2015-638-E AMS - Intellicom, Inc. for CG Comm. Center wiring

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DocuSign Envelope ID:A2BEC72B-1019-4ECC-A6DB-E6EE96E550F3 ACORD DATE(MM/DD/yYYY) CERTIFICATE OF LIABILITY INSURANCE 4/1/2015 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 Steven Stacy Pelnik Insurance PHONE (919)459-8000 FAX (919)959-8019 (A/C.No.Exth (A/C,No): 100 Ridgeview Drive ADDRess:Steve.Stacy @Pelnik.com Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# Cary NC 27511 INSURERA:Selective Insurance INSURED INSURER B:Builders Mutual Insurance Co 10844 Intellicom Inc. INSURER C: 2902 5 Miami Blvd Ste C INSURERD: INSURER E: Durham NC 27703 INSURER F: COVERAGES CERTIFICATE NUMBER:CL154112016 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 SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100 000 PREMISES(Ea occurrence) 5 2162397 9/1/2015 9/1/2016 MEDEXP(Anyoneperson) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY jBCI LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED S 2162397 4/1/2015 9/1/2016 BODILY INJURY(Per $ AUTOS AUTOS ( accident) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accdent) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 6,000,000 DED RETENTION$ S 2162397 9/1/2015 9/1/2016 $ WORKERS COMPENSATION X P OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B (Mandatory In NH)EXCLUDED? N/A PWC1010380-TEMP 4/1/2015 4/1/2016 ( rY ) E.L.DISEASE-EA EMPLOYEE $ 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) CERTIFICATE HOLDER CANCELLATION (919) 644-3324 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Purchasing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN & Central Services ACCORDANCE WITH THE POLICY PROVISIONS, PO Box 8181 i Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE I Steven Stacy/STACY ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(7014m1