Orange County NC Website
DocuSign Envelope ID: 32E08BD7-D7A9-4E3B-9E4A-7202C5E86675 <br />186591 <br />DATE(MMIDOfYYYY) <br />CERTIFICATEOFLIABILITYINSURANCE <br />121121201' <br />THISCERTIFICATEISISSUEDASAMAnEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND.EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES <br />THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />BELOW. <br />REPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER. <br />IMPORTANT: <br />11thecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto <br />thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsementAstatementonthiscertificatedoesnotconferrightstothe <br />certificateholderInlieuofsuchendorsement(s). <br />PRODUCER <br />~~~~~CTPhyllisWhite <br />CommercialLines-(919)676.8834 <br />PHONE <br />919.334.263'877.506.0509 <br />No: <br />E.MAIL <br />WellsFargoInsuranceServicesUSA.Inc. <br />phyllis.white@wellsfargo.com <br />ADDRESS: <br />8540ColonnadeCenterDrive,Suite111 <br />INSURERISIAFFORDINGCOVERAGE <br />NAlC' <br />Raleigh,NC27615 <br />17370 <br />NautilusInsuranceCompany <br />INSURERA: <br />INSURED 2522. <br />GreatDivideInsuranceCompany <br />INSURERS: <br />EnvironmentalHoldingsGroup,LLC <br />19682 <br />HartfordFireInsuranceCompany <br />INSURERC: <br />190KittyHawkDrive <br />FederalInsuranceCompany <br />20281 <br />~\:!.RERD: <br />INSURERE: <br />Morrisville,NC27560 <br />INSURERF: <br />CERTIFICATENUMBER:8482252 <br />COVERAGESREVISIONNUMBER:Seebelow <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWTHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTIMTHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN.THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOVVNMAYHAVEBEENREDUCEDBYPAIDCLAIMS. <br />INSRPOUCYEFF <br />TYPEOFINSURANCE <br />LIMITS <br />POLICYNUMBER <br />MMIDDNYYY <br />X COMMERCIALGENERALUABILITY <br />1.000,000 <br />EACHOCCURRENCE <br />ECP015059831609/30/2015 <br />X <br />A09/30/201' <br />300.000 <br />ClAIMS.MADEOCCUR <br />~:C~iJ9F~~~E~te' <br />X <br />ContractPollution <br />MEDEXP(Anyoneperson)5.000 <br />xcu,Contractual <br />1.000,000 <br />PERSONAL8.AfNINJURY <br />1,000.000 <br />GENERALAGGREGATE <br />AGGREGATELIMITAPPLIESPER <br />1,000.000 <br />PRODUCTS.COMPIOPAGG <br />POUCYLOC <br />5.000 <br />Deductible <br />OTHER <br />AUTOMOBILELIABILITY <br />X <br />IrE~~~~~lrINGLELIMIT <br />1,000,000 <br />B9130/2015 <br />BAP1505985169/30/201' <br />80DlLYINJURY(Perperson) <br />ANYAUTO <br />AllO......-NED <br />SCHEDULED <br />BODILYINJURY(Peraeatient)S <br />AUTOS <br />AUTOS <br />NON-Q......-NED <br />rp~~;:d~gAMAGE <br />HIREDAUTOS <br />AUTOS <br />$1,000 CompiCoilOed. <br />UMBRELLAUAB <br />X <br />10,000,000 <br />FFX150598616 09/301201'09/30/2015 <br />EACHOCCURRENCE <br />A <br />ROCCUR <br />EXCESSL1AB <br />10,000.000 <br />CLAIMS-MADEAGGREGATE <br />10,000 <br />OEDXRETENTION <br />WORKERSCOMPENSAT10N <br />SORetention <br />9/30/201' <br />9/30/2015 <br />X <br />WCA150598416 <br />B <br />X~i~TUTE <br />ER <br />ANDEMPLOYERS'UABIUTY <br />YIN <br />1,000,000 <br />ANYPROPRlerORJPARTNERiEXECUnVE <br />E.L,EACHACCIDENT <br />OFFICERiMEMBERE)(CLUDED? <br />1,000,000 <br />(MandatoryInNH) <br />E.LDISEASE-EAEMPLOYE <br />1.000,000 <br />'(;'~QpERATrONSbelowE.l.DISEASE.POLICYLIMIT <br />09/30/2015 <br />C09/30/201' <br />Rented/leasedEquipment <br />$380.000 eachitem:$600.000 Tolal <br />22UUMJC1697 <br />DESCRIPT10NOFOPERAT10NSLOCAnONSVEHICLES(ACORO 101,Additio"~1Rem~r1<.,Sehedule,maybeattaehedmore'piceIsrequired) <br />Re:Projects <br />-CedarParkGroveFloorTileDemolition <br />-CedarParkGroveWindowAbatement <br />OrangeCountyislistedasadditionalinsuredasitrelatestogeneralautoliabilityinaccordancewiththetermsandconditionsofthepolicy. <br />Umbrella/Excessfollowsformasitrelatestoadditionalinsured. <br />CANCELLATION <br />CERTIFICATEHOLDER <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCelLEDBEFORE <br />OrangeCounty <br />EXPIRATIONTHEREOF,NOnCEWILLDELIVERED <br />POBox8181 <br />ACCORDANCEWITHTHEPOLICYPROVISIONS. <br />Hillsborough,NC27278 <br />AUTHORIZEDREPRESENTAnVE <br />TheACORDnameandlogoareregisteredmarksofACORD@1988-2014ACORDCORPORATION.Allrightsreserved. <br />ACORD25(2014/01) <br /> <br />