2019-147-E AMS - Boomerang ES Change Request 1

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DocuSign Envelope ID:2EB3A06B-5524-4E21-B639-AFB110FDD324 70BODMEpES 4L�. sL1r- � t ACOR0. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY} 10r191z018 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 1NSURER(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 he 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME* Sheila Walker BB&T Insurance Services, Inc. PHCO H a,:704481-2692 FAX LAX No: 704482-6244 5925 Carnegie Blvd Suite 400 ADDREESS: swalker@bbandt.com Charlotte, NC 28209 INSURER(S)AFFOR0INGCOVERAGE NAiCS 704 954-3000 14990 INSURER A:P""$yws"ia kat�u�Mutual roe Ina Co INSURED INSURER B: Boomerang Design PA INSURER C PO Box 2285 Shelby, NC 28151 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 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. �NSR ADOLSU POLICY EFr POLICY EXP TR 'TYPE OF INSURANCE R POLICY NUMBER (MM0DIYYYY) (MM0DIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY y BP90670238 2/11/2018 021111201 EACHOCC URRENCE $1 000 000 occuCLAIMS-MADE �OCCUR ppR IEa occurrence) s300 000 MED ExP(Any one person) $5 000 PERSONAL SADVINJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- Lj POLICY Ll ECT LOC PROpUCTS-COMPIOP AGG s2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y AU9067023$ 7J1112018 4Z1111201 CO ao!Iden SINGLE LIMIT 1,000,000 x ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS ONLY AUTOS x AUTOS ONLY x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR Y UL9067023$ 2/11/2018 0211112019 EACH OCCURRENCE s3,000,000 EXCESS LIAR CLAIM MADE AGGREGATE s3,000,000 DEi] x RETENTION$10000 $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y 1 N ANY PROP RIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached tf more space is required) Certificate Holder is automatically listed as Additional Insured IF required in their written contract with the Insured.Blanket Additional Insured Endorsement applies. Project: 510 Meadowlands Assessment CERTIFICATE HOLDER CANCELLATION Orange Count Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S211866481M19444739 BW5