2016-487-E AMS - Hillsborough Plumbing Co, Inc. to replace water pump and piping

Browse Search

DocuSign Envelope ID:7C64F6F6-183B-4CE7-90AC-CB4486B1 EBDO AC J CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/16/2016 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 NAME: Colonial Insurance Agency Hillsborough AICONN.Ext): (919)732-2191 A/C,No): (919)732-2192 E-MAIL ADDRESS: PO Box 490 INSURER(S)AFFORDING COVERAGE NAIC II HILLSBOROUGH NC 27278 _INSURER A:Owners 32700 INSURED INSURER B: Hillsborough Plumbing Company Inc INSURER C: 1020 Nc Highway 57 INSURER D: INSURER E: Hillsborough NC 27278-8987 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1651601634 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 INSD WVD POLICY NUMBER (MM/DDIIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR PREMISES S( RENTED occurrence) $ 300,000 35203246 5/14/2016 5/14/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 79 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: • Premises/Operations $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 4725694701 5/14/2016 5/14/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Uninsured/Underinsured $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ 4725694700 5/14/2016 5/14/2017 $ WORKERS COMPENSATION X STATUTE OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED?(Mandatory In NH) 35041871 5/14/2016 5/14/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Leased or Rented 35203246 5/14/2016 5/14/2017 Limit 50,000 Equipment Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) . Job: John Link Building - Mop Sink Certificate Holder is addiitonal insured with respects to General Liability by signed written contract. CERTIFICATE HOLDER CANCELLATION psorrell @orangecountync.go SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE CARLA MOORE/CARLAz41—_-4--- 9._ '7`2'� p n ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S025(7n14m i