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DocuSign Envelope ID:693B03F5-75D8-4B13-9FF9-25BE7951 COCF <br /> , PICKROO-01 CSHUMPERT <br /> ',C4C) EY CERTIFICATE OF LIABILITY INSURANCE DATE(MMNDIYr/VI <br /> 61312016 <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 CONTACT <br /> Cindy Shum <br /> Davis-Garvin Agency,Inc.-SC PHONE 3 pert Ax <br /> One Fernandina Court (NC.No,Sul).(803)732-6331 rA C,No):(803)407-5400 <br /> Columbia,SC 29212 A-MAIE Cshum ert <br /> ADDRESS: p @davisgarv(n.com _ <br /> INSURER(S)AFFORDING COVERAGE NAIL# <br /> INSURER A:Carolinas Roofing&Sheet Metal Contractors SIF 20006 <br /> INSURED INSURER S: <br /> Pickard Roofing Company,Inc. INSURER C: <br /> 825 E Trinity Ave INSURER D: <br /> Durham,NC 27704 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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFpF POLICY EXP <br /> INSD WVD POLICY NUMBER IMMIDDPCIT(I_(MM/DD(YYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO REN tED <br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ _ <br /> GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ <br /> O- <br /> POLICY EC I 1 WC <br /> PRODUCTS-COMP/OPAGO $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) _ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED — SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS _AUTOS ( I <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE' $ <br /> EXCESS UAB CLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X PEATUTE EOTy <br /> AND EMPLOYERS'LIABILITY <br /> A ANY PROPRIETORIPARTNER/EXECUTIVE Y./NN NIA X CRS0000057 01/01/2016 01101/2017 EL.EACH $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory lnNH) 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 ff <br /> i <br /> • DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORO 101,Additional Remarks Schedule,may he attached It more space is required) <br /> Job: Old Court House-Hillsborough 1 <br /> i <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I <br /> Orange County NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange nge County ACCORDANCE WITH THE POLICY PROVISIONS- <br /> Hilisborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ZZ--' 19----- r <br /> I <br /> I <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />