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DocuSign Envelope ID: F2DC536B-9A37-41 CF-8A34-E60971 FF929E <br /> A�oRD® CERTIFICATE OF LIABILITY INSURANCE 4/DATE(M 7 DPI <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 NAMEACT Sandy Krevonick <br /> BB&T Insurance Services, Inc. PHONE 804-678-5026 FAX 888-751-3010 <br /> 2108 W. Laburnum Ave Suite 300 (A/C,No Fct)' <br /> PO Box 17370 ADORIF S:skrevonick @bbandt.com <br /> Richmond VA 23227 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A;Travelers Indemnity Company 25658 <br /> INSURED 35MOSELARC INSURER B:Travelers Property Casualty Co of A 25674 <br /> Moseley Architects PC INSURER C:Travelers Casualty&Surety Company 19038 <br /> 11430 North Community House Road, Suite 225(#5 on <br /> INSURER Specialty Insurance Company 37885 <br /> pp0 . <br /> Charlotte NC 28277-1502 INSURERE: <br /> _INSURER F; <br /> COVERAGES CERTIFICATE NUMBER: 1196161919 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 TYPE OF INSURANCE Ann SUBR POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER (MMIDDIYVYYI (MMlDD/YYYYI LIMITS <br /> B x COMMERCIAL GENERAL LIABILITY 6600J676414 5/6/2017 5/6/2018 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $1,000,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL BADVINJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000,000 <br /> POLICY X mi. X LOC PRODUCTS-COMPIOPAGG $2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY BA1613L673 5/6/2017 5/6/2018 COMBINED SINGLE LIMIT $ - <br /> (Ea accident) 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ '.. <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ■ AUTOS ( ) <br /> X HIRED AUTOS © NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per acclden$ <br /> A X UMBRELLA LIAB X OCCUR CUP6687Y204 5/6/2017 5/6/2018 EACH OCCURRENCE $5,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED X RETENTION$10,000 .. $ <br /> C WORKERS COMPENSATION UB5837Y089 5/1/2017 5/1/2018 x PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE y N!A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <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 DPR9907847 12/1/2016 12/1/2017 $4,000,000 Per Claim <br /> Liability $6,000,000 Aggregate <br /> $200,000 Deductible <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> Umbrella Liability does not extend over Professional Liability <br /> Additional Named Insureds: <br /> Moseley Architects PC <br /> Moseley Scott's Addition LLC <br /> Moseley Architects of Maryland Inc. <br /> See Attached... <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278-2505 <br /> AUTHORIZED REPRESENTATIVE <br /> tLIEtiiiallop j2.4..........Q....... <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />