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From:Cathy C.Lucas,AAI FaxID:SummersThompsonLowry Page 2 of 2 Date:1111/2012 08:26 AM Page:2 of 2
<br /> JFWIL-1 OP iD: CC
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE 311`IYYYY)
<br /> 10!131!12
<br /> THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> -IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in Ileu of such endorsement(s).
<br /> PRODUCER 919-968-4472 NAME: Cathy Lucas,AAI
<br /> Summers Thompson Lowry,Inc. 919-942-4221 .919-969-5311
<br /> 100 Europa Drive,Suite 571 N 77777M.No:919-9424221
<br /> Chapel Hill,NC 27517 ADDgs;Oath stiinsure.com
<br /> C. Duke Thompson CPCU ARM
<br /> INSURER(S)AFFORDING COVERAGE NAIC/
<br /> INSURER A:The Charter Oak Fire ins Co 25615
<br /> INSURED J.F.Wilkerson Contracting Co. INSURERS:Builders Mutual Insurance Co.
<br /> Inc., INsuRERc:Travelers Indemnity Co. 25658
<br /> P.Q.Box 183
<br /> Morrisville,NC 27560 INSURER D:
<br /> INSURER E
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> 1LTR TYPE OF INSURANCE POLICY NUMBER MMIOD MMroD/YYYY LIMITS
<br /> GENERAL LIABILITY
<br /> EACH OCCURRENCE $ 1,000,00
<br /> C X COMMERCIAL GENERAL LIABILITY X 0683546151 04/01/12 04/01/13 PREMISES Ea occurrence $ 300,00
<br /> —...�
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,00
<br /> PERSONAL&ADV INJURY $ 1,000,00
<br /> GENERAL AGGREGATE $ 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00
<br /> POLICY X PRO- LOC /d ded $ 2,50
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 00
<br /> Ea accident $ _ r
<br /> A X ANY AUTO X 81066354615COF 04/01/12 04/01/13 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED —---—
<br /> AUTOS AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS Per accident $
<br /> r
<br /> $
<br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 6,000,00
<br /> C EXCESSUAB CLAIMS-MADE CUP68354615IND 04/01/12 04/01/13 AGGREGATE $ 6,000,00
<br /> DED I I RETENTION$ 0 rod/Comp $ 6,00000
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY YIN X WC LI U- O R
<br /> B FFICERPMIREIMBERR EXCLUDED? ❑ N 1 A CP101769700 04/01/12 04/01/13 E.L.EACH ACCIDENT $ 500,00
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500,00
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is requlred)
<br /> Certificate holders as included as additional insured as respect to general
<br /> liability & business auto as required by written contract.
<br /> Project: Buckhorn - Mebane EDD, Phase 2, Water and Sewer Improvement,
<br /> Orange County, NC
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGE2
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County, NC(owner)& ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hobbs, Upchurch& Associates, AUTHORIZED REPRESENTATIVE
<br /> P.A.(engineer)
<br /> BOx 8181
<br /> Hillsborough,INC 27278
<br /> O 1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
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