2011-328 Planning - DOT Construction, Inc. for bus shelters at DTCC

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OP ID: MM '`~~~ CERTIFICATE OF LIABILITY INSURANCE DATE,MM/DD/YYYY) 09/30/11 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 policy(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). PRODUCER ~ ~ 704-375-8000 CONTACT, Knauff Insurance Agency, Inc. NAME: P O Box 33789 704-334-6526 Charlotte NC 28233-3789 ac° No Ext : ac No E MAIL , St@V@n Santee - ADDRESS: PRODUCER . DOTCONS C STOMERID . INSURERS) AFFORDING COVERAGE NAIC # INSURED DOT Construction, Inc INSURERa:Penn National Mutual Casualty 14990 Ha Chung Kim 4801 E Inde endence Bl d #506 INSURER B :Great American Insurance Co. 16691 . p v . Charlotte, NC 28212 INSURER c INSURER D : INSURER E INSURER F ~.vvarv~~acJ GtK~IFIGATE NUMBER' Dc~mm~~r uruaorn. ~ ,wnraacr~. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE RIOD 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CL90626971 11/30/10 11/3O/11 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $ 5,00 PERSONALB ADVINJURY 1 000 00 , , , $ 2 000 00 GENERAL AGGREGATE , , $ GEN'LAGGREGATELIMITAPPLIESPER: PRO PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY X - LOC ~ $ AUT OMOBILE LIABILITY X COMBINED SINGLE LIMIT A X ANY AUTO U90626971 11/30/10 11/30/11 (Ea acddent) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS PROPERTY DAMAGE (Per acddent) $ NON-0WNED AUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 A EXCESS LIAB CLAIMS-MADE AGGREGATE 3 000 00 X UL90626971 11/30/10 11/30/11 $ , , DEDUCTIBLE $ X RETENTION $ 1 O 000 WORKERS COMPENSATION ' WCY TA U- T - X ~ $ AND EMPLOYERS LIABILITY Y/N M R A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED9 ^Y N / A 090626971 11/30/10 11/30/11 E. L. EACH ACCIDENT $. 500,00 (Mandatory in NH) if es, describe under E.L. DISEASE - EA EMPLOYE $ SOO,OO A DESCRIPTION OF OPERATIONS below Inland Marine E.L. DISEASE -POLICY LIMIT $ 500,00 CL90626971 ~ 11/30/10 11/30/11 Lease/ren 100,00 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is an additional insured on all liability policies except employers liability 1WC) with respects to work ppertormed by the named insured for such dditi l i a ona nsured if required by written contract signed by an authorized representative of the named insured. rcorrrrrwrr ur.r ..~., Orange County Attn: David Cannel/ Po Box 8181 Hillsborough, NC 27278 ORACOUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE _ _ ~.-- ~ - v,aaa-wuyACt~KU L:VFtPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD