2019-301-E AMS - Summit Design and Engineering EMS stormwater maintenance

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DocuSign Envelope ID:49C3D6C6-17EB-4320-B1DF-601984A397F2 DocuSign Envelope ID:49C3D6C6-17EB-4320-B1DF-601984A397F2 Ai d DATE(MM/ ) V CERTIFICATE OF LIABILITY INSURANCE o3/zo/2019zo19 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(fes)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 NAMe T Crystal Ireland Business Insurers of Carolinas PAHO No I (919y 968-4611 FAX Nc (919)968.8991 800 Eastowne Drive,Suite 208 ADDRESS: cireland@business-insurers.com PO BOX 2536 INSURER(S)AFFORDING COVERAGE NAIC IJ Chapel Hill NC 27515-2536 INSORERA: Travelers Indeminity 25658 INSURED INSURER B: Travelers Property Cas Co of America 36161 Summit Design and Engineering Services PLLC INSURER C; Accident Fund General Ins Co 12304 504 Meadowlands Drive INSURER D: INSURER E: Hillsborough NC 27278 INSURERF• COVERAGES CERTIFICATE NUMBER; CL1B32025274 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSK LIR TYPE OFINSURANCE INSD VIVA POLICY NUMBER MMIDDIYYYY MMIDDT FXP M'YY LIMITS ]< COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO KERTE17- CLAIMS-MADE IX-1OCCUR PREMISES Eaoccurrenca S 100,000 MED EXP(Any one person) $ 5.000 A Y 6304KO89149 01/01/2019 01/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GMLAGGRE13ATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY[g j�T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMB NEDSINGLE LINT $ 1,000.000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y 810-2J958216 04/02/2019 04/02/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PR P R E $ AUTOS ONLY AUTOS ONLY Per accido Experience Mod Factor 2 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 6,000,000 B A EXCESS LAB 11 CLAIMS-MADE CUP41<264429 01/01/2019 01/01/2020 AGGREGATE S 6.000,000 DIED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITY STATUTE X ER YIN 1,000,000 C ANY PROPRIEB R EXCLUDED? EXECUTIVE ❑ NIA WCV6179537 01I01/2019 01I01/2020 EL EACH ACCIDENT $ OFFICER/ME(Mandatory in NH) EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below [EL DISEASE-POLICY LIMIT $ Excess Policy over GL,AU,WC DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project:Link Facility Orange County is included as Additional Insured with regards to General Liability and Auto Liability policy 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 ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street AUTHORIZED REPRESENTATIVE /1 ) Hillsborough NC 27278 ©1988-2016 ACORD CORPORATION, All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD