2016-516-E DEAPR - Clark Poe Construction, Inc. - removal of lead paint abatement at Hollow Rock Store

Browse Search

DocuSign Envelope ID:41 BE4325-OBD2-422C-9B8E-5573261 DCDC4 ,__--...4)^ POECL-1 OP ID: DS Ac�RL�►"' DATE(MM/DDIYYYY) r,,,_r- CERTIFICATE OF LIABILITY INSURANCE 08/26/2016 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 Christopher Ives Rubish High&Rubish Insurance Agency PHONE FAX P.O.Box 3040 (A/C.No,Ext):919-913-1144 (A/C,No):919 913-1155 6015 Farrington Rd.Ste 101 E-MAIL //�� chrisrhi handrubish.com Chapel Hill,NC 27517 ADDRESS: hrisr@highandrubish.com g Jeffrey A.Rubish INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Owners Insurance Company 32700 INSURED Clark Poe Construction Inc INSURER B:Builders Mutual Insurance Co 134 Granger Rd Chapel Hill,NC 27516-4503 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 ADDL S POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N W SR VD POLICY NUMBER LIMITS {MMIDD/YYW W ) {MM/DD/ YY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 35228565 02/18/2016 02/18/2017 DAMAGE TO RENTED 300 DOD PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 ',... PERSONAL&ADVINJURY $ 1,000,000 ',. GENERAL AGGREGATE $ 3,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 500,000 (Ea accident) $ A X ANY AUTO 5063197100 02/18/2016 02/18/2017 BODILY INJURY(Per person) $ ,, ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTO-OWNED JP R ACC DENT) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- '0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE WCP104101001 08/06/2016 08/06/2017 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 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION ORANG-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORANGE COUNTY ENVIRONMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AGRICULTURE, PARKS AND ACCORDANCE WITH THE POLICY PROVISIONS. RECREATION PO Box 881 AUTHORIZED REPRESENTATIVE HILLSBOROUGH, NC 27278 )�b�v a � 1 l� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD