2016-135-E AMS - Statler Gilfillen for Board of Elections storage upfit design

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DocuSign Envelope ID: C5B8B85E-6DD1-43BO-8A3D-A46835EB2CE7 GILFSTI OP ID: C1 7 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 08/12/2015 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 NAME: Philip S.Wolf The Insurance Center of Durham PHONE FAX 1920 Front St.,Suite 710 Igfc tao,EXt)r_919-471-2541 {nrc,No):,919-471 2'132 P.O.BOX 15369 E-MAIL Durham,NC 27704- ADDRESS:Phi l @insuranCecenterOfdurham.com — Philip S.Wolf INSURERS AFFORDING COVERAGE NAIC_#-_- INSURER A:Auto-Owners Insurance Co. 118988 INSURED Statler W. G€lfillen & INSURERS: Valerija Gilfiilen 3302 Saint Marys Rd. INSURER c Hillsborough, NC 27278-9726 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 j --- AMU SUER POLICY CFF POLICY RXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER t MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 -t--- r'DAMAGE 70 RENTED -- -- _. CLAIMS-MADE A OCCUR X 35A47799 oar1112015 08111/2016' PREM)ISES{Ea occurrence)___,$. ..._. 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Excluded r.GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 i,X PRO- l POLICY JECT �_. LOC PRODUCTS COMP/OP AGG �$ _ 2,000,000 OTHER: $ COMBINED SINGLE LIMI T AUTOMOBILE LIABILITY j (Ea accident)- _ BODILY INJURY{Per person) ANY AUTO { san) $ P -)ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTdS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE 1$ .------- OLD RETENTION$ I$ WORKERS COMPENSATION LIABILITY PER ATUTE J___I_ER H'._ �AND EMPLOYERS`LIABILITY Y t N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ NIA OFFICERIMEMSER EXCLUDED? a -- --._..---- ( EMPLOYEE $describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY ;(Mandatory m CY LIMIT $ DESCRIPTION OF OPERATIONS t LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Management Consultant,Architect CERTIFICATE HOLDER CANCELLATION ORAN016 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 8981 Hillsborough, NC 27278 AUTHORIZED REPRESENTA Philip S.Wolf 4 ©1988-2014 ACORD COR RATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I