2014-552-E DEAPR - Cleve Wagstaff Stone Masonry, LLC for construction of stone culverts $5,980

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DocuSign Envelope ID: F4162074- 2BC7- 47BC- B784- BCEEDFDDC55C ---Ili CLEVE -1 OP ID: BP CERTIFICATE OF LIABILITY INSURANCE r ATE(MINDD1YYYY) l� 1012412414 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(lea) must be endorsed, It SUBROGATION IS WAIVED, Subject to the terms and Conditions of the policy, certain policies may requlre an endorsement. A statement on this certificate does not confer rights to the certificato Balder In lieu of such endorsemant(s ). PRODUCER CONTACT NAME: Phlll" ip Allen Thompson- Allen, Inc. PHONE 336 -599 -2175 FAX 336 -599-6932 P. O. Box 100 ��: - -._ Roxboro, NC 27573 AD S: Barbara Piper — -- -- INSURER(S) AFFORDING COVERAGE I NAIC ff INSURER A : Clncinnatl Insurance Company 10677 INSURED Cleve Wagstaff Stone Masonry INSURERB:CinCirinati_Indetnni Company -- 23280 309 Wagstaff Carver Rd INSURERC: - -_ _ Roxboro, NC 27574 — INSURER D: INSURER E : - - - -- INSURER F : r.r_nrrrrnwrc ■rrrReoeo. RFVISIC]N WIIMRFR- v 1 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. AODL 511R - ...,_...,.-__._.� POLICY EFF LTR TYPE OF INSURANCE � f hMlDDlYYYY rhAf0DlYYYY LIMITS A X COMhIFRCUIL GENERAL LIARILnY EACH OCCURRENCE $ 1,000,00- CLAIMS-MAOE X] OCCUR I ENA 0119816 0110212014 0110212015 O ..- 6cl0 RFt 1-1-0 PRet,11SLS(ta_ccourrente }- -- 5 - ..._ -- ©_ j MEO EXP (Any -ane persen) 5 . ___ -- 6,00... PERSONAL 4ADVINJURY S 1,000,00 GE[fl- AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000, 00 i GL;GY L1 !E � LOC PRGDUCTS - COMP10t' AGG S _-- - -- —� -- 2,000,00 - - - -- OTHER: 3 COMBINED SINGLE LIMIT S 1000,000 AUTOMORILELIABILITY � Eaaccidenl). ._- ......._.1...._ ............. A ANY AUTO EBA 0067748 04104/2014 04/04/2015 1130DILY INJURY (Per person) S _ — ALL OWNED X SCHEDULED BODILY INJURY (Per attidenl) S _.,V. AUTOS AUTOS NON -OWNED X X PROPERTY DAMAGE (Peraccidontl S HIREOAUTOS 5 )( UMBRELLA LIAR X OCCUR EACH OCCURRENCE — — S -- 6,0_0_0,00 AGGREGATE A EXCESS LIAa CLAIIAS-MADE EN 0119816 0110212014 0110212015 $ 5,000,00 OED F RETENTIONS S _ WORKERS COMPENSATION STD- ORH B AHD EMPLOYERS' LIAaRITY Y IN ANY TROPRIETORrPARTIIERit!- MVTIVE WC1822051 -10 01/0212014 01!0212016 $ 1 r000,Q0 -TE — .- ... -_- E -L. EACH ACCIDENT Ems- DISEASE • EA EMPLOYEE S 1,000,00 OFFICERWd kMEREXCLUDED? ❑ (Mandatory In NH) h NIA I E DISEASE • POLICY LIMIT 5 1000000 r , If os, detcritounder DESCRIPTION OF OPERATIONS ba'ow 1 I I DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORO 103, Addltlon31 Ramorks Schodula, may bo attaehad II more spa co is requ €rod) Orange County CIO DEAPR -Lori Taft P.O. Box 8181 Hillsborough, NC 27278 ACORD 25 (2014101) ORANGEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Barbara Piper t' nc 44RR -?flTk ArnRD The ACORD name and logo are registered marks of ACORD ti TION. All r1ahts reserved.