2011-039 AMS - H. M. Kern Corp for Health Department Renovations at Whitted Building $763,800

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OP ID PF ~CORl7~ .CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDfYYYY) KERNHMl 02/02/11 ~ ~ HIS ERTIFICATE IS SSUED AS A ATTER OF INFORMATIO PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HOLDER SIA Group . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 827 Gum Branch Rd. Jacksonville NC 28540-0000 Phone: 910-455-7576 Fax: 910-455-7481 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Uriicri InS. CO./BEK 25844 wsuRER B: The Hanover Ins . Grou 22292 tion C R INSURER C: Builders Mutual Ins Co orrppora ern H.M. P . O . BOX 19 42~i INSURER D: Greensboro NC 27419-9424 I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN , POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER ICY C IV DATE MM/DD/YYYY Y %PI N DATE MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 , 000 , OOO A X COMMERCIAL GENERALUABILITY CPA42033384 07/01/10 07/01/11 PREMISES (Eaoccurence) S 100,000 CLAIMS MADE ~ OCCUR MED IXP (Any one percon) S 10 , 0 0 O PERSONAL 8 ADV INJURY S 1 , 000 , 000 GENERAL AGGREGATE S2,000,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG S 2 , O O O , OOO POLICY JPERCT LOC Ben. 1,000,000 AUT OMOBILE LWBILITY COMBINED SINGLE LIMB s 1 000,000 A X ANY AUTO CPA42033384 07/01/10 07/0.1/11 (Ea accident) , ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per garcon) HIRED AUTOS BODILYINJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ~ AUTO ONLY - EA ACCIDENT 8 ANY AUTO OTHER THAN EA ACC S AUTOONLY: AGG 5 EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ 5 , O O O , O OO A OCCUR ~CLAIMSMADE CPA42033384 07/01/10 07/01/11 AGGREGATE s5,000,000 S DEDUCTIBLE ~ $ X RETENTION S l O, 0 0 0 $ WORKER S COMPENSATION ' ILITY X TORY LIMBS ER C AND EMPLOYERS LUlB ECUTIVE~ R ~ PWCOOOOOI3 07/01/10 07/01/11 E.LEACHACCIDENT $ 500000 EXCLUDEDT ICER/MEMBE O (Mandatory in NH) E.LDISEASE-EAEMPLOYE 5500000 ff yes, describe under SPECIAL PROVISIONS b ow E.L DISEASE -POLICY LIMIT S 5O OOO O OTHER B Leased/Rented Eq RHR562812601 07/01/10 07/01/11 L/R Eq 150,000 B Builders Risk RHR562812601 07/01/10 07/01/11 B/Risk 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: Orange County Health Department Renovations, 300 West Tryon St, Hillsborough NC. Orange County Government is included as additional insured with respect to general liability and auto liability; waiver of subrogation applies with respect to general liability, auto liability and employers liability. Excess liability is follow form. See attached for cancellation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ORANGO 9 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LUIBILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Orange County Government 200 3 Cameron Street REPRESENTATrves. ///yam f Hillsborough NC 27278 AUTHORIZE~~ NTA~;WEW,tiV/ ACRD 25 (2009/011 ©1988-2W009,'A~;C~ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD