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DocuSign Envelope ID:49C3D6C6-17EB-4320-B1 DF-601984A397F2 <br /> DocuSign Envelope ID:49C3D6C6-17EB-4320-B1DF-601984A397F2 <br /> AC ® DATE(MMIDDIYYYY)QRO CERTIFICATE OF LIABILITY INSURANCE <br /> 05/17/2019 <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_ Carla Moore <br /> Colonial Insurance Agency Hillsborough PHONE h1afal. (919)732-2191 Ic Mo: (919)732-2192 <br /> 103 Millstone Dr. Suite A ADD ILSS• Carla@colonial-agency.com <br /> Po Box 490 INSURERS AFFORDING COVERAGE NAIL# <br /> Hillsborough NC 27278 INSURER : Starr Surplus Lines Ins.Co- 13604 <br /> INSURED INSURER B: <br /> Summit Design And Engineering Services, PLLC INSURER C <br /> 504 Meadowlands Drive INSURER D <br /> INSURER E' <br /> Hillsborough NC 27278 iNsuRER <br /> COVERAGES CERTIFICATE NUMBER: 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 CLAIMSADDLSUBR IN . <br /> LTXP R TYPE OF INSURANCE POLICY NUMBER M�MMD YY MMIDWY POICVYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE F1 OCCUR E6A 1 P EM L I V KLIV I L <br /> ISFS F�occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ <br /> POLICY PRl7 LOC PRODUCTS-COMPIOP AGG $ <br /> IFCT <br /> OTHER. $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIM $ <br /> q%LG_M <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OVITIED PRO RTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Poracp ! <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ <br /> WORKERS COMPENSATION SEA LITE ER <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANY PROPRIETOR/PARTNERiEXECUTIVE E L EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? ❑ NIA <br /> (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS bel w E L DISEASE-POLICY LIMIT $ <br /> Professional, E&O Contractors Occurence 5,000.000 <br /> A Pollution Liability N N SLSL-PRO-262380-19 04/02/2019 04/02/2020 Aggregate 5.000.000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is requiredl <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 W Margaret Lane <br /> AUTHORIZED REPRESENTATIVE <br /> I Hillsborough NC 27278 r <br /> Fax: Emall:abarnes@orangecountync.gov ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />