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y 1 ® t DATE(MWDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 1/3/2014 <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(ies)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 lieu of such endorsement(s). <br /> CONT <br /> PRODUCER N MEACT Mark MCLamb, CIC <br /> Craft Insurance Center PHONE (336)375-0600 FAX c o:(336)375-7004 <br /> 823 North Elm Street A-MARIL .mmclamb @craftinsurance.com <br /> PO BOX 14946 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Greensboro NC 27415 INSURERAAll America Insurance Company 0222 <br /> INSURED INSURERB:Central Mutual Insurance 20230 <br /> Lomax Construction, Inc. INSURER CBuilders Mutual Insurance 10844 <br /> PO Box 35169 INSURERD:Peerless Indemnity Insurance 18333 <br /> INSURER E: <br /> Greensboro NC 27425 INSURERF: <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 /> INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MMIDD MMIDD <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> GE TO 11 <br /> X COMMERCIAL GENERAL LIABILITY AEMI N Ewen $ 300,000 <br /> A CLAIMS-MADE X❑OCCUR X Y CLP 7967877 /1/2014 /1/2015 MEDEXP Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> JECT <br /> POLICY X PRO-POLICY $ <br /> AUTOMOBILE LIABILITY Ee eBIINEDtSINGLE LIMIT 11000,000 <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED X Y 7967876 /1/2014 /1/2015 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> Uninsured motorist combined $ 11000,000 <br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 <br /> X <br /> B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED X I RETENTION$ S 7967878 /1/2014 /1/2015 $ <br /> C WORKERS COMPENSATION Y X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOR/PARINER/EXECUTIVE E.L.EACH ACCIDENT $ 11000,000 <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) 002462712 /1/2014 /1/2015 E.L.DISH-ASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 <br /> A Inland Marine CLP 7967877 1/1/2014 /1/2015 Rental Equipment $100,000 <br /> D Builders Risk IM957153 /1/2014 /1/2015 Builders Risk $5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) <br /> Project: 1st Floor Renovation of Whitted Building, Hillsborough, North Carolina. <br /> Orange County, Owner, Designer & Designer's Consultants are Additional Insureds on the General Liability <br /> and Automobile policies if required by written contract, agreement or permits only as respects to <br /> operations of the Named Insured on a primary and non-contributory basis. Waiver of subrogation is <br /> provided in favor of the additional insureds under the General Liability, Automobile and Workers <br /> Compensation policies if required by written contract. The umbrella policy is written on "follow the <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> Mark McLamb, CIC/IQIIt `"� �� <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025 oninms m Tho annian nnma and Inn^ara raniatararl mnrlra of Af_npn <br />