2016-486-E DEAPR - Legacy Research Associates - Amendment to contract re Blackwood Farm archaeological survey of slave cemetery

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DocuSign Envelope ID:9D7E7A6C-13EC-4E60-BBF2-A03BC04BB388 LEGAC-1 OP ID: CH Al.7(:)1Z/=," DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/12/2016 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 Robert M.Good First Insurance Services,Inc. NAME` P.O.Box 13687 C,N No,Ext):919-941-0549 PHONE FAic,No(: 919-941-0135 RTP,NC 27709 E-MAIL Robert M.Good ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartford Casualty Insurance Co 29424 INSURED Legacy Research Associates Inc INSURER B: 125 West Woodridge Dr Durham, NC 27707 INSURER C 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD POLICY NUMBER /Y (MM/DD/YYYY) (MM/DDYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR X 22SBAL05758 03/16/2016 03/16/2017 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ Business Owners MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 4,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG_ $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO 22SBALO5758 03/16/2016 03/16/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ XXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXX DED RETENTION$ $ XXXX WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE 22WBCCM2318 03/14/2016 03/14/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 PROPERTY 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Dept of Environment, Agriculture and Parks & Recreation are listed as additional insureds if required by a written/executed contract or agreement prior to a loss. CERTIFICATE HOLDER CANCELLATION COUNTY3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE-WITH THE POLICY PROVISIONS. of Environment Agriculture &Parks&Recreation - Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD