2020-153-E DEAPR - Susan Hatchell Landscape architecture Blackwood Farm Park contract amendment

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DocuSign Envelope ID:8880C4F3-E132-469D-9F1A-0516B69BADB7 II AC CPRf>e, CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDrYrrvy 0112912020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subjectto the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does riot confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Carolyn Martin NAME: Carter Glass Insurance Agency RICNM1lo Ext: (919)781-1973 AIC Not: (919)781-1974 5901 Falls of Neuse Rd EMAIL cmartin@carterglassinsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 Raleigh NC 27609 INSURERA: Nationwide Mutual Fire Insurance Company 23779N INSURED INSURERB: Hartford Ins.CO.of Midwest 37478 Susan Hatch ell L and scape Architectu re PLLC INSURERC: 711 W North St INSURERD: INSURERE: Raleigh NC 27603-1418 INSURERF: COVERAGES CERTIFICATE NUMBER: 2019-2020 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 MAY BE ISSUED OR MAY PERTAIN,THE I NSURANC E AFFO RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC LUSI ON S AN D CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE 1NSD WVDI POLICYNUMBER MMfDDIYYYY MMMDDIYYYY _ LIMITS X COMMERCIAL OFNERALLIABILITY EACH OCC ORR ENCE S 1,000,000 PA AGET N 300.000 CLAIMS-MADE �OCCUR PREMI E$ Eaaecurrence $ MED FXP(Any oneperson) $ 9,000 A ACPBPOF2222888274 12/02/2019 121D212020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LACGREGATELIMrrAPPLIESPER: GENERALAGGREGATE ; 2,000,000 POLICY❑PRO- ❑LOC PRODUCTS-COMPIOPAGG $ 2.000,000 JECT OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1.000,000 Ea accldenl ANYAUTO BODILY INJURY(Per person) $ A OWAIEO SCHEDULED ACPBPOF•2222888214 12/02/2019 12/02/2020 BODILY INJURY(Per acoldenl) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY Ix AUTOS ONLY Per accident S x UMBRELLA LIAR x OCCUR EACH OCCURRENCE s 1,000,000 A EXCESSLlAa CLAIMS-MADE ACPCAF2222888274 1210212D19 12/02/2020 AGGREGATE s 1,000,000 DEb I XI RETENTION$ D $ WORKERS COMPENSATION X S ATUTE ER H AND EMPLOYERS'LIABILITY YIN 1,000,00D ANY PROPRIETCWPARTNERlEXECUTIVE E.L.EACH ACCIDENT $ B OFFICEWMEMSER EXCLUDED? NIA 22WBCCL3569 121D212019 121D212020 [Mandatory In NHI E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,ODD,OffO DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATION S I VEHICLES[ACORD 101.Add lSlonal Remarks Schedule,may be attached if more space is required] Project:Blackwood Farm Park Certificate Holder is additional insured as pertains to General Liability. Orange County Department of Envlronment,Agriculture,Parks and Recreation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Dept of EnvironmentAg Parks&Rec ACCORDANCE WITH THE POLICY PROVISIONS. do Marabeth Carr OCLA AUTHORIZED REPRESENTATIVE PO Box 8181 y 4 Hillsborough NC 27278 Q 1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD