2019-290-E Planning - McAdams contract amendment 4

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DocuSign Envelope ID:C671 C7DE-9689-4962-8BA2-D41 EAEDE4E95 CERTIFICATE OF LIABILITY INSURANCE DATE 1 3125/2019(MMIDDNYYY) 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 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 Harriet Thomas NAME: JJ Wade & Associates A/CNNo Ext: (704)892-9297 FAX No: (709)896-0985 P.O. Box 1209 E-MAIL hthomas@jjwadeinsurance.com ADDRESS: 212 S Main St. INSURERS AFFORDING COVERAGE NAIC# Davidson, NC 28036 INSURER A:National Fire Insurance of Hartford 20478 INSURED INSURER B:Continental Casualty Company 20443 The John R. McAdams Company, Inc. INSURERC:Valley Forge Insurance Co. 20508 PO BOX 14005 INSURER D: Research Triangle Park, NC 27709 INSURER E: INSURER F: L COVERAGES CERTIFICATE NUMBER:2018-2019 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 IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 � OCCUR DAMAGE TO RENTED 300,000 PREMISES A CLAIMS-MADE Ea occurrence $ X Contractual Liability X 6045439001 12/31/2018 12/31/2019 MED EXP(Any one person) $ 15,000 X No XCU Exclusion PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PEA ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6045439029 12/31/2018 12/31/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 X 6045439063 12/31/2018 12/31/2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N❑ C (Mandatory in NH) 6045439046 12/31/2018 12/31/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as an Additional Insured with respects to General Liability and Umbrella Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION CSandt@orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Planning and THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 131 W. Margaret Lane AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 c _ J.J. Wade, III/AH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)