ORD-2014-021 Buckhorn-Mebane EDD Phase 2 Sewer Extension – Amendment of Design Contract and Approval of Budget Amendment #7-C

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Client #: 30402 26HOBBSUPC1 ACORD_ CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DO/YYYY) TYPE OF INSURANCE 5/23/2014 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 endorsement(s). PRODUCER C BB &T Insurance Services, Inc 693 -2610 ac, No : 888 831 -8410 140 Applecross Road, Suite B Pinehurst, NC 28374 $300,000 MED EXP (Any one person) $ 10,000 910 693 -2610 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: onal Trust Insurance Co. 20141 $2,000,000 INSURED INSURER B: FCCI Insurance Company 10178 Hobbs Upchurch &Associates PA INSURER C : B P.O. Box 1737 INSURER D: Southern Pines, NC 28388 INSURER E: 9130/2013 09/30/2014 INSURER F : $1,000,000 BODILY INJURY (Per person) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 AD DL INSR SUBR WVD I POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE A OCCUR CPPOO152792 i 9/30/2013 09/30/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS CA00246832 9130/2013 09/30/2014 COMBINED COMBINED SINGLE LIMIT $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 UMB00152542 9/30/2013 09/30/201 EACH OCCURRENCE $4 000 000 AGGREGATE s4,000,000 DED X RETENTION $1 O OOO $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ,, / N ANY PROPRIMB R/PXCLUDE /EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 001 WC13A69276 9/30/2013 09/30/201 X WCPS TATU- OTH- IMI PP E.L. EACH ACCIDENT $50O 000 E.L. DISEASE - EA EMPLOYEE $5OO OOO E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Corp. Owners, Fred Hobbs and David Upchurch are excluded from Worker's Compensation coverage. Orange County 200 S. Cameron Street Hillsborough, NC 27278 ACORD 25 (2010/05) 1 of 1 #S12388686/M11261376 I.ANI.CLLA 1 IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VPG