2016-509-E AMS - Muter Construction for canopy modifications

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DocuSign Envelope ID:2B4514AD-1 E9B-4DC5-B1AD-F2D340A0BB77 MUTER-1 OP Id:TI ACC RQ' I LIABILITY INSURANCE DATE(MMIDD/YYW) 01/13/2015 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:ACT Lindsay C.Frazier, CISR Senn Dunn-GSO 3625 N.Elm St. {nlc°NN,Eat):336-272-7161 FAX No); 336-514-9416 Greensboro,NC 27455 E-MAIL Pressley A.Ridgiil,Jr. ADDRESS: Ifrazier @senndunn.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Co. 10677 INSURED Muter Construction, LLC INSURER B:Hanover Insurance Group John Muter INSURER C: 100 N.Arendell Ave Zebulon, NC 27597 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 S POLICY EFF POLICY EXP TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ENP 0222614 01/08/2015 01/08/2016 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ _ 2,000,000 POLICY X PRO LOC $ JFCT AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A X ANY AUTO ENP 0222614 01/08/2015 01/08/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS JPER ACCIDENT) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE ENP 0222614 01/08/2015 01/08/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X TU- OTH- AND EMPLOYERS'LIABILITY TORY LISTAMITS ER YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 2137567 01/08/2015 01/08/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Leased/Rented IH6-A096902-01 09/03/2014 09/03/2015 Limit 150,000 Equipment Ded 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Cedar Grove Community Center-Roof Replacement Orange County is additional insured with respects to General Liability arising from the operations of the Named Insured as required with written contract. 30 days prior written notice of cancellation except 10 day nonpayment of premium is required to the certificate holder. CERTIFICATE HOLDER CANCELLATION ORANGI6 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. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE v441,( bee ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and Jogo are registered marks of ACORD