2013-154 DEAPR - NW Poole Well Co for Irrigation well and hook-ups A$18,964

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---� NWPOO.1 OP ID,CR CERTIFICATE OF LIABILITY INSURANCE DATE(05/16/13 16113""' 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 CONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(ft 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 endorsemen s. PRODUCER 919-772„0 T Jones Insurance Agency,Inc. PHHONE P O Box 407 919-779-4025 a N AIC No): Gamer,NC 27529 ADDRESS: Hal Averette,CIC,CWCA IHStT S AFFORDING COVERAGE NAIL# INSURER A:National Trust insurance Co 20141 INSURED N W Poole Well&Pump Co INSURER B:FCCI Insurance Company 10178 Mary Ann Letchworth INSURER C: P.O.Box 1958 INSURER D: Wendell,NC 27591 'INSURER E: INSURER P: 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 RESPPCT 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. ILTR TYPE OF INSURANCE POLICY NUMBER EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 DAMAGE TO RENTEU- A X COMMERCIAL GENERAL LIABILITY X CPP00049186 07101/12 07101/13 PREMISES Ea occurrence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL a ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2:000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,0 POLICY X PRO- LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY (Ea SINGLE LIMIT 1,000,00 Ea accident B X ANY AUTO X CA0005935 07/01112 07/01/13 BODILY INJURY(Per person) $ ` ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Par accident $ UMBRELLALIAB I X I OCCUR EACH OCCURRENCE $ 1.000,00 B EXCESS LIAR CLAIMS-MADE UMS00031454 07101112 07/01/13 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION X I WC STATU- I IOTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA 010•WCI IA 58147 07/01/12 07/01/13 EL EACH ACCIDENT $� 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 5iIIi+QQ If yes,descxibe under 500 Q0 DESCRti71ION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S + A Leased Equip CPP00049186 07/01112 07/01/13 Limit 100,00 Ded 50 I I i-1 I DESCRIPTION OF oPERATiONs i LOCATbNS i VENK:LES(Attach ACORD 101,Add/mW Remarks Schedtde,I more space is required) The below certificate holder is hereby additional insured as respects to General Liability and Auto Liability coverage per CGLOS41210 per CAU0421208 CERTIFICATE HOLDER CANCELLATION ORANGEI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Govemment AUTHOraED REPRESENTAWE P.O.Box 8181 jr f Hillsborough,NC 27278 `�- 01988-2(110 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD