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DATE ( MM/DD/YYYY)
<br /> A [.1® CERTIFICATE OF LIABILITY INSURANCE 1013/2018
<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: Sandy Krevonick
<br /> McGrifff Insurance Services PHONE FAx
<br /> 2108 W. Laburnum Ave Suite 300 c No. Ext : 804 - 678 -5026 A/c , No) : 888 - 751 -3010 _
<br /> PO Box 17370 A DRESS : skrevonick bbandt , com
<br /> Richmond VA23227 INSURER(S) AFFORDING COVERAGE NAIC #
<br /> —..._
<br /> INSURER A : Travelers Indemni r Company 25658
<br /> INSURED 35MOSELARC INSURER B : Travelers Property Casualty Co of Amer 25674
<br /> Moseley Architects PC - - -
<br /> 11430 North Community House Road , Suite 225 INSURER C : Travelers Casualty & Surety Company 19038
<br /> Charlotte , NC 28277- 1502 INSURER D : XL Specialty Insurance Company 37885
<br /> INSURER E :
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER , 733060908 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 EFF POLICY EXP LIMITS
<br /> LTR D POLICY NUMBER MMIDDIYYYY MM/ DDlYYYV
<br /> 13 X COMMERCIAL GENERAL LIABILITY 680OJ6764141847 5/6/2018 5/6/2019 EACH OCCURRENCE $ 1 ,000, 000
<br /> CLAIMS - MADE l 1 OCCUR DAMAGE TO R TED
<br /> PREMISES Ea occurrence $ 1 ,000,000
<br /> MED EXP (Any one person) S 10 ,000
<br /> PERSONAL & ADV INJURY $ 1 ,000, 000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000, 000
<br /> JECT POLICY PRO- a LOG PRODUCTS - COMP/OP AGG $ 2,000, 000
<br /> OTHER ;
<br /> B AUTOMOBILE LIABILITY BA1613L67318GRP 5/6/2018 6/6/2019 COMBINED SINGLE LIMIT $ 1 , 000, 000
<br /> Ea accident _
<br /> X ANY AUTO BODILY INJURY ( Per person) $ —
<br /> OWNED SCHEDULED BODILY INJURY (Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON -OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> S --
<br /> A X UMBRELLA LIAR X OCCUR CUP6687Y2041847 5/6/2018 5/6/2019 EACH OCCURRENCE $ 5, 000, 000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S 5, 00000
<br /> DED X RETENTION $ $
<br /> C WORKERS COMPENSATION U84K6246221847E 5/1 /2018 5/1 /2019 X PER OTH-
<br /> AND EMPLOYERS' LIABILITY Y 1 N STATUTE PER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA
<br /> A E. L . EACH ACCIDENT $ 1 , 000, 000
<br /> OFFICERlMEMBEREXCLUDED7
<br /> (Mandatary in NH ) E1, DISEASE - EA EMPLOYEE S 11000, 000
<br /> If yes , describe under
<br /> DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 1 , 000, 000
<br /> D Professional UPR9932712 12/ 112018 12/ 1 /2019 Per Claim $ 4,000, 000
<br /> Liability Aggregate $6,000,000
<br /> Deductible $2001000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required)
<br /> Umbrella Liability does not extend over Professional Liability
<br /> Additional Named Insureds :
<br /> Moseley Architects PC
<br /> Moseley Scott' s Addition LLC
<br /> Moseley Architects of Maryland Inc.
<br /> Moseley Architects North Carolina PC
<br /> Moseley Acrhitects of Virginia LLC
<br /> See Attached . . .
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS .
<br /> Orange County
<br /> PO Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough NC 27278 -2505
<br /> © 1988 -2015 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2016/03 ) The ACORD name and logo are registered marks of ACORD
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