimum amount required by law (if required). 6.2 General Liability. Insurance Requirements: Upon award, the Vendor shall required to obtain and furnish to the City, prior to the contract being effective, Certificates Insurance approved by the City. All ] insurance policies shall be with insurers with an acceptab rating, registered and licensed to do business in the State of Florida. The Vendor shall be require to name the City as an additional narned insured with the following minimum coverages: a. Workers' Compensation: Upon the effective date of this agreement, Vendor shall provide proof of workers' compensation insurance in the minimum amount required by law (if required). b. Comprehensive General Liability Insurance: Shall be maintained by the Vendor with minimum limits not less than the following: $1,000,000 Bodily Injury and Property Damage- each occurrence $1,000,000 Personal and Advertising Injury- each occurrence $2,000,000 General Aggregate $2,000,000 Products/Completed Operations Aggregated Limit $ 59000 Medical Payment $ 100,000 FireDarnage Legal Liability Coverage shall include contractual liability and Vendor's liability. c. Automobile Liability Insurance: Shall be maintained by the Vendor with a combined single limit of not less than $ 1,000,000 bodily injury and property damage in accordance .With the laws of the State of Florida, as to the ownership, maintenance and use ofall owned, non -owned, leased or hired vehicles. 6.3 Requirements. 'This paragraph shall be applicable to Sections 6.1 and 6.2. The insurance required by this Article shall include the liability and coverage provided herein, or as required by law, whichever requirements afford greater coverage. All of the policies of insurance so required to be purchased and maintained for the certcates (or other evidence thereof) shall contain a provision or endorsement that the coverage afforded shall not be canceled, materially changed or renewal refused until at least thirty (30) days prior written notice has been given to the City and the Vendor by certified mail, return receipt requested. All such insurance shall remain in effect until final payment, Unless agreed to by the City to the contrary, the City shall be named on the foregoing insurance policies as "additional insured". The Vendor shall cause its insurance carriers to furnish insurance certificates specifying the types and amounts of coverage in effect pursuant hereto, the expiration dates of such policies, and a statement that no insurance under such policies shall be canceled without thirty (30) days prior written notice to the City in compliance with other provisions of this Agreement. For all Services performed pursuant to this Agreement, the Vendor shall continuously maintain such insurance as required by Sections 6.1, 6.2, and 6.3. In the event Vendor fails to maintain said insurance, City, at its option, may elect to ten-ninate this Agreement by written notice to Vendor. 6.4 Indemnification and Hold Harmless. For all Services perfon-ned pursuant to this Agreement, the Vendor agrees to the fullest extent pen-nitted by law, to indemnify and hold harmless the City and its employees, officers, and attorneys from and against all claims, losses, damages, personal injuries (including but not limited to death), or liability (including reasonable attorney's fees), directly or indirectly arising from the negligent acts, effors, omissions, intentional or otherwise, arising out of or resulting from Vendor's perfon-nance of any Services provided pursuant to this Agreement. i ne YTi to provide for such defense, at the option of the City, as the case may be, of any and all claims of liability and all suits and actions of every name and description that may be brought against the City or its employees, officers and attorneys which may result from the Services under this Agreement whether the Services be performed by the Vendor or anyone directly or indirectly ernployed by them. In all events, the City shall be pen-nitted to choose legal counsel of its sole choice, the fees for which shall be reasonIble and subJect to and included with this indemnification provided herein. This paragraph 6.4 shall survive ten-nination of this Agreement. 6.5 Standard of Care. In performing its Services hereunder, the Vendor shall use that degree of care and skill ordinarily exercised, under similar circumstances by reputable persons I 1 11111111 Jill 1111111 111 111111 ARTICLE 7 TERMINATION OF THE CONTRACT 7.1 Termination by City. The City Council may terminate this Agreement with five (5) days written notice to Vendor. Such termination shall be at City Council's sole discretion. 7.2 Termination for Cause by Ci!y. Vendor acknowledges and agrees that if, through any cause, the Vendor fails to fulfill in a timely and proper manner its obligations under this Agreement, or if the Vendor shall violate any of the provisions of this Agreement, the City Manager or City Manager's designee may upon written notice to the Vendor, terminate the right of the Vendor to proceed under this Agreement, or with such part or parts of the Agreement as to which there has been default, and may bold the Vendor liable for any damages caused to the City by reason of such default and tennination, In the event of such ten-nination, the Vendor shall not be relieved of liability to the City for damages sustained by the City by reason of any breach of this Agreement by the vendor. 7.3 Termination by Vendor. With at least five (5) days written notice to the City, Vendor may terminate this Agreement if the City fails to comply with the terms and conditions of this Agreement. 7.4 Termination by Consent. This Agreement may be terminated by the mutual written consent of both parties at any time, and without penalty. 7.5 Upon Termination. Upon termination of this Agreement, Vendor shall be entitled to no additional compensation. Upon notice of termination, the Vendor shall cease all Services being provided hereunder. 7.6 Waiver, Failure of the City to insist upon performance within any time period or upon a proper levelorquality of performance shall not act as a waiver of the City's right to later claim a failure to perform on the part of the Vendor. EM30 M, 8.1 Term. The terrn of this Agreement shall commence on. the Effective Date of this Agreement and end on 7/21/2021, unless extended by mutual written agreement of the parties. I . . . . . . . . . . . . . . . . . . . . 9.1 Conflicts, In the event that a conflict arises as to the contents of Exhibit "A" and the Agreement, the Agreement shall govern. [Signature page to follow] =I, I ATTEST: CITY: David L. Greene, City Manager Title: Date: ATTEST,,- Title: ?"Cre4-af—, te4th'c� [ODUMBIWA0120012WO."M Date: , 6, " i - k ` (,'r 1" The foregoing instrument was acknowledged before me this -Z- �1 day of 20 by as L,-', for _6�M� who is personally known or_ produced produced identification 7 (NOTARY SEAL) Notary Publica 'iature Typed or Printed Notary Name: MMUM Proposal Xstream Car Wash and Creamery, would like to propose acceptance from the city of Cape Canaveral to conduct business on our local beach, using an Ice Crea Vending Cart. Our vending cart is commercialized, climate controlled, and in ve attractive and in high professional business condition. We would like to establish beach customer base in need of refreshing water, Ice Cream, and Italian ice, whil they enjoy their day on our local beaches. This cart is owned by our company andl the last lessee of the business allowed the former pennit to lapse unknown to us. We would like to get the permit re -accepted and plan to maintain its active status. Xstream would cooperate with any provisions set by the City in compliance to their current standards and restrictions. The cart will be staffed with an employee from our company and will run weather permitted. Most Saturday's and Sunday's, we will actively operate from hours between I 0am. to 3pm, with the options of running weekly in conjunction during special community events, and/or high beach attendance times. On any given day Xtsream has approximately ten employees', two owners, and two managers to run and maintain the cart. This will include backup to refill cart as needed and immediate assistance for call repair if needed. We plan to start from the north end of the beach starting specifically at Cherie Down Park and making our way South until our daily products last, Xstream already canies the current and proper insurance and workman's comp coverage documentations to comply with general provisions of vendor agreement. We can assure that our performance reviews will always maintain an excell- r'.! ; g rating Our ke Cream and Italian Ice is pri� �%ackqged and the vendor and sales process. Both will be in individual ready to eat cups, and purchasedgracious size. Custard Price: $3.00 Flavors: chocolate, vanilla, strawberry, cookies and cream, 'Nater Bottles: $1 .00: Obtained currently from our Coca-Cola Distributor, Cart Appearance: Photos of our cart are attached for reference. Uniform: Employee's will wear bright colored shirt with our Logo above distinguishing them an employee of Xstream Creamery. Xstream Car Wash and Creamery currently has a beachside location at 7900 N Atlantic Ave, in Cape Canaveral. This will allow -us to run the cart adequately and efficiently. This is where the cart will be stored during non -business hours. We have experience with vending services, and proper business expectations. Our experience already greatly exceeds what is needed to minimally run this cart in a respectful manner. We appreciate the City of Cape Canaveral in consideration of our cart acceptance, for the active beach clientele and to continue the growth our business. Sincerely, Rachel and Scott DeCamp-Owner/Operator, 7900 N Atlantic Ave, Cape Canaveral FL 32920 Owner Rachel 321-403-71555/Owner Scott 321-961-2148 �11 pil iii�pi I . Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing or possession of a controlled substance is prohibited in the workplace and specifying the actions that shall be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the Proposer's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services a copy of the statement specified in subsection (1) above. 4. In the statement specified in subsection (1) above, notify the employees that, as a condition of working on the commodities or contractual services, the employee shall abide by the terms of the statement and shall notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-firee workplace through implementation of this section. As the person authorized to sign the statement, I certify that this Proposer complies fully with the V 111LO101#04AW11 =0 Name of Company fov--w pr'lojQ- [Dowd L6i t ! b42- f• 7. t 0ORIDA INSURANCE CONCEPTS LLC 470 S WICKHAM RD MELBOURNE FL 32904-1160 EXTREMERADS LLC C/O RACHEL DECAMP 5590 DATURA ST COCOA FL 32927-2347 59511 (4-12) P.O. BOX 30660, LANSING, MICHIGAN 48909-8160 * 517-323-1200 AUTO -OWNERS INSURANCE COMPANY AUTO -OWNERS LIFE INSURANCE COMPANY HOME -OWNERS INSURANCE COMPANY OWNERS INSURANCE COMPANY PROPERTY -OWNERS INSURANCE COMPANY SOUTHERN -OWNERS INSURANCE COMPANY You may view Your policy online at www.auto-owners.com. To enroll, use the policy number 723 0 6166 and Personal ID code (PID) 78N 4T7 A:9T. Once enrolled, you may choose to stop m 11 receivingthe D _19!��er P�oficy in the mail. Thank you for selecting Auto -Owners Insurance Group to serve your insurance needs! Feel free to contact your independent Auto -Owners agent with questions you may have. Auto -Owners and its affiliate companies offer a variety of programs, each of which has its own eligibility requirements, coverages and rates, In addition, Auto -Owners also offers many billing options. Please take this opportunity to review your insurance needs with your Auto -Owners agent, and discuss which company, program, and billingo p�on may be most appropriate for you. Auto -Owners Insurance Company was formed in 1916, The Auto -Owners Insurance Group is comprised of five property and casualty companies and a life insurance company, Our A++ (Superior) rating by A,M. Best Company signifies that we have the financial strength to provide the insurance protection you need. - Serving Our Policyholders and Agents Since 1916 - IMIM SOUTHPRN-OWNERS INS. CO. Issued 02-10-2016 ,0,G,CNcy FLORIDA INSURANCE CONCEPTS LLC Company POLICY NUMBER 152382-72306166-16 12-0383-00 MKT TERR 114 Bill INSURED EXTREME CSS LLC Term 03-27-2016 to 03-27-2017 COVERAGE LIMITS OF INSURANCE General Aggregate $2,000,000 (Other Than Products -Completed Operations) Products -Completed Operations Aggregate $1,000,000 Personal Injury And Advertising Injury $1,000,000 Each Occurrence $1,000,000 COMMERCIAL GENERAL LIABILITY PLUS ENDORSEMENT Damage to Premises Rented to You $300,000 Any One Premises (Fire, Lightning, Explosion, Smoke or Water Damage) Medical Payments $10,000 Any One Person Hired Auto & Non -Owned Auto $1,000,000 Each Occurrence Expanded Coverage Details See Form: Extended Watercraft Personal Injury Extension Broadened Supplementary Payments Broadened Knowledge Of Occurrence Additional Products -Completed Operations Aggregate Blanket Additional Insured - Lessor of Leased Equipment Blanket Additional Insured - Managers or Lessors of Premises Newly Formed or Acquired Organizations Extension Blanket Waiver of Subrogation Twice the "General Aggregate Limit", shown above, is provided at no additional charge for each 12 month period in accordance with form 55300. AUDIT TYPE: Annual Audit Forms that apply to this coverage: 59350 (01-15) 55146 (06-04) 55091 (10-08) CO2268 (09-97) CG2407 (01-96) IL0021 (07-02) 55296 (09-09) 55300 (07-05) CCO220 (03-12) IL0017 (11-85) 5551.3 (11-11) 55205 (12-04) SOUTHERN -OWNERS INS. Co. Page 3 Issued 02-10-2016 AGENCY FLORIDA INSURANCE CONCEPTS LLC Company POLICY NUM13ER 152382-72306166-16 12-0383-00 MKT TERR 114 Bill INSUREr EXTREMERADS LLC Term 03-27-2016 to 0127-2017 BUILDING 0001 Location: 104 Monroe Ave Cape Canaveral, FL 32920-2911 Territory: 006 County, Brevard CIL . ASSIFICATION CODE SUBLINE PREMIUM BASIS M B S BASIS I S Uln RAT RATE E Commercial General Liability Plus Endorsement 00501 I Prem/Op Prem 0 p r e m Included At 7.5% Of The Premises Operation Premium Prem/Op cl Included Included Included Included clu Car Washes 10367 Gross Sales Tdedlcn Each 1000 Prem/Op $120,000 12�12066 Prod/Comp Op $120,000 107 Ice Cream Stores 14401 Gross Sales Each 1000 Prem/Op $30,000 .5 8.858 Prod/Comp Op $30,000 .794 Additional Interests 49950 55205 Add'L Insured - O/L/C 1. Tajk Llc Prod/Comp Op Flat Charge I 1 ;111 jpiii�111 11�jpiil pl!! TERRORISM - CERTIFIED ACTS SEE FORM: 59350 LOCATION 0001 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CTS/ CO OF111111111 n _j (If no entry appears above, information required to complete this endorsement will be shown in the Declarations w;p.mt® applicable to this endorsement.) >§x<!«:4 "bodily injury" or "property damage" arising out of "your products" manufactured, sol/<z» »!« or distributed: 2. In connection with the conduct of any operation d bed in the Sle chedu, wco hen nducted by you on your behalf, i scri Paragra,�,h a. of the d t: operations hazard" in the DEFINITIONS Sectio\>»\ re- placed by the following: "Products - completed Operations hazard" a. Includes all "bodily injury" and "property dam- age" that arises out of "your products" if the "bodiiy injury" or "property damage" occurs after you have those relinquished possessioof n products. CG 24 07 01 96 Copyright, Insurance Services Office, Inc_ 1994 age]/! q1111l1111111111 11�11111111!111 The Terrorism Risk Insurance Act of 2002 was signed into law on November 26, 2002. The Act (including ensuing Con- gress ional actions pursuant to the Act) defines an act of terrorism, to mean any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security and the Attorney General of the United States to be (i) an act of terrorism; (ii) to be a violent act or an act that is dangerous to human life, property or infrastructure;to have resulted in damage within the United States or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and (iv) to have been committed by an individual or individuals as part of an ef- fort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States government by coercion. Subject to the policy terms and conditions, this policy provides insurance coverage for acts of terrorism as defined in thz Act. The premium charge, if any, for this coverage is shown separately on the attached Declarations page. In the event of a certified act of terrorism, future policies also may include a government assessed terrorism loss risk -spreading premium in accordance with the provisions of the Act. 53350 (1-15) Page 2 o#2 MARKEL INSURANCE COMPANY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE AURK"Er Issued March 27, 2016 Standard Insure I.The Ins ! d's Name and Mailing Address: NCCI Carrier Code: 22616 EXTREMERADS, LLC P ' oe Ave v I Mo ! 104 Monroe Ave CapeCanaveral ape Canaveral , FL32920-2911 F Fein # I Is ID # 004643566 For complete named Insured: See Attached Named Insured Schedule SIC CODE: 5499 Other work place not shown above: See Attached Location Schedule Type of entity: Limited Liability rnmnnnu 2. The policy period is from 03127=15 to 03/27/2016 [12:01 AM Standard Time] at the Insure 's mailing address. 3. A. Workers Compensation Insurance: Part One of this licy applies to the nrkers Compensation Law of the states listed here, FLORIDA B. Employers Liability Insurance: Part Two of this policy applies to work in each state listed In Item 3A. The limits of our liability under Part Two are., Bodily Injury by accident $ 1,000,000 each accident Bodily Injury by disease: $ 1,000,000 policy limit Bodily Injury by disease: $1,000,000 each employee C. Other States Insurance: Part Three of this policy applies to the states, if any, listed here: All states except those listed in Item 3A of the Information Page and the following states or territories: A7, District of Columbia, ID, IL, ME, MA, MT, NJ, NY, ND, 01-1, OR, WA, VVY, Puerto RJCD and US Virgin Islands, DThis policy Includes these endorsements and schedules: See Attached Schedule of Schedules and Endorsements 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans, Information required is subject to verification and change by audit. e ium Basis Total T� r mi T--�E mated Annual Rate per $100 of Estimated Annual Estimated 7 I m m P mium Code No. Classifications Remuneration Remuneration re Premium See Attached Schedule of Classification and Premium Detail Premium for Increased limits Part Two $120.00 Increased Premium for In T tal t t otal Premium Subject to Experience Modification $694.00 Premium um 9ubjeo To TotalPF m! te Subject Standard Total Estimated Standard Premium $694.00 To im S mium scou I , if pr Premium Discount, if applicable $0.00 Expense Constant Charge $200.00 Terrorism Insurance $6.00 $ -Tofal Estimated Annual Premium $900.00 Minimum Premium: 474�00 Producer: Florida Insurance Concepts Countersigned By: Servicing Office: Date: 03/27/2016 THIS INFORMATION PAGE WITH THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY AND ENDORSEMENTS, IF ANY ISSUED TO FORM A PART THEREOF, COMPLETES THE ABOVE NUMBERED POLICY WC 00 00 CIA