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DocuSign Envelope ID:86AA2D69-2618-49CA-ABD9-3717E162CF6E <br /> DATE LMMIDDIYYYY} <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> ��. 01/06/2020 <br /> THIS CERTIFICATE 15 ISSUED AS A NIATTER OF INFORNIA71ON ONLY AND CONFERS NO RIGHTS UPON THE CERTEFICATE 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 CONTANAME' Carla Moore <br /> Colonial Insurance Agency Hillsborough A"oNNo,EEW (919)732 2191 FAX No: (919)732 2192 <br /> 103 Millstone Dr.Suite A EMAIL ADDRESS, colonial-a enc <br /> ADDRESS: .com C� � Y <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 /> 320 Executive Court INSURER D <br /> INSURER E: <br /> Hillsborough NC 27278 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 /> ILTR NSR ACOLSUBR POLICY TYPE OF INSURANCE POLICY NUMBER MWDDIYEYYY1 iMPkDDffYYYI LIMITS <br /> COMMERCIAL GENE PALLIABILJTY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISESUERa occurrence $ <br /> MED EXP(Any orre person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ <br /> JECT <br /> PO-ICY1:1 PRO LOC PRODUCTS GOMP+OP AGG $ <br /> OTHFR $ <br /> AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ <br /> Ea accident <br /> ANYAUTO BODILYINJURY(Per person) $ <br /> OWNED SCHEDULED L3oDILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED ROPERTY D AGE $ <br /> AUTOS ONLY AUTOS ONLY PeracU $ <br /> c!deni <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DIED I RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY Y r N STATUTE I I ERH <br /> ANY PROPRIETOR:PARTNER+EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFPICER:MEMSER EXCLUDED? MIA <br /> (Mandatoryin NH) E.L.DISEASE-EA EMPLOYE $ <br /> Iryes,describe under <br /> DESCRIPTION OF OPERATIONS below E., 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 0410M020 Aggregate 5,000,D00 <br /> ❑ESCR1P710N OF OPERATIONS+LOCATIONS I VEHICLES (ACCRQ 101.Addlt[on aI Remarks Schedule,may be attached if more space is required) <br /> Project: Capital Projects <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 /> _Py <br /> Hillsborough NC 27278 <br /> Fax: F-mallabarnes@orangecountync.gov ©1988-2015 ACORD CORPORATION. Al rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACOR❑ <br />