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DocuSign Envelope ID: 48ED1D41- DA40- 49D1- A586- 23C127C567EF <br />ASR °� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDD/YYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />7/23/2018 <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 <br />CONTACT <br />NAME: Sandy Krevonlck <br />McGrifff Insurance Services <br />PHONE FAX <br />2108 W. Laburnum Ave Suite 300 <br />(A/C. No Ext: 804- 678 -5026 A/C No): 888-751-3010 <br />ADDRESS: skrevonick@bbandt.com <br />PO Box 17370 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Richmond VA 23227 <br />INSURER A: Travelers Indemnity Company <br />25658 <br />INSURED 35MOSELARC <br />INSURER B: Travelers Property Casualty Co of Amer <br />25674 <br />Moseley Architects PC <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />11430 North Community House Road, Suite 225 <br />INSURER C: Travelers Casualty & Surety Company <br />19038 <br />INSURER D: XL Specialty Insurance Company <br />37885 <br />Charlotte, NC 28277 -1502 <br />INSURER E : <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 838833858 REVISION NUMBER: <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 />INSD <br />SUBR <br />WVD <br />POLICYNUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />680OJ6764141847 <br />5/6/2018 <br />5/6/2019 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE X OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY ❑X PRO- JECT LOC <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />BA1613L67318GRP <br />5/6/2018 <br />5/6/2019 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />CUP6687Y2041847 <br />5/6/2018 <br />5/6/2019 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />$ 5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />UB4K8246221847E <br />5/1/2018 <br />5/1/2019 <br />X PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR /PARTNER /EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICER/MEMBER EXCLUDED? ❑ <br />N/A <br />(Mandatory in NH) <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 />D <br />Professional <br />DPR9919305 <br />12/1/2017 <br />12/1/2018 <br />Per Claim <br />$4,000,000 <br />Liability <br />Aggregate <br />$6,000,000 <br />Deductible <br />$200,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Umbrella Liability does not extend over Professional Liability <br />Additional Named Insureds: <br />Moseley Architects PC <br />Moseley Scott's Addition LLC <br />Moseley Architects of Maryland Inc. <br />Moseley Architects North Carolina PC <br />Moseley Acrhitects of Virginia LLC <br />See Attached... <br />CERTIFICATE HOLDER CANCELLATION <br />©1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <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 />Orange County <br />PO Box 8181 <br />AUTHORIZED REPRESENTATIVE <br />Hillsborough NC 27278 -2505 <br />©1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />