2019-672-E AMS - Fossil Group underground lines locate

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DocuSign Envelope ID:48BFED11-FCD9-49D7-81AD-DC7FF583EBC2 -DA A Rn� CERTIFICATE OF LIABILITY INSURANCE 0TE(MMIDDIYYYY) 03/17/2019 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 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: David Malachi NE BB&T Insurance Services INC/PHS A/C N Ext: (336)972-4879 A/C No):(866)467-8700 414 Gallimore Dairy Rd Ste F ADDRESS: dmalachi@bbt.com Greensboro, NC 27409 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: The Sentinel Insurance Company 238210 INSURED INSURER B: The Hartford 3161 Fossil Utility Group LLC INSURERC: 1589 Skeet Club Rd Ste 102-248 INSURER D 7 High Point, NC 27265 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREM IS (Ea o RENT currDence) $ 500,000 MED EXP(Any one person) $ 10,000 A x 22 WBC AAOZW4 03/17/2019 03/17/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XPOLICY❑ PRO- POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ MBINED SINGLE LIMIT AUTOMOBILE LIABILITY CO $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑ N/A WCG7641 F 06/26/2019 06/26/2020 (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Government,its directors,officers,employees and/or agents are included as Additional Insureds with regards to insureds General Liability policy as required by written contract. A waiver of Subrogation applies in favor of Orange County Government,its directors,officers,employees,and/or agents with regards to insureds listed policy(s). CERTIFICATE HOLDER CANCELLATION Orange County Government 131 W Margaret Lane Ste 300 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hillsborough,NC 27278 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD