2014-539-E AMS - 5th Wall Building Diagnostics Consulting for roof replacement and consulting services for new courthouse $8,800

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DocuSign Envelope ID: CC61AD51-9200-4DEB-BBDA-E50D8BB74136 �1 5THWA-1 OP ID: LJ CERTIFICATE OF LIABILITY INSURANCE DA 02/07/2014Y) 02/07/2014 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 Phone:919-556-3698 CONTACT NAME: Hartsfield&Nash Agency,Inc. Post Office Box 1109 Fax:919-556-8758 AHONNo Exit: A/C No Wake Forest,INC 27588 E-MAIL Lorie Borrelli,CIC,AAI ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC q INSURERA:Hartford Casualty Ins Co. 29424 INSURED 5th Wall Building Diagnostics - INSURER B;Lexington Insurance Co. 19437 Consultants LLC 9601 Bailywick Rd INSURERC: Raleigh, NC 27615 INSURER D: INSURER E: INSURER F: 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 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. 1�7R TYPE OF INSURANCE DD BR POLICY NUMBER POLICY EFF MM/DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY 22SBAVF0089 12/01/2013 1210112014 pREMISETo a RTEDnce $ 300,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&PDVINJURY $ 2,000,00 GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea a�BINEDISINGLE LIMIT $ 2,000,000 A ANY AUTO 22SBAVF0089 12/01/2013 12101/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per acddent $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE 22SBAVF0089 12101/2013 12/01/2014 AGGREGATE $ DED I X I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ORY LI TS E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 B Professional 43926702 02/12/2013 0211212014 ea occ 1,000,000 Liability aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) RE:Window Condition Assessment Southern Human Services Chapel Hill, NC CERTIFICATE HOLDER CANCELLATION ORAN818 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights.reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD f