2018-738-E Planning - Hazen and Sawyer Lake Orange Dam Inspection contract amendment

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DocuSign Envelope ID:9B3E4DCD-E515-4478-B6AB-CB885F37A67E A�� ® DATE 12018 fYYYY) CERTIFICATE OF LIABILITY INSURANCE a6lzslzDle 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 INSURERS), 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 Marsh USA,Inc. NAME: FA1C-- ------ 1166 Avenue of the Americas PHONE A Nei: New York,NY 10036 MRLEft Attn:NewYork-certs@Marsh.oDm Fax:(212)94&0540 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Hartford Fire Insurance Company 19682 INSURED HAZEN AND SAWYER INSURER B:Hartford Casual Insurance CompAny 29424 498 SEVENTH AVENUE INSURER c:Twin Cily Fire Insurance Oompgny 29459 NEW YORK,NY 10018 INSURER D:Zurich Anericarl Insurance Corriggy 16535 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-410311127-01 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP Man VWVD POLICY NUMBER M n YY M b LIMITS A X COMMERCIAL GENERAL LIABILITY 10 UUN 000890 030 018 0312912019 EACH OCCURRENCE $ 1,000,000 AGETO CLAIMS-MADE �OCCUR PRE"'El Me,occu D $ MED EXP(A,ny one -an $ 10,ODD PERSONAL 3 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- F—]LOG PRODUCTS-COMPIOPAGG $ 2.000.000 OTHER: $ B AUTOMOBILE LIABILITY 1OUENUU0960(ADS) 031291201$ 0312912019 COMBINED SINGLE LIMIT $ 1,000,0M Ea acrid n A X ANY AUTO 1OUENAN2667(MA) 03QM018 03129/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Par accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY P r acci sn Comp.IColl.Deductible $ 1,000 X UMBRELLA LIAR X OCCUR AUC-5747241.05 03/2912018 0312912019 EACH OCCURRENCE $ 1,OXODO EXCESS L1AB CLAIMS-MADE AGGREGATE $ 1,000,I)DO DE 1 X I RETENTION$10 000 __. $ C WORKERS COMPENSATION 10 WB AT3837 0312912019 X PER U 0TH- AND EMPLOYERS'LIABILITY YIN STAT rE ANYPROPRIETORIPARTNERIEXECUTIVE � NIA E.L.EACH ACCIDENT _ _ $ 1,000,000 OFFICERIMEMBEREXCLUE - - -- (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ 1,Op0,000 If yes,desenbe under 1 , DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1 01,Additional Remarks Schedule,may be attached K more space is required) Orange County Planning and inspections Department is included as additional insured(except workers'compensation)where required by written eanuact. CERTIFICATE HOLDER CANCELLATION Orange County Planning and Inspections SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Depariment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELRIERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. 131 W.Margaret Lane Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03] The ACORD name and logo are registered marks of ACORD