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DocuSign Envelope ID:CDB26ED1-82FE-487A-872C-345E8A833228 <br /> POLICY NUMBER: CA 0017095 5 <br /> SUMMARY OF ENDORSEMENTS <br /> APPLICABLE TO ALL COVERAGES; <br /> 1-UNAU-9537-MU-04, 11/0$Business Auto Declarations <br /> IL 0017(11/98) Common Policy Conditions <br /> IL 0021 (07/02) Nuclear Energy Exclusion(Broad Form) <br /> IL 00 03(09/07)-Calculation of Premium <br /> STATE: NC <br /> CA 0001 (03106)Business Auto Coverage Form <br /> CA 0126(07110) North Carolina Changes <br /> CA 2048 (02199) Designated Insured <br /> Skanska Usa Building Inc; Skanska Usa Inc_And The Owner 4309 Emperor Blvd Ste 200 Durham, NC 27703-BD46 <br /> CA 2116 (04/10)North Carolina- Uninsured Molorist Coverage <br /> CA 2384(01/06)Exclusion of Terrorism <br /> CA 9903 (03106)Auto Medical Payments Coverage <br /> CA 9910(09/02)Drive Other Car Ccv-Broad Cov For Named Individuals <br /> Total Premium:$107 <br /> Name of Individuals: WILLIAM DICKERSON III <br /> OTC Coverage: Yes <br /> Collision Coverage: Yes <br /> CAU 014(04104)Waiver Of Trnsfr Of Rights Of Recovery Against Olhers To Us <br /> Name of Person or Organization:SKANSKA USA BUILDING INC;SKANSKA USA INC.AND THE OWNER.,4309 EMPEROR BLVD., <br /> STE 200., DURHAM, NC 27703,4309 Emperor Blvd, Ste 200_, Durham, NC 27703 <br /> CAU 014(04104)Waiver Of Trnsfr Of Rights Of Recovery Againsl Others To Us <br /> Name of Person or Organization: BLANKET WHERE REQUIRED IN WRITTEN CONTRACT PRIOR TO LOSS <br /> CAU 05$(12 09)Auto First Choice Endorsement <br /> Premium:$250 <br /> Auto First Choice Physical Damage Premium:$ 125 <br /> Auto First Choice Liability Premium:$125 <br /> IL 008(11/08)-Total Lead Exclusion <br /> IL 009(111DS)-Total Asbestos Exclusion <br /> VEHICLE ENDORSEMENTS <br /> Vehicle#2:2006 FORD CAB FORW 550 BLUE DIAMOND VIN:3FRMLSUBSV240526 <br /> CA 9944(12/93)Loss Payable Clause <br /> See Schedule for Vehicle#2 <br /> Vehicle#3: 2006 GMC C4500 VIN: 1 GDE4Ci 27SF406919 <br /> CA 9944(12193)Loss Payable Clause <br /> See Schedule for Vehicle#3 <br /> Vehicle#4:2006 CHEVROLET KODIAK VIN: 1GSE4C1276F412924 <br /> CA 9944 (12193) Loss Payable Clause <br /> See Schedule for Vehicle#4 <br /> Vehicle#9:2011 FORD F150 VIN: 1FTFXIEFOBFA68694 <br /> CA 9944(12/93)Loss Payable Clause <br /> See Schedule for Vehicle#9 <br /> Vehicle#11. 2015 CHEVROLET SILVERADO VIN: 1GCIKWEG4FF100809 <br /> CA 9944(12/93)Loss Payable Clause <br /> 1-UNAU-9537-NFU-04, 11l0a PREPARED:10-30-2014 Page S of 9 <br /> Includes copyrighted material of Insurance Services Office, Inc.with its permission_ <br />