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HomeMy WebLinkAboutOshkosh Food Cooperative 2024This Agreement is between the City of Oshkosh, a Wisconsin municipal corporation (hereinafter "CITY"), and Oshkosh Food Cooperative, Inc., 155 Jackson St, Suite 101, Oshkosh, WI 54901 (hereinafter "GRANTEE"). WHEREAS, the CITY was allocated approximately $20.5 million in federal funds under the American Rescue Plan Act (ARPA) for various eligible purposes, including, among other things, support to entities negatively impacted by the COVID-19 pandemic; and WHEREAS, on September 28, 2021, the Oshkosh Common Council adopted Resolution 21-498, creating parameters for usage of American Rescue Plan Act funds and specifying that funds spent on non -CITY programming or direct assistance should represent approximately 25% of all ARPA expenditures, providing approximately $5,128,000 of the total ARPA allocation for this purpose.; and WHEREAS, on September 27, 2022, the Oshkosh Common Council approved Resolution 22-411, awarding, among others, a grant to GRANTEE; and WHEREAS, GRANTEE is a Wisconsin cooperative, member -owned, full -service grocery store that exists to strengthen the local economy, promote health, and build community; and WHEREAS, the CITY wishes to award a grant to GRANTEE to satisfy an outstanding loan through the revolving loan fund established in cooperation between the CITY and the Greater Oshkosh Economic Development Corporation. Now, therefore, the parties agree as follows: Section 1. Status of GRANTEE. GRANTEE represents and warrants that it is an organization in good standing under the law, and shall remain as such for the term of this Agreement. GRANTEE represents and warrants that its signatory is authorized to bind GRANTEE and execute this Agreement on GRANTEE's behalf. Section 2. Payment of Grant Award. CITY hereby agrees to pay GRANTEE an amount not to exceed $220,000.00 (hereinafter the "grant award") according to the terms and conditions set forth in Exhibit A of this Agreement. Section 3. Expenditure of Grant Award. GRANTEE shall expend the grant award solely on the programs and/or projects set forth in Exhibit A. Any expenditure that does not comply with this Agreement shall constitute a disallowed cost ("disallowed cost") and be subject to reimbursement as specified in section 15 of this Agreement. Under no circumstances shall GRANTEE extend any portion of the grant award for purposes not specified in this Agreement, or for any other purpose prohibited under law. Section 4. Acknowledgment of Funding Source. Unless otherwise agreed upon in writing between the parties, the GRANTEE agrees that any publications, studies, or reports which are made possible by or derived, in whole, or in part, from the grant award, and any news, articles, brochures, seminars, or other promotional materials, or media, or events, through which GRANTEE publicize the programs or projects, funded in whole or in part by CITY will acknowledge the CITY support in the following manner: "Funding for this project has been provided by the City of Oshkosh." Section 5. The Parties' Relationship. This Agreement shall not be construed as giving rise to any agency, partnership, joint venture, or employment relationship between CITY and GRANTEE. GRANTEE shall have no ability to bind the CITY, and will not hold itself out, as having any such ability. Neither GRANTEE, nor any of GRANTEE's officers, employees, agents, or subcontractors, if any, is an employee of CITY by virtue of this Agreement. GRANTEE"s employees and agents shall not be entitled to any salary or benefit relating to CITY employment. Section 6. No Assignment. GRANTEE shall not assign this Agreement without CITY's written authorization. Any unauthorized assignment shall be void and shall be considered a material breach of this Agreement. Section 7. Indemnification. GRANTEE shall indemnify, hold, harmless, and defend CITY, its' common council, officers, officials, directors, employees, agents, volunteers, and affiliates, and each of them from any and all claims, demands, causes of action, damages, costs, expenses, attorney's fees, consultant's fees, expert fees, losses or liability, in law, or in equity, of every kind and nature whatsoever arising out of or in connection with this Agreement, GRANTEE's performance hereunder, GRANTEE's or subcontractor's negligence, including active or passive, or strict liability, including but not limited to personal injury, including, but not limited to, bodily injury, emotional injury, sickness or disease, or death to persons and/or damage to property of anyone, including loss of use thereof, caused or alleged to be caused by any act or omission of GRANTEE, or any subcontractor, or anyone directly or indirectly employed by any of them, or anyone for the full period of time allowed by law, regardless of any limitation of coverage by insurance, with the exception of the sole negligence or willful misconduct of the CITY. The provisions of this section shall survive the expiration or termination of this Agreement. Section 8. Insurance Requirements. GRANTEE agrees to comply with all of the insurance requirements set forth in Exhibit C. entitled "Insurance Requirements." Failure to maintain required insurance at all times shall constitute a default and material breach. Section 9. Non -Discrimination. In performing this Agreement, GRANTEE shall ensure that any and all contractors are subcontractors, employees, agents, volunteers, officers, officials, directors, volunteers, and affiliates also shall not, discriminate, harass, or allow harassment against any person on the basis of sex, race, color, ancestry, religion, creed, national origin, physical disability, mental disability, mental condition, age, marital status, sexual orientation, or any other basis prohibited under law. Section 10. Compliance with All Applicable Laws. In performing this Agreement GRANTEE warrants that it shall comply with all applicable state, federal, and CITY laws, rules, and regulations whether now in force or hereinafter enacted. Section 11. Accounting. For purposes of performance under this Agreement, and receipt and expenditure of grant award, GRANTEE shall at all times, maintain an accounting system that comports with generally accepted accounting principles. Section 12. Financial Records and Financial Report. GRANTEE shall maintain satisfactory financial accounts, books, records, documents, and other evidence, sufficient to properly reflect the amount, receipt, and expenditure of Grant award. GRANTEE shall submit to CITY a final report in the form identified in Exhibit B. The CITY reserves the right to request quarterly reports relating to the expenditure of the grant award or additional information as needed, also in in the form identified in Exhibit B. Said final report shall be submitted to CITY within fourteen (14) calendar days following the full expenditure of the grant award, or within thirty (30) calendar days following receipt of the funds, whichever is later. All financial records and financial reports shall be prepared in accordance with generally accepted accounting principles. The annual and quarterly reports shall be public records and may be posted on the CITY's website. Failure to maintain proper financial records and submittal of timely financial reports shall be cause for termination as outlined in this Agreement (see Section 17). Section 13. Audit and Examination. Consultant shall fully and completely cooperate with the CITY, the CITY's insurer, the CITY's attorneys, the CITY's Auditors or other representative of the CITY (collectively, the "CITY" for purposes of this Article). a. Cooperation is expected in connection with any internal or governmental investigation or administrative, regulatory, arbitral or judicial proceeding (collectively "Litigation") or internal or governmental Audit, with respect to matters relating to this Agreement. b. Examples of expected cooperation may include, but shall not be limited to, responding to requests for documents and/or other records, and making Consultant's employees available to the CITY (or their respective insurers, attorneys or auditors) upon reasonable notice for: (i) interviews, factual investigations, and providing declarations or affidavits that provide truthful information in connection with any Litigation or Audit; (ii) appearing at the request of the CITY to give testimony without requiring service of a subpoena or other legal process; (iii) volunteering to the CITY all pertinent information related to any Litigation or Audit; and (iv) providing information and legal representations to auditors in a form and within a timeframe requested. c. GRANTEE shall not be entitled to additional compensation for employee services, time or materials necessary for the provision of records under this Section. d. Failure to comply with the request for audit, or a lack of documentation in records may cause termination of this Agreement (see Section 17). Termination of this Agreement for failure to comply may result in all funding becoming disallowed under the terms of this Agreement. Upon termination for failure to comply with this paragraph GRANTEE will promptly repay to CITY on CITY's demand all unused or disallowed funds. Section 14. Preservation of Records. CITY is a governmental entity that is required to comply with Wisconsin Public Records Law. GRANTEE shall preserve and make available all records related to the performance of this Agreement and related to the receipt and expenditure of the grant award until the expiration of seven (7) years from the date of final payment to GRANTEE, or as required by applicable law, whichever is longer. Notwithstanding the above, if there is litigation, claims, audits, negotiations or other actions that involve any of the records cited and that have started before the end of the agreement, then such records must be retained until completion of the actions and resolution of all issues. Section 15. Reimbursement of Disallowed Costs. Within ten (10) business days of the date of CITY's written notice to GRANTEE, GRANTEE agrees to reimburse to CITY any portion of the grant award paid by the CITY, which CITY has in its sole discretion, determine constitutes a disallowed cost. Section 16. Term. This Agreement shall be for a term commencing on January 1, 2023, and expiring on December 31, 2024 or upon acceptance by the CITY of the Final Financial Report whichever is later; unless terminated sooner per this Agreement. Provisions pertaining to liability, preservation of records, and cooperation in audits shall survive termination. Section 17. Termination. The CITY may terminate this Agreement at any time, whenever it is determined that the subgrantee has failed to comply with the conditions of this Agreement. In the event there is cause to believe the subgrantee is in noncompliance with this Agreement or any applicable rules or regulations, the CITY shall promptly notify the subgrantee in writing of the determination of non-compliance, together with the effective date of termination, which shall not be less than thirty (30) days from the date of the notice. If the subgrantee does not correct the noted deficiencies during the correction period above, this Agreement shall terminate. Provisions pertaining to liability, preservation of records, and cooperation in audits shall survive termination. Section 18. Notice. All notices or instruments required to be given or delivered by law or this Agreement shall be in writing, and shall be effective and any applicable time period shall begin the fifth (5th) calendar day from the date of mailing, or if personally delivered, from the date of personal delivery. If notice is given by mail, it shall be delivered by depositing the same in any United States post office, registered or certified mail, postage, prepaid, addressed to: CITY: Mark Rohloff, City Manager City of Oshkosh 215 Church — PO Box 1130 Oshkosh WI 54903 (920) 236-5002 GRANTEE: Oshkosh Food Cooperative, Inc. 155 Jackson St Suite 101 Oshkosh, WI 54901 (920) 424-9494 Section 19. Severability. If any term, covenant, condition or provision of this agreement shall be invalid or enforceable, the remainder of this agreement shall not be affected thereby the remainder of the agreement shall be valid and enforceable to the fullest extent permitted by law. Section 20. Waiver. The election to enforce or not enforce, as well as the timing of enforcement, shall be at each party's sole discretion and shall not act as a waiver of any rights to exercise any right relating to this agreement in the future. Section 21. Amendment. This Agreement may be amended at any time only by a written modification mutually agreeable to both parties hereto. Any request by the GRANTEE for amendments. must be in writing, stating the amendment request and reason for the request. The GRANTEE shall make request in a timely manner, and in no event, less than thirty (30) calendar days before the effective date of the proposed amendment. Section 22. No Third -Party Beneficiaries. Notwithstanding any provisions pertaining to third parties contained within this agreement, none of the obligations contained in this agreement shall run to or be enforceable by any party who is not a party to this agreement. Section 23. Choice of Law. The laws of the State of Wisconsin shall govern the interpretation and construction of this Agreement. Winnebago County shall be the venue for all disputes arising under this Agreement. Section 24. Agreement not to be Construed against Either Party. This Agreement is the product of negotiation between the parties hereto and no term, covenant or provision herein or the failure to include a term, covenant or provision shall be construed against any party hereto solely on the basis that one party or the other drafted this Agreement or any term, covenant or condition contained herein Section 25. List of Exhibits: Exhibit A - Scope of Work Exhibit B - Grant Agreement Report Exhibit C - Insurance Requirements Section 26. Entire Agreement. This Agreement, and any attached Exhibits shall constitute the entire Agreement between the parties here to relating to the Grant Award, and may not be modified except by an instrument in writing, signed by the parties hereto. Oshkosh Food Cooperative, Inc. 155 Jackson St Suite 101 Oshkosh, WI 54901 City of Oshkosh 215 Church — PO Box 1130 Oshkosh WI 54903 EXHIBIT A SCOPE OF WORK Project Description: The Oshkosh Food Cooperative (Co-op) exists to strengthen the local economy, promote health and build community. The mission of the Co-op is to provide a member -owned, full service grocery store in the heart of the city of Oshkosh. The purpose of this ARPA grant is to satisfy an outstanding loan that the Co-op has through a Revolving Loan Fund (RLF) that the city has established in cooperation with the Greater Oshkosh Economic Development Corporation (GO-EDC). Deliverables & Performance Measures: • Not applicable Payment Schedule & Eligible Expenditures: All expenditures must comply with the Coronavirus State and Local Recovery Funds Final Rule. Funding used for ineligible expenditures will require repayment to the City. City will provide payment of $220,000 to the Co-op as follows: • RLF Loan Payoff: $220,000: Upon signing of this agreement, City will transfer funds in its ARPA account to the City's RLF Fund to satisfy the Co-op's RLF loan obligation. City shall notify the administrator of the RLF program GO-EDC that the loan has been paid in full and that GO-EDC may take the necessary steps to remove any liens or other guarantees associated with the subject loan to which the Co-op may have been subject. Exhibit B Grant Agreement Report Organization Agreement No. Contact Person Contact Title 500(v .Q PMSl del+ Phone Number and Email (97�) -258 Report Type ❑ annual Reporting Period ❑ quarterly Grantee Information Grant Amount: `k Z � �� Qq6 j 9 Funding expended during the reporting period: 1 Z' ( I , 0 9 $' 7 q Funding expended to date: j �� 1 30 Remaining award amount: Award Details Receipts and thorough documentation of grant fund expenditures have been maintained and can be produced upon request: Nes ❑ no Grant Outcomes Narrative — description of how the funds were used and what was accomplished through the use of grant funds. Please include any relevant quantitative outcomes, as needed. -I-his i aid +0 o-{ -�t�,� 6�-E-oG Joan 4-o�'►e� T:�)od G--' - op. Grantee Representative Signature I hereby declare that the goods or materials covered by this report are complete and accurate, and are eligible under the agreement. Printed Name: BrerNd n T �► - i S Title: Signature: Date: 312Z)ZL� EXHIBIT C INSURANCE REQUIREMENTS Grantee shall procure and maintain for the duration of this Agreement, including any extensions thereto, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of services hereunder by the Grantee, their agents, representatives, or employees or subcontractors. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess of the specified minimum Insurance coverage requirements and/or limits shall be available to the Additional Insured. Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any Insurance policy or proceeds available to the named Insured; whichever is greater. No representation is made that the minimum Insurance requirements of this agreement are sufficient to cover the obligations of the Grantee under this agreement. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit (i.e., $2,000,000). 2. Automobile Liability: Insurance Services Office Form Number CA 0001 covering Code 1 (any auto), or if Grantee has no owned autos, Code 8 (hired) and 9 (nonowned), with limits no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation insurance as required by the State of California, with Statutory Limits, and Employers' Liability insurance with a limit of no less than $1,000,000 per accident for bodily injury or disease. (WC insurance is not required if the grantee provides written verification it has no employees). 4. Professional Liability (Errors and Omissions) Insurance appropriates to the Grantee's profession, with limits no less than $1,000,000 per occurrence or claim, $2,000,000 policy aggregate. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Grantee including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Grantee's insurance (at least as broad as ISO Form CG 20 10 1185 or both CG 20 10 10 01 and CG 20 3710 01 forms if later revisions used). 2. For any claims related to this contract, the Grantee's insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be in excess of the Grantee's insurance and shall not contribute with it. 3. Each insurance policy required by this clause shall provide that coverage shall not be canceled, except with thirty (30) days prior written notice to the City. Waiver of Subrogation Grantee hereby grants to City a waiver of any right to subrogation which any insurer of said Grantee may acquire against the City by virtue of the payment of any loss under such insurance. Grantee agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self -Insured Retentions Any deductibles or self -insured retentions must be declared to and approved by the City. The City may require the Grantee to provide proof of ability to pay losses and related investigations, claim administration and defense expenses within the retention. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to the City. Claims Made Policies If any coverage required is written on a claims -made basis: 1. The retroactive date must be shown, and this date must be before the execution date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of contract work. 3. If coverage is canceled or non -renewed, and not replaced with another claimsmade policy form with a retroactive date prior to the contract effective date, the Grantee must purchase extended reporting period coverage for a minimum of five (5) years after completion of contract work. Verification of Coverage Grantee shall furnish the City with original certificates and amendatory endorsements or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Grantee's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Subcontractors Grantee shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Grantee shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a format least as broad as CG 20 10 10 01 and CG 20 37 1001. Special Risks or Circtcrostances City reserves right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY ISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG D4 11 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/31/2024 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 The McClone Agency, Inc. PO Box 389 Menasha WI 54952 CONTACT Certificate Department PHONE FAX AIc No EXt : 800-236-1034 A/C No): 920-725-3233 ADDRESS: certificate@mcclone.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Travelers Cas & Sur Co of Amer 31194 License#:100197661 INSURED OSHKFOO-01 Oshkosh Food Cooperative 155 Jackson St., Suite 101 INSURER B : Travelers Prop Cas Co of AM 25674 INsuRERc: Travelers Indemnity Co. of CT 25682 INSURERD: Oshkosh WI 54901 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 167222417 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL D SUBR D POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y BIPAW518619 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 DAMAGETO S(RENTED PREMISES Ea occurrence) $ 300,000 GEN'L X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY1:1 PRO ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X IAUTOS LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED HIRED LX ONLY AUTOS ONLY BIP-4W518619 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUPAW521777 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A UB-4W521279 4/1/2023 4/1/2024 X SPERTATUTE EORH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are additional insureds with respect to general liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Oshkosh 135 Jackson St AUTHORIZED REPRESENTATIVE ALA &�' Oshkosh WI 54901 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD