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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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />12/15/2021
<br />Scott Insurance -Richmond
<br />3900 Westerre Parkway,Suite 200
<br />Richmond VA 23233
<br />Cherice Tracy
<br />804-545-2234 434-455-8524
<br />ctracy@scottins.com
<br />Valley Forge Insurance Company (A)20508
<br />SCHNA-1 Continental Insurance Company (A)35289SchnabelEngineering,LLC
<br />Schnabel Engineering South,PC
<br />11 Oak Branch Dr
<br />Greensboro NC 27407
<br />National Fire Insurance Company of Hartford (A)20478
<br />Continental Casualty Company (A)20443
<br />710223459
<br />A X 1,000,000
<br />X 100,000
<br />X Contractual Liab 15,000
<br />1,000,000
<br />2,000,000
<br />X X
<br />6018601512 7/1/2021 7/1/2022
<br />2,000,000
<br />A 1,000,000
<br />X
<br />X X
<br />6018601526 7/1/2021 7/1/2022
<br />B X X $10,000,00060186015577/1/2021 7/1/2022
<br />10,000,000
<br />X 10,000
<br />C X
<br />N
<br />6018601543 7/1/2021 7/1/2022
<br />500,000
<br />500,000
<br />500,000
<br />A
<br />D
<br />Equipment Floater
<br />Professional Liability
<br />$200,000 retention
<br />6018601512
<br />AEH591906042
<br />7/1/2021
<br />1/1/2022
<br />7/1/2022
<br />1/1/2023
<br />Rented Equip/deductib
<br />Per claim
<br />Annual Aggregate
<br />$225,000/1,000
<br />1,000,000
<br />1,000,000
<br />Umbrella Policy applies over General Liability,Auto Liability and Employers Liability.General Liability does not exclude xcu coverages.
<br />Workers Compensation applies in VA,GA,NC,MD,SC,PA,MD,NJ,NV,TX,NY,TN,KY,WV,CO,ID and DC;and all other states except ND,OH,WA and
<br />WY.Workers Compensation Policy includes USL&H coverage.Coverages provided by Owner or Contractor Controlled Programs are excluded from policies
<br />referenced herein.
<br />IF REQUIRED BY WRITTEN CONTRACT,the following provisions apply to General Liability,Auto Liability,Workers Compensation and Umbrella Liability:
<br />Additional Insureds on a primary,noncontributory basis for General Liability,for ongoing &completed operations for work performed by the Named Insured;&
<br />for Auto Liability &Umbrella Liability
<br />See Attached...
<br />Orange County
<br />P O Box 8181
<br />Hillsborough NC 27278
<br />DocuSign Envelope ID: 3667B243-40E4-479A-AE63-F797402CD54A
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