2015-552-E AMS - Dickerson Fencing & Landscaping 131 W. Margaret Ln fencing

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DocuSign Envelope ID:2E150770-7335-4B4E-BDA7-47D76E2FC4C6 A/'��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kate Ewald NAME: SIA Group Inc. A/C NN.,Ext: (910)455-7576 A/C No: (910)455-7481 827 Gum Branch Road E-MAIL certs @sia rou ADDRESS: g p'com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville NC 28540 INSURERA: National Trust Insurance INSURED INSURER B:The Hanover Insurance Company Dickerson Fencing Co. , Inc c1ba Dickerson Fencing and INSURER C: 202 N Hoover Road INSURER D: Lisa Tilley INSURER E: Durham NC 27703-2302 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1592404659 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE T A CLAIMS-MADE 1X OCCUR PREM SESOEa occurrDence $ 100,000 X Y CPPOO11769 10/24/2015 10/24/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Employee Benefits $ 11 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED AUTOS AUTOS X Y CA0017095 10/24/2015 10/24/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist combined $ 1,000,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 UMB0011508 10/24/2015 10/24/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? ❑ N/A A (Mandatory in NH) y 01OWC15A71429 10/24/2015 10/24/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is included as additional insured on the general and auto liability per forms CGL088 and CAU058. Waiver of subrogation applies in favor of the additional insured with regards to workers compensation (WC000313) , general liability (CGL088) , and auto liability (CAU014) per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tammy Comar ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Diana Evans/CHARLH � { -° .•n° � � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(20140 T)