2014-576-E AMS - FloorChem, Inc. to install opoxy at the jail $12,767

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OUuu JIyrl Crivelupe I0: 33z000U0-+'+ 1 U- 40Ly- Hbl�4 -0V C34y41�yy3U H(_ "J1C" L...,� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD014 10/29/2014 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). PRODUCER John Hackney Agency of Rocky Mount 950 Country Club Road P. 0. BOX 7807 Rocky Mount NC 27804 -0807 CONTACT Sue Alford NAME: PHONE (252) 442 -3186 A/C No: (252) 451 -9400 IAC ADDRESS: sal ford@ jharm. com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Selective Insurance Co of SC 19259 INSURED Floorchem, Inc . 200 Powell Dr. , Ste 103 Raleigh NC 27606 INSURERB:Hartford Ins. Co. of Midwest 37478 INSURER C: INSURER D: INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR COVERAGES CERTIFICATE NUMBER:CL14102901483 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. ILTR TYPE OF INSURANCE INSR WVDR POLICY NUMBER MMIDDY/YEYYY MM/LDD //YYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR S2002943 11/1/2014 11/1/2015 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ r MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 3,000,000 X POLICY X PRO LOC $ AUTOMOBILE LIABILITY MBINED SINGLE LIMIT (CEO, accident 1 000 000 BODILY INJURY (Per person) $ P' ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS S2002943 11/1/2014 11/1/2015 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Peraccidenl $ Underinsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ $ S2002943 11/1/2014 11/1/2015 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE X I WC TORYLIMI_- S7 I OTH- E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 2WBCEG1705 11/1/2014 1/1/2015 E.L. DISEASE -EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project:Orange County Jail - Flooring Upgrades @ 125 Court Street, Hillsborough, NC Orange County PO Box 8181 Hillsborough, NC 27278 ACORD 25 (2010/05) INS025 rgmnns) ni 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 Sue Alford /PSA ©1988 -2010 ACORD CORPORATION. All rights reserved. Tha ACr')Pn name and Innn nre rnnie4nrnrl marke of Annpn