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DocuSign Envelope ID:418ADAA3-2F7B-4243-AF32-4541 C164B6FA
<br /> DATE(MM/DD/YYYY)
<br /> AC D CERTIFICATE OF LIABILITY INSURANCE
<br /> 01/13/2017
<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(ies) 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 Katie Clark
<br /> MCGRIFF,SEIBELS&WILLIAMS,INC.
<br /> NAME:
<br /> P.O.Box 10265 (A/C,No,Ext): 800-476-2211 (A/C,No):
<br /> Birmingham,AL 35202 E-MAIL kclark me riff.com
<br /> ADDRESS: @ g
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Liberty Surplus Insurance Corporation 10725
<br /> INSURED INSURER B:Liberty Mutual Fire Insurance Company 23035
<br /> DH Griffin Infrastructure LLC
<br /> P.O.Box 7657 INSURER C:Commerce and Industry Insurance Company 19410
<br /> Greensboro,NC 27417-0657
<br /> INSURER D:Certain Underwriters at Lloyd's
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:HMWWFJ3Z 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 CONTRACT OR 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 INSD WVD POLICY NUMBER
<br /> R TYPE OF INSURANCE POLICY EFF POLICY EXP
<br /> (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 1000228437-01 10/01/2016 10/01/2017 EACH OCCURRENCE $ 2,000,000
<br /> Blkt Additional Ins.&Blkt Waiver of
<br /> CLAIMS-MADE X OCCUR Subrogation as DAMAGE TO RENTED 50,000
<br /> Required by Written Contract PREMISES(Ea occurrence) $
<br /> X Contractural Liability MED EXP(Any one person) $ 5,000
<br /> X XCU Coverage PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY X LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY AS6-Z51-291714-016 12/31/2016 12/31/2017 COMBINED SINGLE LIMIT
<br /> GVW 20,001 or more: (Ea accident) $ 1,000,000
<br /> X ANY AUTO Comp Ded. 2500 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED C011 Ded. 2500
<br /> AUTOS AUTOS GVW 20,000 or less: BODILY INJURY(Per accident) $
<br /> NON-OWNED Comp Ded.1000 PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS Call Ded.1000 (Per accident) $
<br /> C UMBRELLA LIAB X OCCUR BE015445191 10/01/2016 10/01/2017 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED RETENTION$10,000 $
<br /> B WORKERS COMPENSATION WC2-Z51-291714-026 12/31/2016 12/31/2017 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Combined Inland Marine MACCD1602513 10/01/2016 10/01/2017 Lease/Rent/Borrow Equip $ 10,000,000
<br /> Risks of direct physical loss subj to Ded-5%Min$25,000 $
<br /> Company forms&excl- Ded Max$75,000 $
<br /> Boom/Overload Coy Included Riggers $ 5,000,000
<br /> Installation $ 5,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:Eubanks Road Waste and Recycling Center
<br /> Certificate Holder,Draper Aden Associates,the Designer,the Designer's consultants,and the Construction Manager are Additional Insured on a Primary and Non-
<br /> Contributory basis under General Liability,Automobile Liability,Pollution Liability,and Umbrella Liability as required by written contract.Waiver of Subrogation applies in
<br /> favor of the Certificate Holder with respects to General Liability,Automobile Liability,Umbrella Liability,Pollution Liability, Installation Floater,and Workers'Compensation as
<br /> required by written contract.In the event of cancellation by the insurance companies,the policies have been endorsed to provide thirty days notice of cancellation(except for
<br /> non-payment)to the Certificate Holder shown below.
<br /> As of 1/13/17,the EMF is.78.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Orange County,NC AUTHORIZED REPRESENTATIVE f
<br /> PO Box 8181
<br /> Hillsborough,NC 27278 P "
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<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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