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DocuSign Envelope ID:922D6914-A933-4C2E-BCA1-695766A5D6D2
<br /> Client#:405960 35MOSELARC
<br /> [DATE MM/DD/YYYY)
<br /> M I LIB /2015
<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(les)must be endorsed.If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> BBT Insurance Services, Inc. PHONE 804 359-0044 FAX 8887513010
<br /> A/C,No,Ext: __._.. _(A/C,No)_.
<br /> 2108 W. Laburnum Ave Suite 300 E-MAIL
<br /> ADDRESS:
<br /> PO Box 17370
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> Richmond,VA 23227 INSURER A:Travelers Indemnity Company 25658
<br /> INSURED INSURER B:Travelers Casualty&Surety Cc 19038
<br /> Moseley Architects PC INSURER C:XL Specialty Insurance Company 37885
<br /> 11430 North Community House Road INSURER D:Charter Oak Fire Insurance Co 25615
<br /> Charlotte, NC 28277
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> A GENERAL LIABILITY 68015931_830 05106/2015 05/06/2016 EACH OCCURRENCE $1,000,000
<br /> COMMERCIAL GENERAL LIABILITY PREMISESa occur ence $1,000,000
<br /> CLAIMS-MADE ®OCCUR MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> POLICY PRO )( LOC $
<br /> JECT
<br /> D AUTOMOBILE LIABILITY BA16131_673 5/06/2015 05/061201 (CEO ENED S
<br /> entINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS .._.
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS Per accidentJ____
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR CUP6687Y204 05/0612015 05/061201 EACH OCCURRENCE $5,000,000 _
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5
<br /> ,000 000
<br /> DED XFRETENTION$1®00® $
<br /> B WORKERS COMPENSATION UB5837YO89 510112015 05/011201 LIMITS EB
<br /> IT OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? IN N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Professional DPR9720356 12/0112014 12/011201 $4,000,000 Per Claire
<br /> Liability $6,000,000 Aggregate
<br /> $200,000 Deductible
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Umbrella Liability does not extend over Professional Liability
<br /> Additional Named Insureds:
<br /> Moseley Scott's Addition LLC
<br /> Moseley Architects of Maryland Inc.
<br /> Moseley Architects North Carolina PC
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange COIBn$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2010 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S14634833IM14342474 DLB
<br />
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