2015-164-E DEAPR - McQueen Construction for paving at Blackwood Farm $34,600

Browse Search

DocuSign Envelope ID: B4AED305-BC6D-4956-93F9-OE7970FDE75C MCQUE-1 OP ID: NU 703/23/2015 E(MM/DD/YYYY) `64� CERTIFICATE OF LIABILITY INSURANCE 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 NAME: Arlene Nunn Senn Dunn-Raleigh PHONE FAX 4700 Falls Of Neuse Rd,St 190 AIC No El:919-719-9588 vc No): 919-348-2754 Raleigh,NC 27609-2521 ADDRESS:James P.Lowrey anunn@senndunn.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Builders Mutual Ins.Co. 10844 INSURED McQueen Construction,Inc. INSURER B:Selective Ins Co of S Carolina 19259 619 Patrick Road Baharna, NC 27503 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADD SUER POLICY NUMBER MMLDD1YYYY MM/LDDY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY X S1785111 01/24/2015 01/24/2016 DAMAGES( RENTED PREMISES Ea occurrence) $ 1 00,000 CLAIMS-MADE i X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 Ea accident $ , , S X ANY AUTO 51785111 01/24/2015 01/24/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PR DAMAGE AUTOS PER OP ACCIDENT $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 [� EXCESS LIAB CLAIMS-MADE *S1785111 01/2412015 01/2412016 AGGREGATE $ 6,000,000 DED X I RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WCP1022838 01/24/2015 01/24/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Leased/Rented Eq S1785111 01/2412015 01/24/2016 L&R 150,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Blackwood Farm Park CERTIFICATE HOLDER CANCELLATION ORANG-8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. Department of Environment,Agr AUTHORIZED REPRESENTATIVE Parks and Recreation PO Box 8181 � G% Hillsborou h NC 27278 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD