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~~ CERTIFICATE OF LIABILITY INSURANCE OP ID wr, DATE (MM/DD/YYYY) <br />MCQUE-1 11 03 09 <br />PRODUCER 1 ERTI AT LIED A R N R TI <br />Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Senn Dunn - Raleigh <br />St 650 <br />4505 Falls of Neuse Rd ONL <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />, <br />Raleigh NC 27609-2521 <br />Phone: 919-719-9570 Fax: 919-719-9571 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED INSURER A: Selective Eae Co of S Carolina 19259 <br /> INSURER e: Stonewood Insurance Co. 11828 <br />McQueen Construction Inc, Co. <br />een <br />M <br />H <br />INSURER C: <br />arvey <br />cqu <br />619 Patrick Road INSURER D: <br />Bahama NC 27503 <br /> INSURER E: <br />C`f)VFRAC~F_S <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 W ITH RESPECT TO W RICH 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 />LTR NSR TYPE OF INSURANCE POLICY NUMBER DA ECMM/DFl) C~ DATE MMlOD~ LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 <br />A X X COMMERCIAL GENERAL LIABILITY $17$5111 01/24/09 01/24/10 PREMISES (Eaoccurence) $ 100,000 <br /> CLAIMS MADE ~ OCCUR ~ MED EXP (Any one person) $ 10 , 0 0 0 <br /> PERSONAL&ADViNJURY $ 1, 000, 000 <br /> X Per Prj/Loc agg GENERAL AGGREGATE $ 3, 000, 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 3 , O O O , O O O <br /> POLICY jE a LOC <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />000 <br />000 <br />$ 1 <br />A X ANY AUTO S1785111 01/24/09 01/24/10 (Ea accident) , <br />, <br /> ALL OW NED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br />A X HIRED AUTOS 51785111 01/24/09 01/24/10 gODILYINJURY $ <br />A X NON-OWNED AUTOS 51785111 01/24/09 01/24/10 (per accident) <br />A X $250DED COMP 51785111 01/24/09 01/24/10 pROPERTYDAMAGE <br />$ <br />A X $500DED LOLL S1785111 01/24/09 01/24/10 (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS /UMBRELLA LU\BILITY EACH OCCURRENCE $ 5, 0 0 0, 0 0 0 <br />A OCCUR ~ CLAIMSMADE 517$5111 01/24/09 01/24/10 AGGREGATE $ 5, 000, 000 <br /> <br /> DEDUCTIBLE $ <br /> X RETENTION $ 1 0 0 0 O $ <br /> WORKERS COMPENSATION <br />' X TORY LIMITS ER <br /> <br />$ LIABILITY <br />AND EMPLOYERS <br />ANY PROPRIETOR/PARTNERIEXECUTIVE~ <br />WC10000053732009A <br />01/24/09 <br />01/24/10 <br />E.L. EACH ACCIDENT <br />$ 1, 000, 000 <br /> OFFICER/MEMBER EXCLUDED9 ~.j <br />(Mandatory in NH) <br />E.L. DISEASE-EA EMPLOYE <br />$1,000,000 <br /> If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE-POLICYLIMR <br />$1,000,000 <br /> <br />A <br />A OTHER <br />InlandMarine-Equip <br />Builder's Risk <br />51785111 <br />33972100 LIMIT: $809,000 <br />01/24/09 <br />09/01/09 <br />01/24/10 <br />09/01/10 <br />Per Item $75,000 <br />Ded $500 <br />DESCRIPTION OF OPERATIONS /LOCATIONS (VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Orange County is additional insured in the general liability policy when <br />required by contract with respects the this project only: Project #0716, <br />Fairview Community Park, 195 Torairi Street, Hillsborough, NC <br />(_FRTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />O~NG+_ 8 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> ATIVES. <br />REPRESE <br />N <br />T <br />Orange COUnty ~ <br />129 8. King Street `J~ 1~ <br />a <br />~ <br />_ !_ ~ _~ <br />, <br />illsborou h NC 27278 V <br />~ <br />y <br />I <br />(,Jl:~t '¢•~ <br />ACORD 25 (2009/01) <br />The ACORD name and logo are registered marks of ACORD <br />_ .___ ____ -___.__ __.~PORATION. All rights reserved. <br />