2016-398-E DEAPR - McQueen Construction, Inc. - Fairview parking expansion - 6-21-2016, Item 5-i

Browse Search

l DocuSign Envelope ID:2E5A8509-E4CD-4A45-9241-C69B05F6A27D ___—.....4‘1 MCQUE-1 OP ID:NU ACC®REY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1...... 03/21/2016 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(les) 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 Arlene Nunn Senn Dunn-Raleigh PHONE FAX 4700 Falls of Neuse Rd,St 190 IA/C,No,Boll:919.719-9588 (A/c,No):919-348-2754 Raleigh,NC 27609-2521 EMAIL ADDRESS:anunnesenndunn,com James P.Lowrey INSURER(S)AFFORDING COVERAGE NAIC B INSURER A:Builders Mutual Ins.Co. 10844 INSURED McQueen Construction,Inc. INsuRERB:Selective Ins Co of S Carolina 19259 619 Patrick Road INSURER C: Bahama,NC 27503 - 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. INSR TYPE OF INSURANCE ADDLISUBR' POLICY EFF POLICY EXP LTR ,JNSD I MD POLICY NUMBER (MM/DDIYYYY)I(MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S1786111 01/24/2016 01/24/2017 DAMAGE PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY l-J jE L J LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT S 1 000 000 (Ea accident) � !._._. B X ANY AUTO 51785111 01/24/2016(01/24/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ___ AUTOS ------ NON-OWNED PROPERTY DAMAGE $ _ HIRED AUTOS AUTOS (Per accident) )( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 B EXCESS LIAB . CLAIMS-MADE 51785111 01/24/2016 01/24/2017 AGGREGATE $ 6,000,000 I DED X RETENTION$ 0 $ WORKERS COMPENSATION ! X STATUTE ER H (Mandatory NY PRO RIn NH) 01/24/2017 E.L.EACH ACCIDENT $ 1,000,000 AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N7A' WCP1022838 01/24/2016 OFFICER/MEMBER EXCLUDED? El,DISEASE-EAEMPLOYEE'$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below l E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION ORANGI5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Purchasing 200 S Cameron Street AUTHORIZED REPRESENTATIVE Hillsborough,NC 27278 ice/`-"--- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD