2020-004-E Planning - In Water Services LakeOrange intake tower service

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DocuSign Envelope ID:884B2CFE-2DE5-44E8-9F7A-8208DA7367FC 0 DATE(MMIDDIYYYYJ ACORN CERTIFICATE C E OF LIABILITY INSURANCE 12I1012019 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 polley(les)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 ondorsement(s). PRODUCER CANE,CONTACT Steve Macquarrie International Special Risks AIONo I xt: 781-406-6097 jvc,No- (781)246-7830 50 Salem Street ADDRESS: Steve@isr-insurance-oom Building 8,3rd Floor INSURER(5)AFFORDING COVERAGE NAIL p Lynnfield MA 01940 IN5URERA: Great American Insurance Co. INSURED INSURER B: In-Water Services Co.,Inc. INSURERC: In-Water Properties LLC INSURER D: 3683 Southeast School Road INSURER E: Greensboro NC 27406 INSURER F COVERAGES CERTIFICATE NUMBER: CL1912207445 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. ILTR TYSR PE OF INSURANCE INSD yyyp POLICY NUMaER MMIDD EF MMIDDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 A Y OMH 1391-68-96 07 01/15/2019 01/16/2020 PERSONAL&AOV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per acddenl) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccidenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN SPTER ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ , it yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Protection&Indemnity A OMH 891-58-98 07 01/15I2019 01I15I2020 P&I Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IF more apace is required) 30 day notice of cancellation except 10 days for nonpayment of premium. Certificate Holder is an Additional insured as respects GL coverage as their interests may appear subject to the terms,conditions,exclusions and endorsements set forth in the policy and as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Planning and Inspections Department ACCORDANCE WITH THE POLICY PROVISIONS. 131 W.Margaret Lane AUTHORIZED REPRESENTATIVE P.O.Box 8181 Hillsborough NC 27278 Y� u ,hnAR ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD