2018-200-E Planning - John McAdams contract amendment

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DocuSign Envelope ID: 505AD303- 2BD7- 47C5- A103- 8219E0353948 ACC? " CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY) 2/21/2018 THIS CERTIFICATE IS 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 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 Harriet Thomas NAME: AHONNO Ext. (704) 892 -9297 A C No: (704)896 -0485 JJ Wade & Associates ADDRESS :hthomas @jjwadeinsurance.com P.O. Box 1209 212 S Main St. INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:National Fire Insurance of Hartford 20478 Davidson, NC 28036 INSURED INSURERB:Continental Casualty Company 20443 INSURERC:Valley Forge Insurance Company 20508 The John R. McAdams Company, Inc. INSURER D: PO Box 14005 INSURER E: $ 100, 000 Research Triangle Park, NC 27709 INSURER F: $ 15,000 COVERAGES CERTIFICATE NUMBER:2017 -2018 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD /YYYY LIMITS Hillsborough, NC 27278 X COMMERCIAL GENERAL LIABILITY J.J. Wade, III /AH EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100, 000 • MED EXP (Anyone person) $ 15,000 Contractual Liability X 6045439001 12/31/2017 12/31/2018 • No XCU Exclusion PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 6045439029 12/31/2017 12/31/2018 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS FX AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ X 6045439063 12/31/2017 12/31/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER OTH- STATUTE ER C ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N / A 6045439046 12/31/2017 12/31/2018 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as an Additional Insured with respects to General Liability and Umbrella Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION hfleming @orangecountync.go SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Planning and THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE 131 W. Margaret Lane Hillsborough, NC 27278 J.J. Wade, III /AH ACORD 25 (2014/01) INS025 (201401) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD