2017-550-E DEAPR - Laura A. W. Phillips - Historic Resources Book, Phase 1 review and assessment

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DocuSign Envelope ID: 331 B6A4A-46C2-4E66-A54C-56994DF17997 q - BHE DATE(NIM/DD/YYYI') CERTIFICATE OF LIABILITY INSURANCE R045 9/19/2017 THIS CERTIFICATEIS 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 CONTACT NAME: USAA INSURANCE AGENCY INC/PHS (NC,No,Ext): (888) 242-1430 (NC,No): (888) 443-6112 812846 P: (888) 242-1430 F: (888) 443-6112 n oR'ESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURER A: Hartford Casualty Ins Co 29424 INSURED INSURER B: INSURER C: LAURA A. W. PHILLIPS INSURERD: 59 PARK BLVD INSURERE: WINSTON SALEM NC 27127 INSURERF: 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 TYPE OF INSURANCE ADDL SUBR POLICYEFF POLICYEFP LTR INSR WE'D POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $300, 000 PREMISES(Ea occurrence) A X General Liab X 65 SBA NN0653 09/10/2017 09/10/2018 MED EXP(Any one person) $10, 000 PERSONAL&ADV INJURY $1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2, 000, 000 POLICY PRO- X LOC PRODUCTS-COMP/OP AGG $2, 000, 000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1, 000000 (Ea accident) I ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 65 SBA NN0653 09/10/2017 09/10/2018 BODILY INJURY(Per accident) $ AUTOS ONLY_ AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ - If yes,describe under $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured' s Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Orange County Dept of Environment, BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE g y p , DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Agriculture, Parks & Recreation AUTHORIZED REPRESENTATIVE 4 PO BOX 8181 �� HILLSBOROUGH, NC 27278 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD