2014-214 AMS - Tile Restoration for floor care maintenance at various County buildings $10,240

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/ ® DATE(MM/DD/YYYY) ,aco 1 CERTIFICATE OF LIABILITY INSURANCE 12/12/2013 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 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Beverly ike AAI NAME: Y � Jake A Parrott Insurance Agency Inc PHONE (252)523-1041 aC No:(252)523-0145 2508 N HERRITAGE STREET E-MAI ADL DRESS:bpike @parrottins.com PO BOX 3547 - INSURERS AFFORDING COVERAGE NAIC# KINSTON NC 28502 INSURERA bMIN STREET AMERICA ASSURANCE 29939 INSURED INSURERB:NGM INSURANCE COMPANY 14788 TILE RESTORATION INC INSURERC: C/O ALBRITTON CO INSURER D: PO BOX 160 INSURER E: HOOKERTON NC 28538-0160 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1311506507 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 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A SUBR POLICY EFF POLICY EXP LIMITS LTR R WV J POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500 000 X COMMERCIAL GENERAL LIABILITY PREMISE Ea occurrence $ r A CLAIMS-MADE Fx_1 OCCUR MPK8262X 1/7/2013 11/7/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY EOMaBBIINdEDtSINGLE LIMIT 11000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED B2K8262X 1/7/2013 11/7/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Medical payments $ 2,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ UK8262X 1/7/2013 11/7/2014 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? CK8262X 11/4/2013 1/4/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is an additional insured under form #BPM3105 (ATTACHED) . Coverage for the additional insured will be primary/non-contributory if required in the written contract or agreement between the parties. Insurer waives the `Transfer of Rights of Recovery Against Others to Us' clause if required in the written contract between the parties PER FORM BP 0497 (ATTACHED) . The endorsement s amending the business owners liability coverage form includes several additional insureds automatically. The endorsement states that additional insured status is only provided if there is a written contract or agreement between the parties requiring such status. AUTO: Insurer agrees to waive the `Transfer of CERTIFICATE HOLDER CANCELLATION fbrooks@orangecountync.gov 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 PUBLIC WORKS ATTN: FREDDY BROOKS PO BOX 8181 AUTHORIZED REPRESENTATIVE 600 HIGHWAY 86 NORTH HILLSBOROUGH, NC 27278 I B Pike, AAI/SEVERE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. 44` INS025 igmnnsi rn Th.Af't-%P l Hama anA I—arc rcnie4ororl m—ke of Annizi1