2016-608-E AMS - T.A. Loving Company for Sportsplex Field House pre-construction services

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DocuSign Envelope ID:826509CF-ED5F-4F89-AE19-18F10AF97036 iy 188693 AC®/2®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/18/2016 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 have ADDITIONAL INSURED provisions or 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:ACT Brittany Ervin Commercial Lines—800-366-8834 PHONE FAX Wells Fargo Insurance Services USA,Inc EMA tee, Ext): 704-557-2185 (vc,No):866-332 3051 ADDRESS: brittany.ervin @wellsfargo.com 6100 Fairview Road INSURER(S)AFFORDING COVERAGE NAIC 6 Charlotte,NC 28210 INSURER A: Zurich American Insurance Co 16535 INSURED INSURER B: Commerce&Industry Insurance Company 19410 T.A.Loving Company INSURER C: 400 Patetown RD(27533) INSURER D: PO Drawer 919 INSURER E: Goldsboro NC 27350 INSURER F: COVERAGES CERTIFICATE NUMBER: 10982302 REVISION NUMBER: See below 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 ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 3521190-14 04/01/16 04/01/17 EACH OCCURRENCE S 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ X Contractual MED EXP(Any one person) $ 10,000 X XCU,Indep Corti' PERSONAL&ADV INJURY 5 2,000,000 I GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JECr X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP 3521191-14 04/01/16 04/01/17 COM(Ea accident)BINED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ — B x UMBRELLA LIAB X OCCUR BE 041566449 04/01/16 04/01/17 EACH OCCURRENCE $ 25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ 25,000,000 DED RETENTION$ $ 1 A Y/N -WORKERS COMPENSATION WC 3521189 14 04/01/16 04/01/17 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Project: Orange County Sportsplex Fieldhouse Orange County and CRA Associates are listed as additional insured with respects to General Liability when required by written contract regarding the above captioned project. CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED. IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 I AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) (rills certificate replaces certificate#10970734 Issued on 1011212016)