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DocuSign Envelope ID:489DFD84-DFCE-4EO7-BB35-5F6A708DFA3A <br /> ACC>REP CERTIFICATE OF LIABILITY INSURANCE ) <br /> DATE <br /> 7/10/2015 <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 Mark MCLamb CIC <br /> NAME: <br /> Craft Insurance Center PHONE (336)375-0600 FAX No:x336)375-7009 <br /> 823 North Elm Street E-MAIL <br /> ADDRESS:mmclamb @craftinsurance.com <br /> PO BOX 14946 INSURERS AFFORDING COVERAGE NAIC q <br /> Greensboro NC 27415 INSURERAAll America Insurance Company 0222 <br /> INSURED INSURERB:Central Mutual Insurance 20230 <br /> Lomax Construction, Inc. INSURER C:Builders Mutual Insurance 10844 <br /> PO Box 35169 INSURERD:Peerless Indemnity Insurance 18333 <br /> INSURER E: <br /> Greensboro NC 27425-5169 INSURERF: <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 SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MMIDD MMIDD <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300 000 <br /> PREMISES Ea occurrence $ i <br /> A CLAIMS-MADE OCCUR X Y CLP 7967877 1/1/2015 1/1/2016 M ED EXP(Any one person) $ 5,000 <br /> PERSONAL RADVINJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> POLICY X PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Eaaccld.nl <br /> 1,000,000 <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED X Y AP 7967876 1/1/2015 1/1/2016 BODILY INJURY(Per accident) $. <br /> AUTOS AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> Uninsured motorist combined $ 1,000,000 <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 <br /> B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED I X I RETENTION$ C XS 7967878 1/1/2015 1/1/2016 $ <br /> C WORKERS COMPENSATION Y X WCSTATU- I OTH- <br /> AND EMPLOYERS'LIABILITY Y/N I TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A 0002462713 1/1/2015 1/1/2016 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> JDBand M arine LP 7967877 1/1/2015 1/1/2016 Rental Equipment $100 000 <br /> lders Risk IM957153 1/1/2015 1/1/2016 Builders Risk $5,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) <br /> Project: Department of Social Services Expansion in Hillsborough, North Carolina. <br /> Orange County, Owner, Designer & Designer's Consultants are Additional Insureds on the General Liability <br /> and Automobile policies if required by written contract, agreement or permits only as respects to <br /> operations of the Named Insured on a primary and non-contributory basis. Waiver of subrogation is <br /> provided in favor of the additional insureds under the General Liability, Automobile and Workers <br /> Compensation policies if required by written contract. The umbrella policy is written on "follow the <br /> CERTIFICATE HOLDER CANCELLATION <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 /> Mark McLamb, CIC/RMM �'/`�`'` ?� � <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025(�>ninns)m Tha Ar'r)Rr1 nnma nnri Inrrn nra ranictararl mnrlec nf.Ar-npn <br />