2016-136-E DEAPR - Summit Design & Engineering Services, PLLC - Phase I Environmental Site Assessment

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DocuSign Envelope ID: F4CF91BB-74B3-4B07-9E4A-4099BF54DBE8 ® DATE(MM/DD/YYYYj TI I LI II I 1/25/2016 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 CONTACT Ellen Walker NAME: Business Insurers of Carolinas PHONE o (919)968-4611 q/C No:(919)968-8991 800 Eastowne Drive, Suite 208 E-MAIL ADDRESS:ewalker @business-insurers.com PO Box 2536 INSURERS AFFORDING COVERAGE NAIL# Chapel Hill NC 27515-2536 INSURERA-Ohio Security 24082 24082 INSURED INSURERB:PeerleSS Indemnity Ins Co 18333 Summit Design and Engineering Services PLLC wsURERC:Ohio Casualty Insurance Co 24074 24074 504 Meadowland Drive INSURER 0: INSURER E: Hillsborough NC 27278 INSURER F: COVERAGES CERTIFICATE NUMBER:CL15121414193 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. INBR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DY/YYYY MMILDDY� LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE A CLAIMS-MADE OCCUR PREM SES�a RENTED $ 300,000 BKS55764212 1/1/2016 1/1/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Experience Mod Factor 1 $ AUTOMOBILE LIABILITY CO accMBINED SINGLE LIMIT $ 1,000 000 Ea ident � B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BA8907831 4/2/2015 4/2/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS IX AUTOS Per accident) $ Experience Mod Factor 2 $ X UMBRELLA LIAB OCCUR Umb excess over GL,Auto & EACH OCCURRENCE $ 6,000,000 C EXCESS LIAB CLAIMS-MADE WC AGGREGATE $ 6,000,000 DED X RETENTION$ 10,000 US055764212 1/1/2016 1/1/2017 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED?(Mandatory in NH) XWS55764212 1/1/2016 1/1/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Dept Of Environment, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Agriculture, Parks and Recreation ACCORDANCE WITH THE POLICY PROVISIONS. Marabeth Carr 306 A Revere Road AUTHORIZED REPRESENTATIVE PO Boat 8181 / Hillsborough, NC 27278 Ellen Walker/ELLEN � � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD N S025(201401)