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Otth6er Items
<br /> D.1. / INSURANCE
<br /> Standard Risk Compliance Statement
<br /> Samet hereby confirms that we meet the "Standard Risk Profile" as defined in the Orange County Minimum
<br /> Insurance Coverage Requirements. Our organization operates within the standard risk parameters established
<br /> by Orange County, and we maintain insurance coverage that aligns with these requirements.
<br /> Claims History Disclosure
<br /> Samet Corporation has not had any professional liability claims filed against its professional liability insurance
<br /> in the past 5 years. However, a payment was made under the rectification coverage included in the professional
<br /> liability insurance. Samet Corporation self-reported the claim on June 13, 2022, regarding a metal panel
<br /> installed by a subcontractor that came off of a building during a straight winds storm. The claim was closed on
<br /> May 17, 2023. The professional carrier paid a total of$175,314.09 on the claim.
<br /> CERTIFICATE OF LIABILITY INSURANCE DA4
<br /> s126/2025m)
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATEDOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> Arthur J.Gallagher Risk Management Services,LLC NAME:
<br /> Mail Stop:072102-CHA EMAIL
<br /> PHONE 864-239-2409 ac Ne:704-362-1997
<br /> PO Box 4146 ADDREss: BW2.BSD.Certs a'.com
<br /> Clinton IA 52733-4146 INSURERS AFFORDING COVERAGE NAICD
<br /> INsuRERA:Travelers Pro a Casuatt Co of America 25674
<br /> INSURED SAMECOR-01 INSURER B:PaDifiD n$DranDe COm an,Limited 10046
<br /> Samet Corporation INSURER c:Travelers Indemnil Com an 25658
<br /> 309 Gallimore Dairy Rd,Suite 102
<br /> Greensboro NC 27409 INSURER D:BerkleyRegional Insurance Com an 29580
<br /> INSURER E:Indian Harbor insurance Company 36940
<br /> INSURER F:Travelers Casualty and Surety Comoanv 19038
<br /> COVERAGES CERTIFICATE NUMBER:1848333196 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 =..BR POLICY EFF POLICY EXP LIMITS
<br /> LTR POLICY NUMBER MOND MOND
<br /> C X COMMERCIALGENERALLOBILITY Y Y VTC2K-CO-7W348030-IND-25 10/1/2025 10/1/2026 EACH OCCURRENCE $2,000,000
<br /> E TO
<br /> CLAIMS-MAGE�OCCUR PREM SES Ea oNaugence $1,000,000
<br /> MED EXP(Any ane person) $10,000
<br /> PERSONAL B ADV INJURY $2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000
<br /> POLICY JECT LOC PRODUCTS-COMPIOP AGG $4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILELIABILIT' Y Y VTJ-CAP-7W348029-TIL-25 10/1/2025 10/1/2026 COMBINEDEd�tSINGLE LIMIT $2,000,000
<br /> X ANYAUTO BODILY INJURY(P.,person) $
<br /> OWNED SCHEDULED BODILY INJURY(Pe—ddent) $
<br /> AUTOS ONLY AUTOS
<br /> X HIREDX NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLA UAB N OCCUR Y Y CUP-7W348042-25-25 10/1/2025 10/1/2026 EACH OCCURRENCE $25,000,000
<br /> E X EXCESS LIAB BCS8800458-30 10/1/2025 10/1/2026
<br /> CLAIMSMADE SXS005764205 10/1/2025 10/1/2026 AGGREGATE $25,000,000
<br /> DED 'X RETENTION$ $
<br /> F WORKERS COMPENSATION Y UB-1X658735-25-25-K 10/1/2025 10/1/2026 X
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOWPARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDEO?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$1,000,000
<br /> If yes,Be nbe undo
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Ponution Llablity 30CPIBD5684 10/1/2025 10/1/2026 Professional limit 10,000,000
<br /> Professional Liabd.ry Pollution Limit 10,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACOND 101,AddNicnalRemadl6 Scbedele,may be attached if more space is qd)
<br /> Umbrella/Excess Includes:
<br /> Fair American Select Insurance Company-Policy#CSX-8000609-01-Effective 10/1/25-10/1/26
<br /> Westchester Surplus Lines Insurance Company-Policy#G71744097-007-Effective 10/1/25-10/1/26
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE E%PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Proof of Insurance AUTHORMEDREPRESENTATNE
<br /> q*
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> RFQ 367-005466 /The Renovation& Construction of Sheriff's Office Facilities $
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