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DocuSign Envelope ID: E4652A7D-FDAF-4F3C-BFA4-22CB029C0980
<br /> BIRSI-2 OP ID: LE
<br /> =05'1041201 YY )
<br /> CERTIFICATE OF LIABILITY INSURANCE 5
<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 fire 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 NAME: T Lynne A Meyer,CIC,CPIW,AIMS
<br /> Senn Dunn
<br /> -GSO _
<br /> 3625 N.Elm St. (AICONY�e,Ext)336-346-1302 �_AIX,Noy:336-612-3818
<br /> Greensboro,INC 27455 E.fAA$L er c
<br /> David R.Clem,CIC ADDRESS:Ime y @senndunn.conT
<br /> INSURER(S)AFFORDIN'.G COVERAGE, N'AIC p.
<br /> INSURER A:Transportation Insurance Co. 20494
<br /> INSURED BIRS, Inc. INSURERB:Builders Mutual Ins. Co. - 10844
<br /> Mr. Raven Broeker . . .._.__ p
<br /> PICT Box 36197 INSURER C Columbia Casualt y Company 31127
<br /> Greensboro, NC 27416-6197 INSURER D
<br /> INSURER,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 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 ............. DDL SUBR ...-. -_ POLICY EFF POLICY EhP,
<br /> LTR INSD GWVD POLICY NUMBER j1AMIDDffyYYi !f.lP'1fDDfyyYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH 000U;RRENGE. $ 1,000,00
<br /> CLAIMS-N.IADE OCCUR 014171978219 0510112015 05101120141 PRE1MI ES Ea occurrence $ 100,00
<br /> MFDFXP(Any one person) $ 5,00
<br /> PERSONAL&ADV INJURY $ 1,0001041-
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
<br /> 1131, F7
<br /> POLICY I °' 1 JEGT LOG
<br /> PRODUCTS-COMPiOP AGO 2,000,00
<br /> 07HER: $
<br /> AUTOMOBILE LIABILITY 1 CO II131N'ED SINGLE LIMIT
<br /> Ea act#dens $ _ 1,000,00
<br /> A X ANYAUTO C1071978222 051011201510510112016 BODILY INJURY(Per person) $
<br /> ALLONfNED
<br /> UTOS SCHEDULED
<br /> A AUTOS BODILY INJURY(Per aceidenl)
<br /> ' ' X NON-OWNED PROPER DAMAGE
<br /> .....
<br /> Per acX HIRED AUTOS AUTS cideC $
<br /> ComplColl Ded 1,004111,00
<br /> X UMBRELLA LIAR X�OGCUR EACH OCCURRENCE $ 5,000,00
<br /> .. .........
<br /> A Excess LIAR 01071978253 0510112015 05101/2016 AGGREGATE $ 5,000,00 DED X RETENTION$ 10,'000! $
<br /> WORKERS COMPENSATION PER OTH
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> B ANY PROPRIETORIPARTNERIEXECUTIVE YIN PW0100029002 0510112015 0510112016 E L EACH ACCIDENT $ 500,00
<br /> OFFICERIMEMBER EXCLUDED? �NIA
<br /> -
<br /> (Mandatory In NHI F.L.DISEASE-EA FI.IPLOYF S 500,00
<br /> If yes,describe under ......
<br /> DESCRIPTION OF OPERATIONS be.'o•.0 E.L.DISEASE-POLICY LIMIT I$ 500,00
<br /> A Rental Equipment 01071978219 05101/2015 05/0112016 Limit 100,00
<br /> C E S 01POIlUtion CE05091855996 0510112015 0510112016 Limit 1,000,00
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.,may be attached if more space Is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANINS
<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 REPRESENTATIVE
<br /> AUTAIORI2E0[JREPpRE //'(��ryr
<br /> 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014101) The ACORD name and logo are registered'marks of ACORD
<br />
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