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Client: 126284 <br />RESOBUI <br />ACORD <br />CERTIFICATE OF LIABILITY INSURANCE °"Y""' <br />,~ 08;;$,08 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Wachovia Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />PO Box 97787 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Raleigh, NC 27624-7787 <br />P:919-676-8834 F:919-676-3307 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Amerisure Companies 19488 <br />Resolute Building Company INSURER B: Amerisure Mutual Insurance Company <br />PO Box 3656 INSURER c: Amerisure Insurance Company <br />Chapel Hilt, NC 27515 <br /> INSURER D: <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN <br />LTR DD' <br />NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE <br />DAT M DD POLICY EXPIRATION <br />DATE <br />LIMITS <br />A GENERAL LIABILITY CPP2013875050007 10/01/07 10/01/08 EACH OCCURRENCE $1 QQQ QQQ <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300 000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $1 Q QOQ <br /> PERSONAL 8 ADV INJURY $1 000 000 <br /> GENERAL AGGREGATE $2 000 000 <br /> X GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2 Q00 000 <br /> POLICY X j CT LOC <br />C AUTOMOBILE LIABILITY CA2013873050007 10/01/07 10/01/08 <br /> <br />X ANY AUTO COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1,000,000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br />~ <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS (Per accident) <br /> X $250 Comp Ded <br /> <br />X <br />$500 Coll Ded PROPERTY DAMAGE <br />(Peracddant) <br />$ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC <br />OTHER THAN $ <br /> AUTO ONLY: AGG $ <br />B EXCESSNMBRELLALIABILITY CU2013877 10/01/07 10/01/08 EACH OCCURRENCE $1Q Q00 QQQ <br /> X OCCUR ~ CLAIMS MADE AGGREGATE $10 000 OOQ <br /> <br /> DEDUCTIBLE <br /> X RETENTION $ A $ <br />B WORKERS COMPENSATION AND <br />' WC201388105 10/01/07 10/01/08 X WC STATU- OTH- <br /> EMPLOYERS <br />LIABILITY <br />ANY PROPRIETOR/PARTNERlEXECUTIVE <br />E.L. EACH ACCIDENT <br />$100000 <br />N OFFlCER/MEMBER EXCLUDED? <br />K E.L. DISEASE - EA EMPLOYEE $100 000 <br /> yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$500 000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Re: Orange County Library 137 Margaret Lane, Hillsborough, NC. <br />Telesis Constructiong Management, LLC, Brockweil and Associates, EDi, Inc. Gardner 8r <br />McDaniel, PA and Summit Consulting are named as additional insureds with respect to <br />General Liability, Automobile Liability, and Umbrella Liability for ongoing and completed <br />(See Attached Descriptions) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Telesis Construction Management, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~._ DAYS WRITTEN <br />LLC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />1000 Corporate Drive, Suite 109 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Hillsborough, NC 27278 REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />A~,UKU L~ ILUU1/U2f) 1 of 3 #S1388916/M1263070 LHA02 ©ACORD CORPORATION 1988 <br />