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Client#:929549 22TKCON
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 04/17/2014
<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 /> PRODUCER CONTACT
<br /> BB&T-Cooper,Love,Jackson, PHMNE
<br /> Thornton&Harwell (A/c�No,Ext):615 292-9000 FAX No): 8777677417
<br /> E-MAIL
<br /> PO Box 139 ADDRESS:
<br /> Nashville,TN 37202-0139 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Cincinnati Insurance Company 10677
<br /> INSURED INSURER B:Amerisure Insurance Company 19488
<br /> T&K Construction LLC
<br /> INSURER c:Westchester Surplus Lines Insur 10172
<br /> 235 County Road 1242 rp
<br /> Vinemont,AL 35179 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 /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER
<br /> (MM/DD/YYYY) (MM/DD/YYYI) LIMITS
<br /> A GENERAL LIABILITY X X CPP3658706 03/23/2014 03/23/2015 EACH OCCURRENCE $1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY IRRAMin REoNcTgence) $500,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000
<br /> X PD Ded:500 PERSONAL&ADV INJURY $1,000,000
<br /> X "XUC included" GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> —1 POLICY X ECT LOC
<br /> A AUTOMOBILE LIABILITY X X CPP3658706 03/23/2014 03/23/2015 Es acciden SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident $
<br /> AUTOS AUTOS ( )
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS (Per accident)
<br /> A X UMBRELLA LIAB X OCCUR X X CPP3658706 03/23/2014 03/23/2015 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION X WC207415403 01/01/2014 01/01/2015 X TORYLI I OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITT S FR
<br /> OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE ECUTIVE y N/A E.L.EACH ACCIDENT $1,000,000
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Pollution G27431550001 03/23/2014 03/23/2015 Limit:
<br /> Liability $2,000,000
<br /> A Property Floater CPP3658706 03/23//201 03/23/2015 $1,500,000 any one job
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
<br /> RE:Orange County MSW Landfill Closure Project#350207-142839-018
<br /> Orange County,the Designer,the Designers Counsultants and the Construction Mangager are named as
<br /> additional insured as per written contract,such insurance shall be primary&non-contributory per written
<br /> contract.A waiver of subrogation applies in favor of Orange County. All insurance policies shall contain
<br /> 30 days cancellation notice,or any material change in any of the above policies shall be mail to the owner.
<br /> North Carolina is a covered state on the Work Comp Policy.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ANY OF Orange County THE SHOULD EXPIRATION DATTE V THE DESCR
<br /> EOFE NOTICE POLICIES
<br /> WIBLL CBE CDELIVERED O NE
<br /> P.O.Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2010 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> PAH
<br /> #S12208836/M12034766
<br />
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