2020-193-E AMS - Summit Parking deck design

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DocuSign Envelope ID: 13777B3D-1 1 F6-48F1-9874-3B94A8B3081 0 ACC-" CERTIFICATE OF LIABILITY INSURANCE 7DATE(MMIDDrrYY1r1 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 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 endorsement(s). PRODUCER CONTACT Crystal Perry NAME: Business insurers of Carolinas AIC No Ext- (919)968-4511 Alc.No: (919)968-8991 501 Eastowne Drive,Suite 250 E-MAILcperry@business-insurers.com ADDRESS: PO Box 2536 1NSURER(S)AF FORM NG COVERAGE NAIC# Chapel Hill NC 27515 INSURERA: Travelers Indeminity 25658 INSURED INSURER B: Travelers Property Cas CO ofAmerica 36161 Summit Design and Engineering Services PLLC INSURER C: Accident Fund Insurance Co of America 10166 320 Executive Court INSURER D: INSURER E: Hillsborough NC 27278 INSURER F: COVERAGES CERTIFICATE NUMBER: CL19121927785 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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. IN SR ADUL SUIJR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE CLAIMS-MADE x OCCUR PREMISES Ea occurrence 5 100,D00 M E D E X P(Any one person) s 5,000 A Y 6304KO89149 0110112020 01/01/2021 PERSONAL&ADVINJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE 5 2,000.000 POLICY 19 PRO- ❑ 2.000.000 JECT LDC PRO DUCT S-DOMPIOPAGG 5 OTHER: S AUTOMOBILE LIABILITY COMBINED 51NGLE LIMIT s 1.000,000 Ea accident x ANY AUTO BODILY INJURY(Per perwrll s A OWNED SCHEDULED Y 810-2J958216 04/0212019 04/02/2020 BODILY 1NJURY(Peraccidenll s AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S X AUTOS ONLY AUTOS ONLY Per accident Experience Mod Factor 2 s X UMBRELLA LTAB x OCCUR EACH OCCURRENCE s 6.000,000 B EXCESS LIAR CLAIMS-MADE CUP4K264429 01101)2020 01/01/2021 AGGREGATE 5 6,OD0.00D OE❑ X RETENTION S 10,0od v 5 WORKERS COMPENSATION S ATUTE /� ORH AND EMPLOYERS'LIABILITY YIN CI ANY PROP RIETORIPARTJERIEXECUTIVE El EACHACCIDENT s 1,000,000 OFFICE RIM E M BER EXCLUDED? NIA WCV6179537 01/01/2020 01101/2021 (Mandatory in NH) El DISEASE-EA EMPLOYEE s 1,000,0DO IT yes,descnbe under 1❑0❑000 DESCRIPTION OF OPERATIONS below El DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS LOCATIONS?VEHICLES IACORO 101,Additional Remarks Schedule,may he attached If more space Is required) Project Link Facility Orange County is included as Additional Insured with regards to General Liability and Auto Liability policy as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD