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DocuSign Envelope ID: 454AC100- 1926- 4795- B94B- 86B8B3246CC0
<br />321060
<br />I DATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 4/6/2918
<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 hotder 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 NAME: Kristin Dempsey _
<br />Commercial Lines - (404) 923 -3700 PHONE E , 404 - 923 -3526 FAX No 877- 362 -9089
<br />US] Insurance Services National, Inc. EMAIL _ kristin.dem a @usi.com T
<br />ADDRESS: ps Y
<br />3475 Piedmont Road NE, Suite 800 INSURERS AFFORDING COVERAGE NAWIJ
<br />Atlanta, GA 30305 -2886 INSURER A- ACE American Insurance Company 22667
<br />INSURED INSURER e: National Union Fire Ins. Co, of Pitlsbur h, PA 19445
<br />Mueller Water Products, Inc.; INSURER C. ACE Fire Underwriters Ins, Co, 20702
<br />Mueller Systems, LLC INSURER D: Indian Harbor Insurance Company 36949
<br />1290 Abernathy Road, NE Suite 1200 INSURER E:
<br />Atlanta, GA 30328
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER_ 12935784 REVISION NUMRFR- See below
<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 TC 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 AOOL SUER POLICY EFF POLICY EXP LIMITS
<br />LTR INSO VJVD POLICY NUMBER MWDD/YYYY MMIDDfYYYY
<br />A
<br />}(
<br />COMMERCIAL GENERAL LIABILITY
<br />-. CLAIMS-MADE OCCUR
<br />U
<br />XSLG27871033
<br />SIR applies per policy
<br />10/0112017
<br />1010112018
<br />EACH OCCURRENCE
<br />S 2,U00,0D0
<br />- _-
<br />S 1,000,000
<br />- E T NrEr
<br />PREMISES Ea occurrence
<br />X
<br />$ . _ 0
<br />convactual LlaBrily
<br />terms & Conditions
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY
<br />s 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 10,DOD,000
<br />X POLICY I JEQ LOC
<br />-
<br />$ 5,000,000
<br />PRODUCTS - COMPfOP A6G
<br />- --
<br />S 50.060
<br />OTHER:
<br />SIRIDedmtible
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ISAH99063201
<br />19101/2917
<br />1010112018
<br />COMBIN
<br />Eaaccldent ED SINGLE LIMIT
<br />$ 2,ODO,000
<br />X
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />._. -... --
<br />S
<br />X
<br />BODILY INJURY (Par accident)
<br />x
<br />HIRED x NCN -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAM,AGE
<br />Per accident)—,
<br />$
<br />$
<br />.. X
<br />UMBRELLA LIAR
<br />x
<br />OCCUR
<br />28189312
<br />10/0112017
<br />10/01/2018
<br />EACH OCCURRENCE
<br />S 1O,BDO,OOO
<br />AGGREGATE
<br />$ 1010MAD0
<br />EXCESS LIAR
<br />CLAIMS-MADE
<br />DED RETENTION
<br />'4
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNEPJEXECUTIVE
<br />CF C
<br />IMandatory in NHI
<br />NIA
<br />WLR064417575(AOS)
<br />)
<br />10/01/2017
<br />19101/2017
<br />1019112918
<br />10/9112918
<br />X .STATUTE
<br />__LETH
<br />E.L EACH ACCIDENT
<br />$ 1,OD.000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,OW,000
<br />If yes, describe under
<br />DESCRIPTION OF OPFRATIONS below
<br />E.L.. DISEASE - POLICY LIMIT
<br />S I • �
<br />❑
<br />E &O PL- Primary
<br />MTP004231004
<br />10/0112017
<br />10/91/2918
<br />urnh:$10,000,moDeductible!
<br />too,o 0
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Orange Water and Sewer Authority Advanced Metering Infrastructure System CIP Projeci No. 275 -76
<br />Orange Water and Sewer Authority is additional insured on General Liability as respects liability arising out of Named Insured's operations performed for
<br />them if required by written contrac( subject to the policy's terms, exclusions, and conditions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />P.O. Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Hillsborough, NC 27278
<br />AUTHORIZED REPRESENTATIVE
<br />The ACORD name and logo are registered marks of ACORD 91988 -2915 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103)
<br />
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