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DocuSign Envelope ID:2C304718-BA25-4043-9BDC-F17B3EF664D8 --- -
<br /> 0 DATE(MMJDDNYYY1i
<br /> CERTIFICATE _...
<br /> AC"R" ERTIFICATE OF LIABILITY INSURANCE 8512015
<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 1policy(ies)must the 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 NAMtEA Mitzi-Hines.
<br /> NFP Corporates Services(SE), Inc.
<br /> 74071 Carmel Executive Park C7r, Ste 320 PHONE o- tL7Q4.:2Q0=939 ... - --� � !_i��,N Ai TOA ��-95071
<br /> Charlotte NC 28226 ... ....
<br /> . _ iNSUiRERISJ AFFOR[iINt3 COVERAGE ...- ... _ NAM Yd
<br /> INSURER.„A,, u-Ti.c.-Nortb,Arnerica 535_
<br /> ENSURED BAKEROO INSURER ., merican Guarantee&Liability. ...........
<br /> 262,47..... ..........
<br /> Baker Roofing Company, Baker Renewable Energy, LLC INSUra,.c
<br /> Mercury Realty, LLCI JPB Holdings LLC; Baker South INSURER D,
<br /> Roofing Company,Inc.;Angel Wings 8 LLC
<br /> P 0 Box 26057 ......
<br /> Raleigh NC 27611 1 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:589724416 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE; LISTED BELOW HAVE BEEN ISSLIED "TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTWITHSTANDING ANY REOU3REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT” TO WHICH THES
<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 /> At?gL 5&.DBR... ...... .- ......._— _ - - ' 6y0616Y EFE POLICY EXP _,,,,.----_ ..... ........_.
<br /> LTR' TYPE OF INSURANCE IN POLICY NUMBER MM/L)LrrYYY MMIDDIr"YY LIMITS
<br /> A GENERAL LIABILITY Y GLOO174014-01 711120115 7/112016 EACH OCCURRENCE $1„000,000
<br /> ..,......., I:P' AC L'DC1 RI~tD7ECY — ..........................
<br /> X
<br /> _ MERCIAL GEt10flT�1/;9'DILI'r'Y
<br /> ...
<br /> &C r/,IhftPL CE aaewrrenae.7 S 30GI�0fX?
<br /> AIM°-MAnk.; X CUR MED FXP An one...rsnn' 310,0001
<br /> X i C onlydcluel LreE PERSONAL&ADVINJURY $1,000 000,
<br /> X XCUIncluded GENERAL AGGREGATE. s 2,ugq Ia
<br /> PEN'L AGGREfGATE.LIM41'r APPLOES PER PRCL Ud.TS COM1P)C. AI"C .$2,000 004
<br /> P Di.IGY X P C- LOG $
<br /> A AUTOMOBILE.LIABILITY BARE)174013-01 711.120115 71182016 a OMBINED t,OC9r�,p0©
<br /> .. .....
<br /> .X ANY AId"TO BODILY INJURY Per person) 5
<br /> ALL!D'wf1fNED 1 '{,&it"L79JLFC'7 BPUOIL1'Bh+VJLDRYpeereccidr !} S .....
<br /> _,.,. ALL" AUTO,,
<br /> . ....._.. . ....._
<br /> L�T HIRE1)AUTOS x AUN17S&NNED... PROPERTY accident)DAMAt",E
<br /> A nTCS �r de cy_
<br /> Comprehensiv X Collision RD Deductible $1,000
<br /> B X UMBRELLA LEAR x OCCUR AUCS525043-03 711Y2015 11117 FAC H OCCURRENCE $10,0KEE00
<br /> EXCESS LIAR CL�AVMS-M1�AZDE AGGrREGATE $10,000,000
<br /> _. ....... —
<br /> DED x RETENTEON 10,000 ;S
<br /> A WORKERS COMPENSATION vkC0174015-01 711/2015 78112016 Ix I `nC STATU- OTH
<br /> A.ND EMPLOYERS”LIAWL.ITY YIN ..., TOR.LIM.IVS ... .Ell
<br /> ANY PROPRIFTORYPARTNERPEa]IklTtlV'F�"-'.'� EL EACH A CIDINr $1000000
<br /> u".AIFi ICFFUMEMb9.EER EXCLULDE01 N N!'a .._.._ ..._._....., _._.... ..._,.....,. _..... .....
<br /> (Mandatory EnNHI EL. rDISEASE-EAIEMPLOYF $1,000,000 .-..
<br /> DESCIRip r'ioN CDT'G,.PERATIION,S'beicow �E- DISEASE•r'r"DI IRMY I,IMII't $1,000,000
<br /> ALeaseBReoted Equip CPP0 11 7 46 4 6-Ot 71111 2015 71112016 Per rem 150,000
<br /> Crime MB/01'74648-01 71112015 78112016 Client Coverage 1,000,000
<br /> Builders R'is'k Any One Project 3,0300,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD$01,Additional Reirnarks Schedule,,it more space Is mquiredi
<br /> Orange County is additional insured under the General(Liability for work performed by the named'insured for such additional insured, if
<br /> required by contract signed by an authorized representative of the named insured.
<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 /> P.O Box 8181
<br /> Hillsborough NC 27278 278 AUTHORIZED REPRESENTATIVE
<br /> I A-I�Aoz
<br /> @ 1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(20'10105) The ACO1RD name and logo are registered marks,of ACORD
<br />
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