2015-173-E AMS - Racanelli Construction South, Inc. for Cedar Grove Community Center Construction $2,311,900

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DocuSign Envelope ID:29F350EB-C553-4EEB-BD97-898B3775EE03 RACAN-1 OP ID:DL ACORD" CERTIFICATE OF LIABILITY INSURANCE DATE 03/106/2015 0612015 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 NAME:CT Dylan Lovell Robert C.Bill Associates,Inc PHONE 631-424-3300 FAx 150 Broadhollow Road Suite 307 AIC No Ex1: A!c No):631-427-0105 Melville,NY 11747 E-MAIL ADDRESS:dlovell @robertcbillassociates.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Zurich American Insurance Co. 27855 INSURED Racanelli Construction South, INSURERB: Inc. 1895 Walt Whitman Road,Ste 1 INSURERC: Melville, NY 11747 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. INSR TypE OF INSURANCE DD BR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS-MADE X❑OCCUR X X GLO5918594-09 01/3112015 01/31/2016 DAMAGE TO RE o 300 00 PREMISES Ea ocarrence $ MED EXP(Any one person) $ 10,00 PERSONAL&PDV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 POLICY JEo LOG PRODUCTS-COMPlOPAGG $ 4,000,00 OTHER: Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ E..cddenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per acd $ AUTOS dent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25,000,00 • EXCESS LIAB CLAIMS-MADE X X AUC5918559-09 01/31/2015 01/31/2016 AGGREGATE $ 25,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER • ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 05918595-09 01/31/2015 01/31/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Cedar Grove Community Center Pro'ect Boomerang Design and Architects esign Consultants are included as additional Insured on a primary and non-contributory basis as required by written contract. CERTIFICATE HOLDER CANCELLATION ORANGEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Or BOX County WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD