2016-169-E AMS - Tac Welding to repair drain doors at Animal Services

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DocuSign Envelope ID: D5DO6FFD-4FO6-41F3-995C-9CC783787299 DATE ) 010ERTIFICATE LIABILITY INSURANCE !114/206 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 David Ballard NAME:_ BALLARD INSURANCE AGENCY -PHONE - Fax —-- -" -- — 919-732-2158 __F N�919-732-9636 _(A!C No Exlj__-_--- E-MAIL ballard @ballarda enc inc.com P. 0. BOX 1559 aooRESS;_ _-------._..- 9_Y HILLSBOROUGH NC 27278 _ INSURER(S)AFFORDING COVERAGE INSURERA NAUTILUS INSURANCE COMPANY 17370 INSURED INSURER B: TAC ;dELDING LLC INSURERC: PO BOX 517 tHILLSBOROUGH NC 27278 INSURER D: INSURER 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. _ — -�---- - oot: �B- -POLICY EFF POLICY EXP--� INSR LIMITS LTR i TYPE OF INSURANCE�N SR IVND� POLICY NUMBER tAh11DDlYYYY i M1VAIOD/YWY GENERAL LIABILITY X BN 961618 '01/0612016 01!06/2017 EACH OCCURRENCE S1 ,000 , 000 _ DA A To RFENTE A X COMMERCIAL GENERAL LIABILITY PREtv11SES(Eaaccurrence) $100'000 _ t I CLAIMS-MADE L-�.,OCCUR 1 MED EXP(Any one person) S 5,0 O 0 PERSONAL 8 ADV INJURY s 1'000 , O 0 O — GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER; i ! PRODUCTS-COMPiOP AGG S 2 r 0 0 0:O O O - I 15 X POLICY I LOC I COMBINED SINGLE LI MIT i S AUTOMOBILE LIABILITY (Ea accident) i BODILY INJURY(Per person) S ANY AUTO _ ! ALL OV✓IED SCHEDULED I I BODILY INJURY(Per accident) S - I_--_1 AUTOS SON-O'NAJED I PROPERTY DAMAGE HIRED AUTOS AUTOS 1 j Per aacitlentt i S `UMBRELLA LIAR ( OCCUR I EACH OCCURRENCE $ _ AGGREGATE $ I EXCESS LWB CLARdS-MADE i � --- DED RETENTION S I WC�EAEIMIPLOYE OTH-' WORKERS COMPENSATION OR AND Eh1PLOYFJiS'LIABILITY ANY PROPRICTOR/PARTNER/EXECUTIVE Y� i E.L.EACOFFICERAMEMSER EXCLUDED? U N 1 A(Mandatory in NH) J(E.L.DISE 5 II{It ycs,doscabe under E,L,DISEASE•POLICY LIMIT I S I DESCRIPTION OF OPERATIONS Gelow � f ' DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mores ace Is required) WELDING. CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED PER FORM CG2010 (7/04) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County AUTHORIZED REPRESENTATIVE PO /� ��/ PO Box 8181 /; Hillsborough, NC 27278 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD