2016-386-E DEAPR - Tommy Lawrence Electrical for replacement walking track lighting

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DocuSign Envelope ID:021 EDE57-BA89-4F50-B24D-4B48F14E6FC9 -^"'°`„1 LAWRE-1 OP ID: BP /t C"C0IIf) DATE(MMIDD/YYYY) 1 CERTIFICATE OF LIABILITY INSURANCE 07/19/2016 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 Thompson-Allen,Inc. PHONE Phillip Allen Fax P.O.Box 100 (Arc,No.Ext):336-599-2175 (Arc,No): 336-599-6932 Roxboro,NC 27573 EMAIL Barbara Piper ADDRESS; INSURER(S)AFFORDING COVERAGE 1 NAIL£1 _ INSURER A:Cincinnati Insurance Company 10677 INSURED Tommy Lawrence Electrical INSURER B.:Cincinnati Casualty Company 28665 P.O. Box 641 — Roxboro, NC 27573 INSURER C; INSURER D: INSURER E: 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. ILTR I TYPE OF INSURANCE NSP wvp POLICY NUMBER POLICY EFF I POLICY EXP LIMITS (MM/DD/YYYY) (MMIDDlYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE X OCCUR EPP 0096783 08/1612016 08116/2017 pREM SESO(Ea oacurrencey $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY l PE0 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO EBA 0096783 08/16/2016 08/16/2017 BODILY INJURY(Per person) $ — ALL OWNED ri SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS ( I AUTOS (Peracciden,)-_ II IIII $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A 'EXCESS LIAB CLAIMS-MADE EPP 0096783 08/16/2015 08/16/2016 AGGREGATE '$ 5,000,000 _ DED 1 RETENTIONS _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EWC 0368238-00 • 01/01/2016 01/01/2017 E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N I A —" -- (Mandatory In NH) F,.L.DISEASE-EA EMPLOYEE 5 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Sohodulo,may bo attached II more space Is requirad) Re: Cedar Grove Basketball Courts CERTIFICATE HOLDER CANCELLATION ORANGEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. C/O DEAPR-Lori Taft P.O.Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 Ba ba a Piper 1 \--1 r tYZIAn. C-A9-)0--a--N,.. _ ©1988-2014 ACORD CORPbRATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD