2016-161-E AMS - Triangle Landscaping, Inc. to install vents at 129 E. King St.

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DocuSign Envelope ID: 117C8E54-10CE-4683-B69A-59C65B9D939B DocuSign Envelope ID:B9A906BO-9DD2-4524-9A82-04C276B8A99E �.^�..-��7^r�•��-^�A�i.l..—��`I`LJ OP ID :LH D (MMIDO/YYYY)CERTIFICATE OF LIABILITY INSURANCE F05/16/2015 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(les) 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 Phone: 919-6824814 NAME: 'r Lee Hammond The Consulltant Piaco 5uito 102 Fax:919-6824906 PHONE o_Ext);919-682-4814 FAX 919-682-4906 Durham,NC 27707 E-MAIL _. __ talc xo):_, _______ noDRESS�.,lee sor!insurance cam James E.Sorgi,CIC PRODUCER ---- -- — -- - CUSTOMER ID#:TRIALAN NAIC# INSURED Triangle Landscaping Inc, INSURERA:ErieInsuranceExchange 26271 Brad Lewis dba INSURERB; 3582 Fletchers Way _.._.._,. — ------.____-- Stem,NC 27581 INSURER C: INSURER D: - INSURER E: ? INSURER F; I 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. ILT, TYPE OF INSURANCE AD POLICY SUB MIDDr EFF POLICY EXP Limits L POLICY NUMBER MM D D GENERAL LIABILITY EACH OCCURRENCE l S 1,000,00 OANKGETO RIENTEIS X _�_ COMMERCIAL GENERALLL�IABILITY X 02726204479 03/26/2015 03126/2016 PR[MISESjEaaxurrancaL_, S --- CLAIMS•MACE it(OCCL9 MEO EXP(Any one Person) S PERSONAL B ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS,COMP1OP AGG $ 2,000,00 POLICY P 0 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea atrident) - $ 750,00 A ANY AUTO Q032630379 03/26/2015 03/26/2016 - —-------- BODILY INJURY(Per person) $ ALLOWNEDAVTOS `-- --- -- BODILYINJURY(Peraoadent) S X SCHEDULEDAUTp5 PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) --_i NON-OWNED AUTOS S $ UMBRELLA LIAR OCGUi? ! EACH OCCURRENCE _S EXCESS UAB i CWMS-MADE ` AGGREGATE S DEDUCTIBLE _ ��- RETENTION S 3 S i WORKERS COMPENSATION £ WC STATU OTH AND EMPLOYERS'UABIUTY l X TO1 L�- ---- -— X �ANY PROPRIETOWPARTNERIFXECUTIVEYa NIA 0872600559 03/26/2016 03/26120161EL.EACHALC'OENT S 100,00 1 OFFICER,MEMBEft EXCLUDED? (Mandatory in NH) I E L DISEASE•EA EMPLOYEEi S 100,00 It yyes,de;v bounder DESCft1PTI0NOFOPERATIONSbnIaH l i EL DISEASE-POLICY LIMIT 1$ 500,00 A Contractor's equip 0272620479 03/26/2016 03/26/2016!!Equipment 92,30 I � I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more spice is required) Orange County is an additional insured as respects general liability arising from the insured's operations, as required by written contract, per form ULRH. CERTIFICATE HOLDER CANCELLATION 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 AU THORIZED REPRESEN TAnVE O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD