2016-387-E DEAPR - Tommy Lawrence Electrical for replacement basketball lighting

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DocuSign Envelope ID:2F91 01 CA-E847-4361-830C-861 FF6446820 --" LAWRE-1 OP ID: BP AiWAY?ta CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) k..- 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 NAME CT Phillip Allen Thompson-Allen,Inc. PHONE 336-599-2175 FAX P.O.Box 100 (A/C N,�Ext): (A/C,No):336-599-6932 Roxboro,NC 27573 EMAIL Barbara Piper ADDRESS: INSURER(S)AFFORDING COVERAGE 1 NAIC 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. —T_.___.—.____.__ INSR F ADDL'$UBR POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE INS() WVO POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE X OCCUR EPP 0096783 08/16/2016 08/16/2017 PDREM SES Ea occur encel $ 100,000 I MEI)EXP(Any one person) s 5,000 I PERSONAL&ADV INJURY $ 500,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ '1,000,000 POLICY T I PRO- POLICY PRODUCTS-COMP/OP AUG $ 1,000,000 _ JECT ------- . OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO EBA 0096783 08/16/2016 08/16/2017 BODILY INJURY(Per person) $ ALL OWNED (LLB SCHEDULED BODILY INJURY(Per accident) $AUTOS AUTOS 11 NON OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS I (Per accident) I ) ^_ $ X 1 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A I EXCESS LIAR CLAIMS-MADE EPP 0096783 08/16/2015 08/16/2016 AGGREGATE $ 5,000,000 I DED RETENTION$ s '.. WORKERS COMPENSATION ,AND EMPLOYERS'LIABILITY STATUTE ERH_ ___ 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/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) 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 Baba a Piper 1 --, ,"--(''G--\tY;ma -A)k.&10----, _ O 1988-2014 ACORD CORPbRATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD