2021-077-E AMS - Strickland Waterproofing contract amendment

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DocuSign Envelope ID:B88A1D41-36OD-4202-B502-E623035F9170 STRIWAT-01 JCLARK ,4coRO CERTIFICATE OF LIABILITY INSURANCE DATE,(MM/DD/YYYY) 8/25/2020 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 NAME: Lowry Insurance PHONE FAX PO Box 30517 (A/C,No,Ext): (704)332-8871 (A/C,No): Charlotte,NC 28230 ADDRESS:Cert@lowryassoc.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Liberty Surplus Insurance Corporation INSURED INSURER B:Builders Premier Insurance Strickland Waterproofing Co. INSURER C:United Specialty Insurance Co. 500 North Hoskins Road INSURER D:Builders Mutual Ins Co 10844 Charlotte, NC 28216 INSURER E:Hartford Fire Insurance Co. 19682 INSURER F COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD YW MM DD YW A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 100026399204 7/1/2020 7/1/2021 DAMAGE TO RENTED 50,000 LAA1X PREMISES Ea occurrence $ X XCU, Contractual MED EXP(Any one e' son) $ 0 X Indp.Contractor PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO PCA0027656 7/1/2020 7/1/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED L NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X omp/Coll Ded. 1000 $ C+ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE BTN2016553 7/1/2020 7/1/2021 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WCP1072764 7/1/2020 7/1/2021 1,000,000 ANY PROP RI ETOR/PARTN OFFICER/MEMBER EXCLUDED?ER/EXECUTIVE N/A E.L.EACH ACCIDENT $ (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 $ E Leased/Rented 22MSNN9154 10/1/2019 10/1/2020 Limit 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:ORANGE COUNTY SHERIFF'S OFFICE WATERPROOFING PROJECT.Orange County is hereby an Additional Insured with regards to the General Liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,INC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) @11 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD