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DocuSign Envelope ID: BD2280F8-F51A-494F-9744-35FEOIAD203D <br /> A <br /> DAITE CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 09/30/0 4' <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement.Astatement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Willis of Pennsylvania, Inc. PHONE FAX <br /> c/o 26 Century Blvd. • 877-945-7378 888-467-2378 <br /> P. O. Box 305191 E-MAIL certificates @willis.com <br /> Nashville, TN 37230-5191 <br /> INSURER(S)AFFORDINGOOVERAGE NAIC# <br /> INSURERA: XL Insurance America, Inc. 24554-003 <br /> INSURED <br /> Tandus Centiva US LLC INSURER B:Travelers Property Casualty Company of Am 25674-008 <br /> 311 Smith Industrial Boulevard INSURERC:Travelers Indemnity Company 25658-001 <br /> Dalton, GA 30722-1447 <br /> INSURERD:The Charter Oak Fire Insurance Company 25615-001 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:22195728 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE DD' SUB POLICYNUMBER POLICY EFF POLICYEXP LIMITS <br /> LTR A GENERAL LIABILITY Y US00010327LI14A 5/1/2014 5/1/2015 EACH OCCURRENCE$ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISESOEaoccurence $ 100,000 <br /> CLAIMS-MADEFx-]OCCUR MED EXP(Anyone person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 11000,000 <br /> GENERALAGGREGATE $ 2,000,000 <br /> GEMLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> X POLICY PRO- LOC <br /> $ <br /> B AUTOMOBILE LIABILITY TJCAP823K312A14 9/28/2014 9/28/2015 COMBINED SINGLE LIMIT 2,000,000 <br /> (Ea accident) $ <br /> Ix ANYAUTO BODILYINJURY(Perperson) $ <br /> ALLOWNED SCHEDULED BODILYINJURY(Peraccident) $ <br /> AUTOS AUTOS <br /> HIREDAUTOS HxComv NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Peraccident) $ <br /> $1,000 $1,000 <br /> Coll Ded Ded $ <br /> A X UMBRELLA LIAB X OCCUR US0001061SLI14A 5/1/2014 5/1/2015 EACH OCCURRENCE $ 1,000,000 <br /> EXCESS LIAB I CLAIMS-MADE AGGREGATE $ 11000,000 <br /> DED I X RETENTION$ 10,000 $ <br /> C WORKERS COMPENSATION AOS TC2HUB823K310614 9/28/2014 9/28/2015 X TWCSTAT - 0" <br /> AND EMPLOYERS'LIABILITY <br /> D ANY PROPRIETOR/PARTNER/EXECUTIVE� NIA ** TROUB823K311814 9/28/2014 9/28/2015 E.L.EACH ACCIDENT $ 11000,000 <br /> OFFICER/MEMBEREXCLUDEDI E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> f(Mandatory in NH)yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space is required) <br /> WC Policies: AOS-covers all other states. **-covers AZ, MA, OR, WI only. <br /> Project Name and/or Description: SRS1974 Orange County, Visitors Center <br /> Orange County is included as Additional Insured on the General Liability policy, as respects to <br /> the liability arising out of ongoing and completed operations performed on the project specified in <br /> the construction contract for the period of time required within the contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS, <br /> Orange County AUTHORIZED REPRESENTATIVE <br /> 200 S. Cameron Street <br /> P.O. Box 8 <br /> Hillsborough, NC 27278 <br /> Coll:4527184 Tpl:1861785 Cert:22195728 1988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />