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DocuSign Envelope ID: 80EOOD3A- BO6E -49BE- 9975- 1947B52242CA <br />HAZE &SA -01 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE 07 /02f2018Yj <br />a7rouaol a <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($), 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 CWCT <br />.NAME:_ <br />Ames & Gough PHONE FAR <br />8300 Greensboro Drive IA+C,No, Exta: (703) 827 -2277 (AIC�NOI.(703) 827 - 279 <br />Suite 980 >-Md'L . admin@amosgough.com <br />McLean, VA 22102 ___- --•-•- -- •._ -- -- 1 . <br />INSURED <br />Hazen and Sawyer <br />498 Seventh Avenue <br />New York, NY 10018 <br />A <br />nnVFRA(_1FC r PRTIFIr:ATF NI IIUIRFR- 0F=VICIn1d III IBARr-R- <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 TYPE OF INSURANCE ADDLSUBRi POLICY NUMBER POLICY EFF POLICY EXP LIMITS ffYYyI <br />LIH <br />COIAMERCUIL GENERAL LIABILITY <br />EACH OCCURRENCE <br />CLAIMS l OCCUR <br />DAMAGE RENTED <br />-MADE <br />M S E <br />... <br />MED EXP (Any one person <br />PERSONAL & A.DV INJURY <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER <br />POLICY E PER& F-1 LOG <br />GENERAL AGGREGATE <br />PRODUCT S- COMPIOPAGG <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />a accidentD <br />�_ <br />ANY AUTO <br />BODILY INJd1RY Per eman <br />BODILY INJURY Per ecclden4 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />� <br />OPER Yt AMAGE <br />yyNEp <br />AUTOS ONLY AUOTOS SNLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />H <br />" AGGREGATE _ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DIED RETENTIONS <br />WORKERS COMPENSATION <br />PER 4TH <br />AND EMPLOYERS' LIARI.LITY YIN <br />ECUTIVE <br />ANY PRRMIEETOR EXCLUDED? <br />;Mandatary fn VIII <br />N I A <br />E.L, EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />S <br />If yes describe under <br />' DESCRIPTION OF OPERATIONS beelnw <br />E.L. DISEASE • POLICY LIMIT <br />A <br />Liab <br />AEHDO8231489 <br />03/29/2018 <br />0312912019 <br />Per Claim/Aggregate <br />1,040,000 <br />S jCyberLiability <br />002880201 <br />I <br />08109/2017 <br />08/0912018 <br />Aggregate <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 191, AddlUorml Reroerko Schedule, maybe attached If more apace is required) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Orange County Planning & Inspections Department <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 8181 <br />131 W Margaret Lane <br />Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2015103) O 1988 -2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />