2020-193-E AMS - Summit Parking deck design

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DocuSign Envelope ID: 13777B3D-11F6-48F1-9874-3B94A8B30810 A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 01/06//2020 Y) 020 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 aCONN. Ext: (919)968-4611 ac,No): (919)968-8991 501 Eastowne Drive,Suite 250 E-MAIL c er business-insurers.com ADDRESS: p ry@ PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515 INSURERA: Travelers Indeminity 25658 INSURED INSURER B: Travelers Property Cas Cc of America 36161 Summit Design and Engineering Services PLLC INSURER C: Accident Fund Insurance Cc 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 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. TR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To_7CLAIMS-MADE � OCCUR PREM SES Ea occurrence)l $ 100,000 MED EXP(Any one person) $ 5,000 A Y 6304KO89149 01/01/2020 01/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY Fx_1 PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y 810-2J958216 04/02/2019 04/02/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED I NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Experience Mod Factor 2 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 B EXCESS LIAB CLAIMS-MADE CUP41<264429 01/01/2020 01/01/2021 AGGREGATE $ 6,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X1 STER ATUTE X ORTH- AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBEREXCLUDED? NIA WCV6179537 01/01/2020 01/01/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Excess/Umbrella over GL,AU,WC DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Capital Projects Certificate holder is included as additional insured in reference to the General Liability&Auto Liability policies per 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 Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. Capital Projects AUTHORIZED REPRESENTATIVE 131 West Margaret Lane Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD