2016-160-E AMS - Muter Construction LLC for bus stop and library kiosk at CG Comm. Ctr.

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DocuSign Envelope ID:8C7BFBB9-1651-495E-B1AF-E7C87809E899 MUTER-1 OP ID:SM ,4coRC� CERTIFICATE OF LIABILITY INSURANCE DATE 11M/DD/YYYY) 01/28/2016 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: Sonya Noble AAI, CISR Senn Dunn-GSO PHONE FAX 3625 N.Elm St. A/c No EXt:336-346-1305 A/c,No): 336-612-3813 Greensboro,NC 27455 ADDRESS:snoble senndunn.com Russ B.Bell,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company 12572 INSURED Muter Construction, LLC INSURER B: John Muter 100 N.Arendell Ave INSURERC: Zebulon, NC 27597 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 FArl TO CLAIMS-MADE OCCUR S2193761 01/08/2016 01/08/2017 DAMAGE PREMISES S( RENTED 100 OO Ea occu nce rre $ , MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY� ECT � LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 Ea accident s s A X ANY AUTO S2193761 01/08/2016 01/08/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,00 • EXCESS LIAB CLAIMS-MADE S2193761 01/08/2016 01/08/2017 AGGREGATE $ 5,000,00 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER • ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC9029099 01/08/2016 01/08/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 • Crime B6057255 01/08/2016 01/08/2017 Limit 275,00 B Ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Magistrate Project Orange County is listed as additional insured with respects to General Liability and Automobile Liability as their interest may appear per written contract. 30 day notice of cancellation except for non pay 10 days. CERTIFICATE HOLDER CANCELLATION ORAN181 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. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD