2018-682-E DEAPR - Design Dimensions Inc. CGCC history wall amendment

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DocuSign Envelope ID: BDB1A4FB-EA01-42EA-86AE-3614105F82D5 0 DATE(MMIDDIYYYY) AC" I® CERTIFICATE OF LIABILITY INSURANCE 0812112018 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 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 CONTACT Ann Burnette NAME: John Hackney Agency,Inc AICNo Ext: (252)291-3111 arc Nn: {252}291-6306 3700 Nash Street N EMAIL aburnetteN @jchnhackneyagency.com ADDRESS; P.O.Box 998 INSURER(S)AFFORDING COVERAGE NAiC# Wilson NO 27894-0998 INSURER A: Ohio Security Ins.Co. 24082 INSURED INSURER 8: The Ohio Casualty Ins.Co. 24074 Design Dimension INSURER C: 901 N West Street INSURER D: INSURER E: Raleigh NO 27603 INSURER F: COVERAGES CERTIFICATE NUMBER. CL1882004583 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. fNSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSO WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA A SQQ,naQ CLAIMS-MADE OCCUR PREMISES Eaocc+arrence $ _ MED EXP(Any one person) $ 15,000 A BKS58914959 0812412018 08/24/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2.000,000 POLICY �JECTT LOC PRODUCTS-COMPIOPAGG $ 2,o00,0D0 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident X ANY AUTO BODILY INJURY(per person) S A OWNED SCHEDULED BAS58914959 08/24/2018 08/24/2019 BODILY INJURY(per accldanl) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident. Underinsured motorist 61 s X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 2,000,000 13 EXCESS LIAB CLAIMS MADE US058914959 0812412018 08/24/2019 AGGREGATE S DED RETENTION S S WORKERS COMPENSATION X STATUTE ERH- iAND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIV£ �YIN E.L.EACH ACCIDENT S 1,000,000 A OFFICERIMEMBER EXCLUDED? NIA XWS58914959 08/2412018 08124/2019 (Mandatory In NH) E.I.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S T. DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more apace is required) Additional Insureds and Waiver of Subrogation included when required by written contract or agreement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange Co.Dept.of Environment,Agriculture,Parks and Recreation ACCORDANCE WITH THE POLICY PROVISIONS. P 0 Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NO 27278 J •y. {.•�v ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD