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DocuSign Envelope ID:7C6D8FA9-77D8-4065-9CD5-3E2679971A07 ATLAS-2 OP ID: KB
<br /> ,4Ca�o CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
<br /> �� 12/04/2019
<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 919-556-3698 CONTACT Karen Brewer
<br /> Hartsfield&Nash Agency,Inc. NAME.
<br /> Post Office Box 110 PHONE
<br /> No,Ext):919-556-3698 (AIC No):AX 919-556-8758
<br /> Wake Forest,NC 27588 E-MAIL karen@hartsfield-nash.com
<br /> Don Stroud,CIC,AAI ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Erie Insurance Exchange 26271
<br /> INSURED INSURER B:Accident Fund Insurance Co 10166
<br /> Atlas Engineering Inc. Erie Insurance Companies 26263
<br /> 551-A Pylon Drive INSURER C: p
<br /> Raleigh, NC 27606-1487
<br /> INSURER D:Cincinnati Speciality 13037
<br /> INSURER E:
<br /> INSURER F:
<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 CLAIMS.
<br /> INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> ILTRD WVD M/DD/YYYY MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE FIV X OCCUR Q421990199 06/19/2019 06/19/2020 DAMAGE TO RENTED 1,000,000
<br /> Y PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO Q071730479 07/17/2019 07/17/2020 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED Per OPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000
<br /> _4 EXCESS LIAB CLAIMS-MADE Q301970113 06/19/2019 06/19/2020 AGGREGATE $ 6,000,000
<br /> DED X RETENTION$ 0
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> WCV6074908 07/17/2019 07/17/2020 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> D Drone Liability CSU0110755 02/20/2019 02/20/2020 Per claim 1,000,000
<br /> deductibl 1,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> "Roofing Design for Orange County Motor Pool &Sportsplex Main
<br /> Building'
<br /> Orange County is an additional insured per form CG2010 with respects to
<br /> general liability.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORAN200
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> 200 South Cameron Street
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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