|
DocuSign Envelope ID: B2AEF412-BOEF-459E-B763-A53572F54A27
<br /> 5THWA-1 a'P ID:AJ
<br /> CERTIFICATE F LIABILITY INSURANCE 02/2312015
<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 13Y THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATI'V'E OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed'. If SUBROGATION I5 WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not conifer rights to the
<br /> certificate holder In lieu of such endorsement(s),
<br /> PRODUCER CONTACT Anna Jan.....e Coltraitt
<br /> Hartsfie'Id&Nash Agt:ncy,Inc. .PH❑NE..._., Fax
<br /> Post Office Box 1149 & EXti,919 556 369$ _. ...__._... c,roe)
<br /> Wake Forest,NC 27588 E-MAIL
<br /> Loris Borrelli,CIC,AAI ADDRESS. anna hartsfield-nash.corn.........
<br /> iNSURER'1sl AFFnaDwiue covElvtcE NaIC a
<br /> _.. INSURER Hartford Casualty Ins Co 29424
<br /> INSURED 5th Wall Building Diagnostics ._ ....,_ .m.._ ....
<br /> g 9 INSURER Lexington Insurance Co 19437
<br /> Consultants,LLC __...
<br /> 9601 Bailyviiick Rd INSURER C
<br /> Raleigh,NC 2761115 "NSURr Ica
<br /> INSLiRER 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'P'OLICY 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„Frr IIHS' ........... ... ......._ .._,....... _.._. .......,AIMS §mLlaTt ....m.._._.. ___..,.... .. ..,.,.,.,.,._......_ ._i'DL1CY"EFF,. PC7i<i' `N'ExW .....__._______................... .... ....._. ........._ _..
<br /> LTR TYPE OF INSURANCE POLICY NUMBER IMIMIDDIYYYYI (MMIDDtyyyyl LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,404,00'
<br /> aD Mater Y d5}TS .. . ... ...._
<br /> A X I COMMERCIAL GENERAL LIABILtlTp° 1225BAVF4499 12141/2414 12NtI112D15 PFt,EM15E5(E_a,,caccurrenee � 3tICD,tI4
<br /> .,�CLAIMS-MADE IX I OCCUR MED EXP(Any one person) �$ .10,00(
<br /> _.- . ----- -.......--
<br /> PERSONAL:ADV INJURY $ 2,000,00
<br /> rGENERALAGGREGATE $ 4,400,00(
<br /> _. . .. ......— . ............ ......_......_
<br /> _GENT AGGREGATE LIMIT APPLIES PLR: PRODU4TS-G4MP14P AGG $ 4,000,00
<br /> __.......... -
<br /> POLICY ._ PRO- LDC. S
<br /> AUTOMOBILE LIABILITY COMMINED SINGLE LIMIT
<br /> �(Ea_accodeni}
<br /> _S$......,,_. 2,400,04!
<br /> A ANY AUTO 22SBAVF0089 1214112414 12/01/2415 BCNDILY INJURY(Per person) S
<br /> ALLOW SCHEDULED .....__._ ......._._....... . .... ............... ............
<br /> ....,... AUTOS AUTOS BODILY INJURY(Per acaderrtl 5
<br /> '
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS + AUTOS
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE S 1,000,00
<br /> A EXCESS LIAB CLAIMS-MADE 22SBAVFOOBS 12101/2014 121011'2015 AGGREGATE s
<br /> ....... .. ....... ................,_. ._...�........... _ ..........
<br /> DECD X RETENTION S S
<br /> WORKERS COMPENSATION WC STATU- 4TH-
<br /> AND EMPLOYERS'LIABILITY YIN, .� ,-U. T
<br /> ANY PROPRIETCR)PARTNERIEXECUTIVE E.L.EACH ACCIDENT - $ .......
<br /> OFFICERWEMBER.E::XCLUIDED? NIA ...._..m..mm ...., ._................ ._...... ...... ...., .........
<br /> (Mandatory in NH),. E.L,DISEASE-EA EMPLOYEE S
<br /> If yes descnbe under .......... ...___.... ........ ....,.,.,. . .... ... .
<br /> DESGRIPTI'ON OF OPERAIr IONS below E.,L.DISEASE-POLICY LIMIT S
<br /> B Professional 43926702 42/1212014 0211212016 Occur 1,000,40
<br /> Liability Aggregate 1,000,00
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACRD 541,Additional Remarks Schedule„if more space is required)
<br /> RE:Cates Farmhouse Blackwood Farmhouse
<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 81181
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTAT`[VE
<br /> 1988-2414 ACORD CORPORATION. All rights reserved.
<br /> ACORD 26(2014105) The ACORD name and logo are registered'marks of ACORD
<br />
|