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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 />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 />$
<br />CERTIFICATE HOLDER
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)
<br />AUTHORIZED REPRESENTATIVE
<br />CANCELLATION
<br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
<br />OTHER:
<br />LOCJECT
<br />PRO-POLICY
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />OCCURCLAIMS-MADE
<br />COMMERCIAL GENERAL LIABILITY
<br />PREMISES (Ea occurrence)$
<br />DAMAGE TO RENTED
<br />EACH OCCURRENCE $
<br />MED EXP (Any one person)$
<br />PERSONAL & ADV INJURY $
<br />GENERAL AGGREGATE $
<br />PRODUCTS - COMP/OP AGG $
<br />$RETENTIONDED
<br />CLAIMS-MADE
<br />OCCUR
<br />AGGREGATE $
<br />EACH OCCURRENCE $UMBRELLA LIAB
<br />EXCESS LIAB
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />INSR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)LIMITS
<br />PER
<br />STATUTE
<br />OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />$
<br />$
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />(Mandatory in NH)
<br />OFFICER/MEMBER EXCLUDED?
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />HIRED NON-OWNED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY AUTOS ONLY
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE $
<br />$
<br />$
<br />$
<br />$
<br />INSD
<br />ADDL
<br />WVD
<br />SUBR
<br />N / A
<br />$
<br />(Ea accident)
<br />(Per accident)
<br />The ACORD name and logo are registered marks of ACORD
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
<br />INSURED
<br />PHONE
<br />(A/C, No, Ext):
<br />PRODUCER
<br />ADDRESS:
<br />E-MAIL
<br />FAX
<br />(A/C, No):
<br />CONTACT
<br />NAME:
<br />NAIC #
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />INSURER(S) AFFORDING COVERAGE
<br />$
<br />$
<br />$
<br />$
<br />$
<br />KBZWMEWM
<br />10/01/2022
<br />Orange County
<br />P.O. Box 8181
<br />Hillsborough, NC 27278
<br />6,000,000
<br />1,000,000
<br />800-476-2211
<br />Arch Insurance Company
<br />B
<br />6,000,000
<br />5,000,000
<br />10690
<br />10/01/202210/01/2021
<br />10/01/202210/01/2021
<br />1,000,000
<br />100,000
<br />12,000,000
<br />11150
<br />A
<br />mhawkins@mcgriff.com
<br />Allied World National Assurance Company
<br />ZAGLB9247600
<br />03125099
<br />Martha Lee Hawkins
<br />A
<br />A
<br />12,000,000
<br />5,000,000
<br />McGriff Insurance Services, Inc.
<br />P.O. Box 10265
<br />Birmingham, AL 35202
<br />10,000
<br />FSC II, LLC
<br />701 Corporate Center Drive. Suite 101
<br />Raleigh, NC 27607
<br />01/06/2022
<br />10/01/2021
<br />ZAWCI9966600
<br />10/01/2021
<br />Herbicide/Pesticide Applicator Endt
<br />1,000,000
<br />10/01/2022
<br />10,000
<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 />6,000,000
<br />ZACAT9276800
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />X
<br />Page 1 of 1
<br />DocuSign Envelope ID: 728B9CE0-812A-45E1-9198-7EEBE2CA7EF6
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