2016-240-E AMS - Intellicom, Inc. to install cables in Whitted Rm. 210

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DocuSign Envelope ID: DA583654-9F26-4D03-8996-80949B3474CA ACO CERTIFICATE F LIABILITY INSURANCE DATE(MMIDD, 3/28/2016 16 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 House Account NAME: Pelnik Insurance PHONE E (919)459-8000 NC No;(919)959-8019 100 Ridgeview Drive ADDRESS: Suite 100 INSURERS AFFORDING COVERAGE NAIC it Cary NC 27511 INSURERA:Selective Ins Cc of America 12572 INSURED INSURER B Builders Mutual Insurance Cc 10844 INSURER C: PLC Communications Inc. DBA: Intellicom Inc. INSURER D: 2902 S Miami Blvd Ste C INSURER E: Durham NC 27703 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632813089 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 INSD WVQ POLICY NUMBER POLICY POLICY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS-MADE �X OCCUR DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ r S 2162397 4/1/2016 4/1/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 1 X POLICY❑ PRO- ❑ LOG PRODUCTS-COMP/OP AGO $ 3,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY (CEO, ccident MBINED SINGLE LIMIT $ 1,000 i 000 a A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED S 2162397 4/1/2016 4/1/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ Uninsured motorist property $ X UMBRELLA LIAB OCCUR EACH OCCURRENCEE $ 6,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 6,000,000 DED I X I RETENTION$ 0 S 2162397 4/1/2016 4/1/2017 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY Y/N STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? B (Mandatory In NH) PWC1010380 4/1/2016 4/1/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Leased Rented Equipment s 2162397 4/1/2016 4/1/2017 Limit 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 181,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (919) 644-3324 f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN t PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Steven Stacy/STACY ©1988-2014 ACORD CORPORATION. All rights reserved: ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0251�n1ann