Orange County NC Website
Browse       Search
Client#: 1151158 20STATECON <br /> ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 D 51151 20014 14"YY) <br /> 5/15/ <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 /> NAME: <br /> BB&T Insurance Services,Inc. PHONE 919 281-4500 FAX Ne: 8887468761 <br /> AIC No Ext <br /> Post Office Box 13941 E-MAIL <br /> ADDRESS: <br /> Durham,NC 27709 INSURER(S)AFFORDING COVERAGE NAIC# <br /> 919 281-4500 INSURER A:Selective Insurance Co of Ameri 12572 <br /> INSURED INSURER B:Builders Mutual Insurance Compa 10844 <br /> State Contracting Inc <br /> INSURER C <br /> 2815-C Superior Dr <br /> INSURER D <br /> Wake Forest,NC 27588 <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 CONTRACTOR 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 /> LTR TYPE OF INSURANCE INSR W D POLICY NUMBER POLICY MMILDID I LIMITS <br /> A GENERAL LIABILITY S2023996 5/10/2014 05/101201 EACH OCCURRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES EaEoccurrence $100,000 <br /> CLAIMS-MADE �OCCUR MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE s2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY PRO LOC $ <br /> A AUTOMOBILE LIABILITY S2023996 5/10/2014 05/10/201 COMBINED.,an,) $1,000,000 <br /> LIMIT 1,000,000 <br /> IX ANY AUTO - BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS X NON-OWNED PerOPERTY DAMAGE $ <br /> $AUTOS <br /> A X UMBRELLA LIAR X OCCUR S2023996 5/10/2014 05/10/2015 EACH OCCURRENCE s5,000,000 <br /> EXCESS LIAS CLAIMS-MADE AGGREGATE s5,000,000 <br /> DED I X RETENTION$O $ <br /> B WORKERS COMPENSATION 11521490 5/10/2014 05/10/2015 X I WC STATU- FORT H- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 <br /> OFFICER/MEMBER EXCLUDED? N NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> A Rented/Leased S2023996 5/1012014 05/10/2015 $50,000 <br /> Equipment <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) <br /> **Workers Comp Information** <br /> Other States Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD TI H <br /> Orange County THE EXPIRATION DATE ABOVE DESCRIBED POLICIES CANCELLED BEFORE <br /> THEREOF,EOF, NOTICEWILLL BE DELIVERED IN <br /> P O Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> 11988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S12343085/M12314488 JAW <br />