2019-270-E AMS - Mobile Communications change order request

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DocuSign Envelope ID:47205FAF-9CD2-4A40-BD26-FF33C4A659C6 AC R e DATE(MMIDD/YYYY) _ CERTIFICATE OF LIABILITY INSURANCE 612112018 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 INSURER(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 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 endorsements). ONTACT PRODUCER Stephens Insurance, LLC NAME: Stephanie Jones . 111 Center Street, Suite 100 PHONE o 501 377-3445 FWC AX,No; 501 210-4627 Little Rock, AR 72201 E-MAIL ADDRESS: Ste ha nie.Jon esO Step hens.com INSURER(S)AFFORDING COVERAGE NALC'$ www.stephens.com INSURERA: Massachusetts Bay Insurance Company 22306 INSURED INSURER B. The Hanover Ins Uran Ce Company_ 22292 Mobile Communications America, Inc. INSURERC: Allmedca Financial Benefit Insurance Co 41640 & Subsidiaries 885 Cripple Creek INSURERD; Lawrenceville GA 30043 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER.- 43742355 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INnIC;ATED. NOTWITHSTANDING ANY REQUIREMENT, TFRM OR CONDITION OF ANY CONTRACT OR OTHER ❑OCUMENT 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. INSR TYPE OF INSURANCE ADDLSl1BR POLICYNUMBER lP MDffYrr MM?DDY7YYYY LIMITS EXII LTR A V COMMERCIAL GENERAL LIABILITY ZDT-D351274-61 8/23/2018 8/23/2019 EACH OCCURRENCE $1 000 000 CLAIMS-MADE F OCCUR PREMiS S Ea ocrurcence $100 000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000 000 GERL AGGREGATE LI MIT APPLIES PER: GENERAL AGGREGATE $2.000,000 PODGY[7]jR O- LOC PRODUCTS-COMPIOP AGG s2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ADT-D342535-01 8/23/2018 8/23/2019 LE9 a dQOI51NG E LIMIT $1 000 000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYCAMAGE $ AUTOS ONLY AUTOS ONLY Per accident) J Ga rage kes e L al Liabi litv $ B UMBRELLA LIAR M,/ OCCUR UHT-1)351276-01 8/23/2018 8/23/2019 EACH OCCURRENCE $10 000 000 EXCESS LIAR CLAIMS-MADE Commercial Follow AGGREGATE $10 000 000 DE❑ I VI RETENTIONsNII Form Policy $ C WORKERS COMPENSATION W2D-D343901-01 8/23/2018 8/23/2019 �/ STATUTE ER AND EMPLOYERS'LIABILITY ANYPRDPRIETORIPARTNERIEXECUTIVE YIN NIA F 1,EACH ACCIDENT $1 000 000 orrICERIMEMSE R EXCLUDE67IN (MandaloryIn NH) E.L.DISEASE-EA EMPLOYEE $ I#yes,deacribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT $1 000 000 B Professional Liability LHT-D351277-01 8/23/2018 8/23/2019 Each Claim Limit$2,000.000 Aggregate Limit$2,000,000 DESCRIPTION Or OPERATIONS I LOCATIONS I VEHICLES(ACORR 1e1,Additional Remarks Schedule,may be attached itmore space is required) CERTIFICATE HOLDER CANCELLATION Orange County Emergency Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE PO BOX 81 S 1 ACCORDANCE W THTHE POL CYPROVISION WILL BE DELIVERED IN 200 S Cameron Street Hillsborough NC 27278 A U TH O R rZ E D FR EPRESEN TATiVE Sian Payne ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and Toga are registered marks of AGOR❑ 43742355 I ]g119 Master Certificate I Stephanie Jones 18121J2Mfl 5;39;03 PM (CI]T) I Page 7 of 2