2020-213-E Planning - In Water Services gate stem

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DocuSign Envelope ID:2E2387F3-3A58-44C5-A8FF-30C659A8AB71 DATE(MMIDDIYYYY) AC"REP CERTIFICATE OF LIABILITY INSURANCE o3r1712o2a 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 pollcy(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 endorsement(s). PRODUCER CONTACT Steve Macquarrie International Special Risks PHONE(AIG,NoExt: (781)295-0270 � No): (781)246-7830 50 Salem Street E'MA L Steve@ISr-insurarlce.com ADDRESS: Building B,3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Lynnfeld MA 01940 INSURER A: Great American Insurance Co. INSURED INSURER B: In-Water Services Co.,Inc. INSURER C: 3683 Southeast Schooi Road INSURER D: INSURER E: Greensboro NC 27406 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2012008107 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. EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDAIM LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTETY CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 50,OOa MED EXP(Any one person) $ 5,000 A Y OMH 891-58-96 08 01115/2020 01/15/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X I LOG PRODUCTS POLICY ❑IR $ 1,0aa,a00 OTHER: AUTOMQBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION 5 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'L€ABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDEO? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descr€be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Protection&Indemnity A OMH 891-58-96-07 01/1512020 0111512021 P&I Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 30 day notice of cancellation except 10 days for non payment 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 BE 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD