Orange County NC Website
DocuSign Envelope ID: E9612703-F25B-492D-9C8C-EC3F9728ECE6 <br /> A CCP RE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 6/29/2016 <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 CONTACT Crystal Ireland <br /> NAME: y <br /> Business Insurers of Carolinas (A/ONN Ext): (919)968-4611 (NC,No): (919)968-8991 <br /> 800 Eastowne Drive, Suite 208 E-MAIL ci <br /> ADDRESS: reland @business-insurers.com <br /> PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Chapel Hill NC 27515-2536 INSURERA:Penn National Ins. Companies 14990 <br /> INSURED INSURER B Bridgefield Casualty Insurance 10335 <br /> Warren-Hay Mechanical Contractors Inc INSURERc:Philadelphia Insurance Comp 18058 <br /> Sheet Metal Duct Suppliers LLC INSURER D: <br /> PO Box 818 INSURER E: <br /> Hillsborough NC 27278 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL161514307 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 EFF POLICY EXP <br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> CX90726312 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X PRO- <br /> POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ 1,000,000 <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED AX90726312 12/31/2015 12/31/2016 BODILY INJURY(Per $ <br /> AUTOS AUTOS ( ) <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accident) <br /> Endorsements $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 <br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 <br /> DED RETENTION$ UL90726312 12/31/2015 12/31/2016 $ <br /> WORKERS COMPENSATION X PER 0TH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? N N/A <br /> B (Mandatory in NH) 0196-40173 12/31/2015 12/31/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> C PHSD1108639 12/31/2015 12/31/2016 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> 1 <br /> CERTIFICATE HOLDER CANCELLATION <br /> abarnes @orangecountync.gov <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> / <br /> J Knauff, IV/IREL01 � �- ;` <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> 1 N S 025(9014011 <br />