2011-355 SW - Patriot Building Company, Inc. for recycling concrete pad

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CERTIFICATE OF LIABILITY INSURANCE 71/17/11(MMIDDIYYYY) OP ID MA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the po icy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). UUNIAUI PRODUCER NAME: TriSure Corporation-HS PHONE 4325 Lake Boone Trail VC,No,Ext: (ac,No): Suite 200 ADDRESS: Raleigh NC 27607 CUSTOMERID#. PATRI-5 Phone:919-469-2473 Fax:919-467-4987 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Amerisure Mutual Ins. Co. Patriot Building Company, Inc INSURER B: Ward Setzer 400 Millstone Drive Ste 100 INSURER C: Hillsborough NC 27278 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 cu "WGETOEM A X COMMERCIAL GENERAL LIABILITY CPP2048089 09/01/11 09/01/12 PREMISES(Ea occurrence) $ 100000 CLAIMS-MADE FX]OCCUR MED EXP(Anyone person) $ 10000 X Blanket Addl Insd X PERSONAL&ADV INJURY $ 1000000 X Pollution COy GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3000000 POLICY X JECOT LOC Ben. $ 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident) A X ANY AUTO CA2048088 09/01/11 09/01/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X UMBRELLA LIAB X OCCUR CU2078090 09/01/11 09/01/12 EACH OCCURRENCE $ 5000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5000000 DEDUCTIBLE $ X RETENTION $ 0 $ OTH- A WORKERS COMPENSATION WC204$ 1 09/01/11 09/01/12 X TORY LIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEa E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBEREXCLUDED? /A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 A Leased/Rented CPP2048089 09/01/11 09/01/12 Limit $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Orange County is also listed as additional insured with respects to General liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORA131X THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Asset Management Services AUTHORIZED REPRESENTATIVE 131 West Margaret Lane Hillsborough NC 27278 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD