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DocuSign Envelope ID:739D4C9E-26DC-45C4-A5C5-1B75846342B1
<br /> c� DAVISIM-01 TSHREWSBERRY
<br /> ACQ► � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 16..� 11/28/2018
<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 CONTACT
<br /> NAME:
<br /> Harold W.Wells&Son,Inc. PHONE FAX
<br /> 1 IN3rd Street (A/C,No,Ext):(910)762-8551 (A/C,No):(910)254-9404
<br /> IL
<br /> Wilmington, NC 28401 ADDRESS:insurance@wellsins.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Continental Casualty Company 20443
<br /> INSURED INSURER B:Hartford Insurance Company of the Midwest 37478
<br /> David Sims and Associates Consulting Engineers PC INSURERC:
<br /> 108 Giles Avenue Suite 100 INSURERD:
<br /> Wilmington,NC 28403
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM DD Y MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR B1076401294 03127/2018 03/2712019 DAMAGE TO RENTED 300,000
<br /> X X PREMISES Ea occurrence $
<br /> X BUSINESS OWNERS MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO B1076401294 03/27/2018 03/27/2019 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PerOaccitlenDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE B1076342926 03/27/2018 03/27/2019 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 0
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> YIN 22WBCCM5985 05/01/2018 05/01/2019 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE LN] N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> A Professional Liab AEH591894118 11/08/2018 11/08/2019 EACH CLAIM 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> As required by written contract,certificate holder is also an additional insured per form SB146932 and includes ongoing&completed operations on a primary
<br /> &noncontributory basis per form S6146968.
<br /> Waiver of subrogation applies as required by written contract.
<br /> 30 day notice of cancellation applies,except for nonpayment which is 10 days.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count Housing Authority THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 Y 9 Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Orange County, North Carolina
<br /> 300 West Tryon Street
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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