Orange County NC Website
Browse       Search
DocuSign Envelope ID: DDEE9F74-82D3-4FB8-B7A2-C28AC485259B <br /> ® DATE(MMJDE"YYY) <br /> AC"R a CERTIFICATE OF LIABILITY INSURANCE <br /> o5/o7i2o95 <br /> THIS CERTIFICATE IS HUED 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 NW,cT OeAnn Mlmms <br /> Walker Insurance Agency,Inc. PHONE 336 599 9751 FAX,NO) <br /> HO No Ext� ( } <br /> PO Box 1035 ADDREss deann @walkerinsurance.biz <br /> INSURER(S)AFFORDING COVERAGE NAIC 8 <br /> Roxboro NC 27573 INSURER A: Erie Insurance 26271 <br /> INSURED wsuRER B: Ede Insurance 26271 <br /> Asphalt Experts Inc INSURER C: Ef1e Insurance 26271 <br /> Doug Robins INSURER D: Ede Insurance 35585 <br /> 51112 Neal Rd Suite 100 INSURER E: <br /> Durham NC 27705 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 /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br /> rA TYPE OF INSURANCE INSD POLICY NUMBER MF�JYYYY 1MID01YYYY LIh11TS <br /> X COMMEROAL GENERAL L"LiTY EACH OCCURRENCE $ 1000000 <br /> CLAR,IS-F,tADE A E TO REN <br /> OCCUR PREhtISES(Eaoccurrence $ 1000000 <br /> MED EX.P(My one p'rson) $ 5000 <br /> N N Q39-1750490 03/9702015 03/117/2016 PERSONAL&ADV IN JURY $ 1000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENFRAL AGGREGATE $ 2000000 PRO- PRODUCTS-COffPJOPAGG $ 2DD0000 <br /> POLICY� �LOC $ <br /> OTHER: <br /> AUTOMOBILELIAB1LITY EahaxideDlSpVGLELIMIT $ 1000000 <br /> ANY AUTO DOM-Y"JAJRY(Perperson) $ <br /> ALL OWNED SCHEDULED N N Q03-1740029 03/17/2015 03/17/2016 BODILY"JJRY(Per accident) $ <br /> B X <br /> .AUTO X AUTOS OEU PROPERTYDMIAGE $ <br /> Per aca dent) <br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5000000 <br /> C <br /> EXCESS LIAB CLAims,- 1DF N N Q27-1770098 03/17/2015 03/17/2016 AGGREGATE $ <br /> DED X RETENTION$ $ <br /> WORKERSCOMPENSATION X Sl"ATUTF I FORT H_ <br /> AND EMPLOYERS'LI ABILITY <br /> ANY PROPRIETORIPARTNERiEXECUTIVE Y!N NIA E.L.EACH ACCIDENT $ 1000000 <br /> D OFHCMId EIABER EXCLUDED? Y❑ N Q87-6700165 03/17/2015 03/97/2016 <br /> (MandetoryinNH) EL DISEASE-EAE7APLOYEE $ 10000 <br /> ifyas,descnbeunder ELDISE.ASE-POLICY LIMIT $ 1000000 <br /> DESCRIPTION OF OPE RAT D NS Wow <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addilienak Remarks Schedule,may be attached if more space is required) <br /> Project Name: Efland Cheeks Park <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County DEAPR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 302 W Tryon St ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Hillsborough NO 27278 CA) - <br /> Fax- Email: Q 1988-2014 ACORD CORPORATION. All rights reserved, <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />