Orange County NC Website
Browse       Search
47. <br />,~co~rA-~ ~Ef~~'~-FIC~;T~ :t7F ~:~I~,;B°lt;t"T~' lt~~t~R~tNC~ <br />L <br />' DATEIMMfiO/YYYY) <br />am 2/ls/2011 <br />Tti1S :CERTIFICATE IS ISSUED-AS A RLtriTTER"OF INFORMA'TiOt~{ "ONLY AIJl7 :COtJF~fi.S .NO RfGHTS" UPON 7HE CERTIFICATE i90LDER. THfS <br />CERTIFICATE DOES NC!T AFFIRMATIVELY QR IJEGATtVECY AMEWp; EXTEAtR OR ALTER THE COVERAGE"AFFORDED BY THE POLiCfES <br />'BELOW. THfS. CERTIFICATE OF IN~UI2dNCE DUES NOT CONSTITUTE A CONTRAiC't' f3ETYJEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR F+RODUCER, AND THE CERTIFICATE HOLDER. <br />fMPORTA(JT: if the certificate holder (s an RDDfTfONAI INSURED, the policy(tes) mast ke.endorsed. 1(SUBROGATION tS WAIVED, subject to <br />the terms and conditions 'of th¢ policy, certain policies may require an endorsement A sfatemerst on this certifcate does not confer rights to Ehe <br />certificate holder iri lieu of such endorsement(s). <br />PRODUCER "O~cTJUlie Sizeunoie _ <br />_ _ <br />._ <br /> <br />Pelnik Insurance & E'inancial. ServiCE?9 _ <br />_ <br />=~ <br />PHPNE (919) 459-8000 F'~ N , (819)A59-8019. <br />idd 12idgeview Drive ~p~s; jnlie.sizemore{pelnik,com <br />.. <br />.____-..- <br />.~ <br />--.- <br />- <br />suite iDfl - <br />_.~ <br />. <br />-._ <br />- <br />PRODUCER ooao~soo <br />s~a~ER la#. <br /> <br />CarY NC '27511 Y _~_._.._.~..._ <br />tN5t1RERI5i AFFORISINGCOVERAG~ _.____- <br />NAIC it ` <br />INSURfU ~ .w-~~~ <br />INSt1rlERil:EranlCflr77¢Atfl Mutual IAS .Co 39$6 <br /> iNSUaER B ~tlildexs Mntual Insurance Ca ~ <br /> <br />JUI?Y D BROOKS CONTRACTOR INC. <br />iNSURERC~EssE:x Insurances -Co an <br />_ <br />~ ___ <br /> <br />. <br />1195 BEAI, RD ~ <br />_ __ <br />. <br /> tNSUREao: <br />" -----L--_.._~..,..-ry -_ - <br /> INSURER E • <br />GOLDSTON NC 27252-9595 n{suR>tf: `~~" t <br />c..vv ucf-ut~ (:tlill['IL:AT E (1UMBER;L:L,13Y 14utl213 REVISI6N Nt! NIt3ER~ " <br />THIS IS TO CERTIFY THAT THE POLCIES OFiNBURANCE LISTED: BELOW. HAVE BEEN ISSUED TO Ti1E INSUIIED.NAMED ABOVE FOR"TIiE I?gI:ICY PERiOO <br />INR.ICgTEp: NOTWITFiSTAh1DING ANY REQUIREMENT; TERM.OR CONDITIDN pF AN1C CONTRACT IJR OTHER DtSCUMENT ViliTti RESF'EOi"f0 iNHICti THIS <br />CERT1FtCATE MAY BE ISSUED OR MAV PERTAIN; fiHE INSURANCE AFFORDED BY 'fNE POLICIES DESCRIBED- HEREIht tS:SUB:IECT TO ALL 'fltE TERryiS, <br />EXCLUSIONS AND COIdDIT1ONS OF SUCH POllC1ES. LiMtTS SHOWN MAY HAVE BEEN REDUCEb BY .PAID CLAIMS: <br />Il7>t TYPEflF INSURANCE O POLICY NUMBER PMI~O EFF POLICY EXP LlFifiT9 ~ yv <br /> riENERAL~tIAelt.lTY EACH ~DURRENC>e S I,"DO,O.;~DbO <br />_ ~ CDMMERGAL GENERAL UABIGTY 0~~~~~~~ <br />~E;_~[~~4rra <br />~' 300 000 <br />A _ _~ CLAiMSdd,AD'e ~ DCY:UR P6000154 !18/2011 /18/2012 heED F.xP Erna Ps'~~„_, S 5 , q00 <br /> _ _~,...,_ ~_ <br />..- PER~NAt,}t:AOVINJURY~ S 1,000.,°OOR <br /> _, <br />- _. <br />GENERAI.AOGRE <br />GATE _ <br />5 2;,0'aD:~DQO <br /> GFJ7LAGC,REGATtLBdiTAPPLIESPER; _ <br />_ <br />PROOULIS-CDMP:%DP.AGG.. <br />_. <br />• .fi 2.,~DDO;OOb <br /> ~ POLICY . ~~ LOC ~ _ <br />. S <br /> ASITOMOBNJ: Ll46Tl.lTY <br />% ~, AtITD COMBiNE17 $INGLE'UMIT <br />(Ea accidomf S 1, D 00 , DD D <br /> <br /> <br />A <br /> <br />ALL oWNEp AUTD5 <br />6001?IS4 <br />/18/2011 <br />/181ZO1P <br />~ILYI~D~~°f~~i - <br />S~ <br /> __ <br />SCHEDULE6 kUTQS BOb1LY INJURY (Aor accldarlU S ~_~~~J.YT <br />_ <br />_. <br /> <br />X <br />HIRED AUTOS ~ PRDPFDiTY~QAMAGE <br />{PDretspdaiit} <br />_ <br />__ <br />~ _._, <br />. <br />.. <br />S <br />. <br />. <br />.~ <br />. <br /> ~ NON-DWNq] AUTDS _ <br />_ s <br />~ <br />_ <br />._. <br />..__~ <br /> <br /> }[ UMBRELLA t1A6 <br />_ DCCUR <br />EACH OCCURRENCE <br />S 6,DD0~{ODQ - <br /> 17fCE$S tJA6 <br />_.~,„_ <br />._~ CLAIMS~MAi51: <br />AGIiREGATE <br />g 6,OQ4;000 <br /> <br />_ _ <br />_ <br />neaucTJBLE -T <br />~ <br />~ ~~~'~~~"` . <br />s <br />A % RETENTlDN S 10 006 P6000YSd !18/toil /18/zo12 $ <br />$ WORKERS COMPFJ{SAT10N <br />AND EMPLDYERS' 1JABILITY Y <br />N WC STATU• OTI{= <br />~ TSN3Y.LIMI7 _ <br />~_._...._. - <br /> f <br />ANYP(tOPR1ETORlPARTNERIEXECUTIVE <br />EXCLUOED7. ~~ <br />O <br />~ <br />~l~ <br />i <br />N /~ E.L-E.4CHACCIOEN7 <br />- $ ~, QQO QQ_a <br />L <br /> tAa <br />i <br />F <br />t} <br />1r <br />d <br />c rCP1000641 ~ ~ /18/2011 /18/2012 EL. DISEASE=~.t.Eblitl.DY 5 1 OOD-a00 <br /> a, <br />o <br />alho te+dor <br />~DE&IXtIPTtONOFOPEiZATIONShefow <br />~ q <br />EL. DIS(_ASE,POiJCYLltd1T <br />$ i ooD: ~aoD. <br />C Motor Truck Cargo . - 12125 /1/2011 /i/2oi2 LJmlt $25;000 <br />oadlx,9k,;r. $1, 000 <br />DESCRIPTION OF OPERATIONS! LOCA7tONS /VEHICLES {Attach ACORC tDy Addlflahat Romarka~Sehadula, it moro apaw Isrnqutradl <br />{ 9I9) 66I-9038 SHOULD ANY OF THE A90YE DESCRIBED POLICIES BECANCELLEtt BEFORE <br />TNE. E!IPIF;4TION PATE THEREOF, NOTICE WILL BE QEUVEREO iN <br />FaCf.rts'Rr.GE WITH THE PIIUCY PROVISItlNS. <br />• AUTI{GRke~:t REPRESENTATiV£ <br />,7ulie- Sizemore/JSZM ~w='`~~ <br />ACQRD 25 (2DD91a9) O 1988-2a09 ACORD CORPORATION_ AJI rights reserved_ <br />Itv~uzs cryDasos} I ne wt:ue2o name and Togo are registered martcs of ACORD <br />