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ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />INSR ADDL SUBR <br />LTR INSD WVD <br />PRODUCER CONTACT <br />NAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ <br />PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person) $ <br />OWNED SCHEDULED <br />BODILY INJURY (Per accident) $AUTOS ONLY AUTOS <br />HIRED NON-OWNED <br />PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY <br />(Per accident) <br />$ <br />OCCUR EACH OCCURRENCE <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $ <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />COMMERCIAL GENERAL LIABILITY <br />Y / N <br />N / A <br />(Mandatory in NH) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <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 />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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />$ <br />$ <br />$ <br />$ <br />$ <br />The ACORD name and logo are registered marks of ACORD <br />9/7/2021 <br />(704) 332-8871 <br />10725 <br />Strickland Waterproofing Co. <br />500 North Hoskins Road <br />Charlotte, NC 28216 <br />13868 <br />12537 <br />10844 <br />19682 <br />A 1,000,000 <br />X 100026399205 7/1/2021 7/1/2022 <br />50,000 <br />XCU, Contractual 0 <br />Indp. Contractor 1,000,000 <br />2,000,000 <br />2,000,000 <br />1,000,000B <br />PCA0027656 7/1/2021 7/1/2022 <br />Comp. Ded. $1000 Collision Ded. $1000 <br />5,000,000C <br />BTN2127656 7/1/2021 7/1/2022 5,000,000 <br />0 <br />D <br />WCP1072764 7/1/2021 7/1/2022 1,000,000 <br />N 1,000,000 <br />1,000,000 <br />E Leased/Rented 22MSNN9154 10/1/2021 Limit 250,000 <br />Orange County is hereby an Additional Insured with regards to the General Liability per written contract. <br />Orange County Asset Management Services <br />300 West Tryon Street <br />Bldg B 3rd Floor Office 10 <br />Hillsborough, NC 27278 <br />STRIWAT-01 JCLARK <br />Lowry Insurance <br />PO Box 30517 <br />Charlotte, NC 28230 Info@lowryassoc.com <br />Liberty Surplus Insurance Corporation <br />Builders Premier Insurance <br />United Specialty Insurance Co. <br />Builders Mutual Ins Co <br />Hartford Fire Insurance Co. <br />X <br />10/1/2022 <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />DocuSign Envelope ID: EB46448D-9558-4CD0-81EA-DA7DDEFB9C51