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DocuSign Envelope ID:098B7080-775F-4220-9432-FB15222455EA
<br /> HAZE&SA-01 KGODWIN
<br /> ,4coR0` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 5/13/2020
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 CONTACT
<br /> NAME:
<br /> Ames&Gough PHONE
<br /> 8300 Greensboro Drive (A/C,No,Ext): (703)827-2277 (A///C,No):(703)827-2279
<br /> Suite 980 ADDRESS:admin@amesgough.com
<br /> McLean,VA 22102
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Hartford Fire Insurance Company A+ XV 19682
<br /> INSURED INSURER B:Hartford Casualty Insurance Company A+ XV 29424
<br /> Hazen and Sawyer INSURER C:Travelers Indemnity Company of Connecticut A++(Superior) 25682
<br /> 498 Seventh Avenue INSURER D:Twin City Fire Insurance Company A+ XV 29459
<br /> New York,NY 10018 INSURER E:Continental Casualty Company CNA)A XV 20443
<br /> 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM DD YYY MM DD YYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 42UUNBH8062 3/29/2020 3/29/202, DAMAGE TO RENTED 1,000,000
<br /> X X PREMISES Ea occurrence $
<br /> X Contractual Liab. MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY ] PRO ❑X LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X 42UENBH7997 3/29/2020 3/29/2021 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PRO
<br /> HIRED $
<br /> AUTOS ONLY AUTOS ONLY
<br /> Comp./Coll. Ded $ 1,000
<br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X ZUP31N1064A20NF 3/29/2020 3/29/2021 AGGREGATE $ 2,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> D WORKERS COMPENSATION X PER OTH-
<br /> ANDEMPLOYERS'LIABILITY STATUTE ER
<br /> 42WBADOSYE 3/29/2020 3/29/2021 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A X E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> E Professional Liab. AEHOO8231489 3/29/2020 3/29/2021 Per Claim/Aggregate 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mores ace is required
<br /> RE:RFQ#5283—ON-CALL PROFESSIONAL ENGINEERING SERVICES RELATED TO THE LAKE ORANGE DAME ERGENCY ACTION PLAN(EAP)
<br /> Orange County,INC is included as additional insured with respect to General Liability,Automobile Liability and Umbrella Liability when required by written
<br /> contract.General Liability,Automobile Liability and Umbrella Liability are primary and non-contributory over any existing insurance and limited to liability
<br /> arising out of the operations of the named insured and when required by written contract.General Liability,Automobile Liability,Umbrella Liability and
<br /> Workers Compensation policies include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by
<br /> written contract.30-day Notice of Cancellation will be issued for the General Liability,Automobile Liability,Umbrella Liability,Workers Compensation and
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 9 y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough,INC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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