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DocuSign Envelope ID:98CAB32E-1814-4C97-B61 E-1314BE79B81 EA <br /> AC�0 DATE(MM/DD/YYYY) <br /> �. CERTIFICATE OF LIABILITY INSURANCE 01/06/2022 <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 Martha Lee Hawkins <br /> NAME. <br /> McGriff Insurance Services,Inc. FAX <br /> P.O.Box 10265 (A C NNo Ext): 800-476-2211 A/C,No): <br /> Birmingham,AL 35202 E-MAIL mawns me <br /> ADDRESS: hki riff.com @ 9 <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Arch Insurance Company 11150 <br /> INSURED INSURER B:Allied World National Assurance Company 10690 <br /> FSC II,LLC <br /> 701 Corporate Center Drive.Suite 101 INSURER C: <br /> Raleigh,NC 27607 <br /> INSURER D <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:KBZWMEWM 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 EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY ZAGLB9247600 10/01/2021 10/01/2022 EACH OCCURRENCE $ 6,000,000 <br /> � OCCUR DAMAGETORENTED <br /> CLAIMS-MADE <br /> PREMISES Ea occurrence $ 100,000 <br /> MED EXP(Any one person) $ 10,000 <br /> X Herbicide/Pesticide Applicator Endt PERSONAL&ADV INJURY $ 6,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 12,000,000 <br /> POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 12,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY ZACAT9276800 10/01/2021 10/01/2022 COMBINED SINGLE LIMIT 6,000,000 <br /> Ea accident $ <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> B UMBRELLA LIAB X OCCUR 03125099 10/01/2021 10/01/2022 EACH OCCURRENCE $ 5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED I X I RETENTION$10,000 $ <br /> A WORKERS COMPENSATION ZAWC19966600 10/01/2021 10/01/2022 X I PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <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 /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> RE:Construction of the Lake Orange Erosion Control Barrier Replacement Project <br /> The Contractor shall name the Owner,the Designer,the Designer's consultants,and the Construction Manager are included as Additional Insured under General Liability, <br /> Automobile Liability and Excess Liability as required by written contract.A Waiver of Subrogation applies in favor of Owner with respect to Workers'Compensation <br /> coverage as required by written contract. <br /> CERTIFICATE HOLDER CANCELLATION <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 /> Orange County AUTHORIZED REPRESENTATIVE <br /> P.O.Box 8181 / <br /> Hillsborough,NC 27278 <br /> Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />