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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 />3/14/2023
<br />Sutter,McLellan &Gilbreath,Inc
<br />33 Buford Village Way Suite 329
<br />Buford GA 30518
<br />Charlotte Boren
<br />770-246-8300 678-802-3971
<br />cboren@smginsurance.com
<br />Travelers Indemnity Co.25658
<br />NETPSYS-01 Charter Oak Fire Ins.Co.25615NetPlannerSystems,Inc.
<br />3145 Northwoods Parkway
<br />Suite 800
<br />Peachtree Corners GA 30071
<br />Travelers Prop Cas Co of Ameri 25674
<br />Farmington Casualty Co 41483
<br />St.Paul Surplus Lines Ins.Co
<br />Travelers Cas &Surety Co America 31194
<br />2072883779
<br />A X 1,000,000
<br />X 300,000
<br />10,000
<br />1,000,000
<br />2,000,000
<br />X
<br />Y Y DT-CO-1J389435-IND-22 12/31/2022 12/31/2023
<br />2,000,000
<br />B 1,000,000
<br />X
<br />X X
<br />Y Y 810-1L511122-22-26-G 12/31/2022 12/31/2023
<br />C X X 10,000,000YCUP-1J452674-22-26 12/31/2022Y 12/31/2023
<br />10,000,000
<br />X 10,000
<br />D X
<br />N
<br />Y UB-8J495959-22-26-G 12/31/2022 12/31/2023
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />B
<br />E
<br />F
<br />Leased/Rented Equipment
<br />Professional Liability
<br />Crime -Incld 3rd Party
<br />630-5H613887-TIL22
<br />ZCO-41N4389A
<br />105695297
<br />12/31/2022
<br />12/31/2022
<br />10/13/2022
<br />12/31/2023
<br />12/31/2023
<br />10/13/2023
<br />Deductible:$2,500
<br />$10M Ea Act E&O /Agg
<br />Deductible:$$25,000
<br />150,000
<br />10,000,000
<br />2,000,000
<br />Fiber Install Project Plan Timeline
<br />To obtain copies of endorsements -please click the following link:
<br />https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:ed0a21f0-61ee-32c3-9fe4-93d0e3a8b372
<br />IL T8 01 10 93 -General Liability Forms /Endorsement Schedule
<br />CGT1 00 0219 -Commercial General Liability Coverage form (Included AI P&NC Coverage)
<br />CG D6 04 02 19 -Blanket Additional Insured -Automatic Status If Required BY Written Contract (Contractors)
<br />See Attached...
<br />Orange County Informatoin Technologies
<br />131 West Margaret Lane #300
<br />Hillsborough NC 27278
<br />DocuSign Envelope ID: D84862E2-2392-4DF6-A303-B7799FD027EB
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