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DocuSign Envelope ID:296C1EF2-ADDC-421A-8009-A03097D2751D <br /> MCQUE-1 OP ID: NU <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 03121/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME: Arlene Nunn <br /> Senn Dunn-Raleigh PHONE 919-719-9588 FAX <br /> 4700 Falls of Neuse Rd,St 190 AIC No Ell: A/C,No): 919-348-2754 <br /> Raleigh,NC 27609-2521 E-MAIL ESS;anunn@senndunn.com <br /> P.Lowrey SenndUnn.COm <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Builders Mutual Ins.Co. 10844 <br /> INSURED McQueen Construction,Inc. INSURER 8:Selective Ins Co Of S Carolina 19259 <br /> 619 Patrick Road <br /> Bahama,INC 27503 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR TYPE OF INSURANCE ADDL WVD POLICY NUMBER MM/DDY� MMLDDNYYY LIMITS <br /> B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE ® OCCUR S1785111 01/24/2016 01/24/2017 DAMAGE TO RE 100 000 <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> POLICY Fx—]PEC LOC PRODUCTS.COMP/OP AGG $ 3,000,000 <br /> OTHER: I $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ 1,000,000 <br /> B X ANY AUTO 51785111 01/24/2016 01/2412017 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED (BODILY INJURY Per accident <br /> AUTOS AUTOS ) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> $ <br /> X I UM13RELLALIAB X OCCUR EACH OCCURRENCE $ 6,000,000 <br /> B EXCESS LIAB CLAIMS-MADE S1785111 01/24/2016 01/24/2017 AGGREGATE $ 6,000,000 <br /> DED X I RETENTION$ 0 $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN X STATUTE ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE WCP1022838 0112412016 01/2412017 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG15 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron Street <br /> Hillsborough, INC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />