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DocuSign Envelope ID: C28BF39E- EOF1- 42FB- 9F5B- 93F375B7013B <br />CERTIFICATE OF LIABILITY INSURANCE <br />�� 1/1/2019 <br />DATE (MM /DD /YYYY) <br />2/28/2018 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Lockton Companies <br />CONTACT <br />NAME: <br />PHONE FAX <br />o Ext . A/C No <br />444 W. 47th Street, Suite 900 <br />Kansas City MO 64112-1906 <br />(816) 960 -9000 <br />E -MAIL <br />ADDRESS: <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Y <br />N <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Lexington Insurance Compny Company <br />19437 <br />$ 1,000,000 <br />INSURED TERRACON CONSULTANTS, INC. <br />1312893 2401 BRENTWOOD ROAD <br />INSURER B: Travelers Property Casualty Co of America <br />25674 <br />INSURER C: The Travelers Indemnity Com an <br />25658 <br />INSURER D: <br />RALEIGH NC 27604 <br />INSURER E: <br />INSURER F: <br />• <br />COVERAGES TERC001 CERTIFICATE NUMBER: 15244029 REVISION NUMBER: XXXXXXX <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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />MM POLICY EFF DD/YYYY <br />EXP <br />MM/ DY/Y YYY <br />LIMITS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Y <br />N <br />TC2J- GLSA- 1118L293 <br />1/1/2018 <br />1/1/2019 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1,000,000 <br />• <br />MED EXP (Any one person) <br />$ 25,000 <br />CONTRACTUAL LIAR <br />• <br />XCU COVERAGE <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY JE� [::] LOC <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />$ <br />AUTOMOBILE <br />LIABILITY <br />Y <br />I�j <br />TC2J- CAP- 131J3858 <br />1/1/2018 <br />1/1/2019 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 2,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ XXXXXXX <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ xxXXXXX <br />OWNED <br />AUTOS ONLY SCHEDULED <br />PROPERTY DAMAGE <br />Per accident <br />$XXXXXXX <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />$XXXXXXX <br />UMBRELLA LIAB <br />OCCUR <br />NOT APPLICABLE <br />EACH OCCURRENCE <br />$ XXXXXXX <br />HCLAIMS-MADE <br />AGGREGATE <br />$ XXXXXXX <br />EXCESS LIAB <br />DED RETENTION $ <br />$ XXxxXXX <br />B <br />C <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/MEMBEREXCLUDED? ❑N <br />(Mandatory in NH) <br />N/A <br />N <br />TC2JUB131J374218 AOS <br />TRKUB131J384618 (AZ,MA,WI) <br />TC2JUB 13 1 J374218 (CA) <br />1/1/2018 <br />1/1/2018 <br />1/1/2018 <br />1/1/2019 <br />1/1/2019 <br />1/1/2019 <br />X STATUTE ERH <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />PROFESSIONAL <br />N <br />N <br />26030216 <br />1/1/2018 <br />1/1/2019 <br />$1,000,000 EACH CLAIM & <br />LIABILITY <br />$1,000,000 ANNUAL AGGREGATE <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: 70171288 SPORTSPLEX FIELD HOUSE TESTING. ORANGE COUNTY, NC IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY, <br />AUTO LIABILITY AND UMBRELLA/EXCESS LIABILITY, AS REQUIRED BY WRITTEN CONTRACT. <br />CERTIFICATE HOLDER CANCELLATION <br />15244029 <br />ORANGE COUNTY, NC <br />P.O. BOX 8181 <br />HILLSBOROUGH NC 27278 <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 />AUTHORIZED REPRESENT <br />©1 8'015 ACORD CORPORATION. All riahts reserved <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />