2012-070 AMS - Penn-Davis Coating Inc for Resurface Kennel walls @ Animal Services $24570

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, A /~~~1 ~7 r~ ~ `~'~= "' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03I09/12 THIS CERTIFICATE IS ~SSUED 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 certiflicate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER 919-772-0233 Jones insurance ~qency ~f1C NAMEACT , . P O Box 407 919-779-4025 PHONE qX a~ No EM : A/C No : Garner, NC 27529 -n~aa~ Jerry E. Jones, CIC ADDRESS: cusTOenER io a: PENND-1 INSURER S AFFORDING COVERAGE NAIC # INSURED Penn Davis Coating, inc. ~NSUReRn:Cincinnati Insurance Com an ~~67] P O Box 575 Garner NC 27529 iNSUReR e: Builders Premier insurance Co 13036 , INSURER C : INSURER D : INSURER E : ~ ~ INSURER P : --" ° rtcv~a~Vn rvVrvICiGK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH E POIICY 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 POI.ICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE POLICY NUMBER Y PO~ CY EXP LIMITS GENERAL LIABILITV EACH OCCURRENCE $ 'I,OOO.~OO A x COMMERCIAL GENERAL LIABIUTV CPP0738957 07/25/12 01/2$/13 pREMISES Ea occurrence $ 50~,~0 CLAIMS-MADE ~ OCCUR MED EXP (My one person) $ ~ ~,~~ PERSONAL 8 ADV INJURY $ 'I OOO OO , ~ GENERALAGGREGATE OOO OO S Z , , GEN'L AGGREGATE LIMIT APPLIES PER: PR~ PRODUCTS - COMP/OP AGG $ Y,OOO,OO POLICY X LOC Em Ben. s 100/30 AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ~ OOO OO A X ANVAUTO CPA0738957 01/25/12 01/25/13 ~Eaaccident) ~ , ALL OWNED AUTOS BODILY INJURY (Per parson) 5 SCHEDULEDAUTOS BODILVINJURY(Peraccitlent) $ X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON-OWNEDAUTOS g X Comp Ded $ s UMBRELLA LIAB X OCCUR EACH OCCURRENCE OOO OO $ S A EXCESS LIAB CLAIMS-MADE AGGREGATE , ~ OOO OO S S CCC4453037 01/25/12 01/25/13 , , DEDUCTIBLE $ RETENTION 5 . $ WORKERS COMPENSATION WC STATU- OTH- x AND EMPLOYERS' LIABILITY Y~ N ~ B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ^ N ! A PWCOOZOH~ O O'IIZS/'IZ 01/25/13 E.L. EACH ACCIDENT $ 'I OO,OO (Mandatory in NH) If yes describe under E.~. DISEASE - EA EMPLOYE S ~ 0~,~~ , DESCRIPTION OF OPERATIONS r below E.L. DISEASE • POLICY LIMIT JOO,OO $ Q Leased/Rented CPA0738957 01/25112 01/25/13 Limit 80,00 Ded t,oo DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES ~Attach ACORD 107, Additional Remerks Schedule, if more epace ia requirad) RE: Orange County Animal Services I.LR 1 11'11.Y 1!' 1"I( ll I IFK f+A \I/+CI 1 I~TIfl~1 ORANGEI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Of8ng2 COU11ty PUbI1C ACCORDANCE WITH THE POLICY PROVISIONS. WO~ICS Wayne Fenton AUTHORIZED REPRESENTATIVE 131 W Margaret Lane Ste 101 ~~Q L~~~ Hilisborou h NC 27278 CU 7988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD