2018-290-E Planning - Hazen & Sawyer Lake Orange dam

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DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA ACbRi>* CERTIFICATE OF LIABILITY INSURANCE DATE jMMODNYYYj 06128/2018 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, EX'T'END 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 Marsh USA, Inc. 1166 Avenue of the Am ericas CONTACT NAME: PHONE FAX N : WL New York, NY 10036 Attn: NewYork.certs@Marsh.com Fax: (212) 946 -0500 10 UUN UU0890 0312912018 0312912019 INSURER(S) AFFORDING COVERAGE NAIC p INSURER A : Hartford Fire Insurance Compan 19682 $ INSURED HAZEN AND SAWYER INSURER B : Hartford Casual Insurance Company 29424 INSURER c: Twin Cily Fire Insurance Company 29459 498 SEVENTH AVENUE INSURER D! Zurich American Insurance Company 16535 NEW YORK, NY 10018 INSURER E! PRODUCTS - COMP(OP AGG $ 2.000.000 INSURER F : $ 13 A COVERAGES CERTIFICATE NUMBER. NYC010311127 -01 REVISION NUMBER: 3 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. INSIR LTR TYPE OF INSURANCE J= S M POLICY NUMBER MM1D6Y EFF MMIDDY yy LIMITS A X COMMERCIALGENERALUABILIY CLAIMS -MADE F_x1 OCCUR 10 UUN UU0890 0312912018 0312912019 EACH OCCURRENCE $ 1A40,000 DAMAGE TO RENTED PREM SES E&occu ro $ MED EXP An one rsan $ 10,000 PERSONAL 3 ADV INJURY $ 1,00000 GENL AGGREGATE LIMIT APPLIES PER: POLICY Lfl JE LOC OTHER: GENERAL AGGREGATE $ 2,000,OOD PRODUCTS - COMP(OP AGG $ 2.000.000 $ 13 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON - OWNED AUTOS ONLY AUTOS ONLY 1OUEN000960 (AOS) IOUENAN2667 (MA) 03012018 03129!2018 U3i29f2019 0312912019 COMBINED SINGLE LIMIT Ea acci nl $ 1.000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE P acted n4 Comp - (Call. Deductible $ 1,000 X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE AUC- 5747241.05 0312912018 03+2912019 EACH OCCURRENCE S 1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION $10 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER (EXECUTIVE OFFICER(MEMBEREXCLUDED'1 (Mandamry In NH) II yes describe, under DESCRIPTION OF OPERATIONS below NIA 10 WB AT3837 0312912019 X PER OTH- E.L. EACH ACCIDENT - -- $ 1,DD0,000 - E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E -L. DISEASE - POLICY LIMIT a 1 DESCRIPTION OF OPERATIONS I LOCATIONS F VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached if more space is required) Orange County Planning and inspections Department is included as additional insured (except workers' eampensation) where required by written contract. CERTIFICATE HOLDER CANCELLATION Orange County Planning and Inspections Deparlmenl PO Box 8181 131 W. Margaret Lane Hillsborough, NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AtITHORIZE.D REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _rA ML AM.D" �'p�.+a�rc w eel• V 19135 -ZO1 ti AQUKU L:UKPOKA I IUN. All rights reservea. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD