2019-273-E Planning - Froehling & Robertson Lake Orange ASR testing

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DocuSign Envelope ID: DAD8677E-5BD9-49A9-8752-89E081765EE6 A Rn0 CERTIFICATE OF LIABILITY INSURANCE DAT5/(13/2019 ) 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 endorsement(s). PRODUCER CONTACT NAME: certificatesVAWV@McGrifflnsurance.com McGriff Insurance Services PHONE FAx 2108 W. Laburnum Ave Suite 300 AIC No Ext: 804-359-0044 A/C No):888-751-3010 PO Box 17370 ADDRESS: Richmond VA 23227 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Valley Fore Insurance Company 20508 INSURED 35FROEHROB INSURERB:Continental Insurance Company 35289 Froehling & Robertson Inc 3015 Dumbarton Road INSURERC:XL Specialty Insurance Company 37885 Richmond VA 23228 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1355260119 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY Y Y 6023711554 12/31/2018 12/31/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE1:1 OCCUR PREMISES(Ea occurrence)TE ence) $300,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 6023711568 12/31/2018 12/31/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLA LIAB X OCCUR Y Y 60237111540 12/31/2018 12/31/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$In nnn $ B WORKERS COMPENSATION Y 6023711537 12/31/2018 12/31/2019 X PER X OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Professional Liability DPR9936116 1/1/2019 1/1/2020 $5,000,000 Each Claim $5,000,000 Aggregate $250,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) If required by written contract the General Liability and Auto Liability policies include Blanket Additional Insured endorsements and Waivers of Subrogation are included with respect to General Liability,Auto Liability and Workers Compensation on a Blanket basis. The Umbrella policy follows form with respect to Additional Insured and Waiver of Subrogation Endorsements on the underlying General Liability,Auto Liability and Workers Compensation policies as required by written contract. Orange County Planning and Inspections Department is to be named as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Planning and Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. 131 W. Margaret Lane P.O. Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD