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Docu Sign-Envelope rID: F8FCAFA8-FBB2-47AF-964F-11 E53C70E4A1 OWENS-1 OP ID:TL TE
<br /> CERTIFICATE OF LIABILITY INSURANCE F DA 02/20/22015 015(MM/ ,f'
<br /> 02
<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 /> Senn Dunn-Raleigh PHONE Tammy Coolidge FAX
<br /> 4700 Falls of Neuse Rd,St 190 AIC No Ext:919-791-9861 A/c No; 919-372-3716
<br /> Raleigh,NC 27609-2521 E-MAIL s:tcoolidge@senndunn.com
<br /> Benjamin T.Singleton,AAI
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Builders Premier Insurance Co. 13036
<br /> INSURED Owens Roofing,Inc. INSURER B:Builders Mutual Ins.Co. 10844
<br /> Owens-Hart, LLC
<br /> 301 W. Cabarrus Street INSURER C
<br /> Raleigh, NC 27601 INSURERD:
<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 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 /> INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS
<br /> LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
<br /> A X COMMERCIAL GENERAL LIABILITY PCP000244003 05/01/2014 05/01/2015 DAMAGE TO RENTED 100 00
<br /> PREMISES Ea occurrence $ s
<br /> CLAIMS-MADE Fx—1 OCCUR MED EXP(Any one person) $ 10,00
<br /> PERSONAL&ADV INJURY $ 1,000,00
<br /> GENERAL AGGREGATE $ 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00
<br /> POLICY X PRO LOC $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> A X ANY AUTO PCA000733702 05101/2014 05/01/2015 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS PER ACCIDENT
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,00
<br /> B EXCESS LIAB CLAIMS-MADE UMB002114402 05/01/2014 05/01/2015 AGGREGATE $ 4,000,00
<br /> DED I X I RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION X WC YS OTH-
<br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER
<br /> B ANY PROPRIETOWPARTNER/EXECUTIVE Y/N WCP102219702 01/0112015 01101/2016 E.L.EACH ACCIDENT $ 1,000,00
<br /> OFFICERWEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00
<br /> A Intallation Cov. PCP000244003 05/01/2014 05/13/2015 Job Site 1,050,00
<br /> Max Loss 3,150,00
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Orange County is included as an additional insured with regards to general
<br /> liability as stated in the policy language with written contract prior to
<br /> any loss.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORAN818
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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