Orange County NC Website
DocuSign Envelope ID: 44301OD1- F2AE- 4EA4- A39D- 96B8D483592A <br />WARRE -1 OP ID: MR <br />CERTIFICATE OF LIABILITY INSURANCE <br />71,1112/2014 M <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 INSURE=R(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ees) 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 <br />Summers Thompson Lowry, Inc. <br />100 Europa Drive, Suite 571 <br />CONTACT <br />G. Roberts, AAI, CISR <br />-NAME: Margo <br />FAx <br />Arc No Ext:919- 969 -5300 ,Vc No: 919 -942 -4221 <br />EMAIL o stlinsure.com <br />ADDRESS: mar g @stlinsure.com <br />Chapel Hill, NC 27517 <br />Larry A. Summers <br />1213'112013 <br />12/3112014 <br />EACH OCCURRENCE <br />AFFORDING COVERAGE <br />NAIC q <br />INSURER A: Selective Ins. CO. of America <br />125572 <br />$ 5,00 <br />INSURED Warren -Hay Mechanical <br />Contractors, Inc. <br />PO Box 818 <br />INSURER B: <br />INSURER C : <br />GENERAL AGGREGATE <br />INSURER D: <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X PRO LOC <br />JECT <br />Hillsborough, NC 27278 <br />INSURER E <br />$ <br />INSURER F: <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREUAUTOS NON -OWNED <br />Aurps <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 />MSR <br />LTR <br />TYPE OF INSURANCE <br />DD <br />BR <br />POLICY NUMBER <br />MMIDDIYYYYY <br />MMIDD�YY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FX1 OCCUR <br />Hillsborough, INC 27278 <br />S 2058359 <br />1213'112013 <br />12/3112014 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />100 00 <br />$ , <br />MED EXP (Any one person) <br />$ 5,00 <br />PERSONAL & ADV INJURY <br />$ 1,000,00 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X PRO LOC <br />JECT <br />PRODUCTS - COMPIOP AGG <br />$ 2,000,00 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREUAUTOS NON -OWNED <br />Aurps <br />S 2058359 <br />12/31/2013 <br />12/31/2014 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />S 1,000,00 <br />BODILY INJURY {Per person) <br />$ <br />BODILY INJURY (Per accident] <br />$ <br />PROPERTY DAMAGE <br />PER ACCIDENT <br />$ <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAR <br />I X <br />OCCUR <br />CLAIMS -MAOE <br />S 2058359 <br />12131!2013 <br />12!3112014 <br />EACH OCCURRENCE <br />$ 3,000,00 <br />AGGREGATE <br />3 3,000,00 <br />DED I X RETENTION $ 0 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N lA <br />WG STATU- OTH• <br />TORY LIMITS ER <br />F.L. EACH ACCIDENT <br />S <br />E.L. DISEASE - EA EMPLOYE <br />— <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks $chedulo, if more space Is required) <br />For Information Purposes <br />CERTIFICATE HOLDER CANCELLATION <br />ORANGE1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Orange County <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 8181 <br />AUTHORIZED REPRESENTATIVE <br />Hillsborough, INC 27278 <br />R4".1 Pt S �uw, mn �.► S <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />