2016-592-E AMS - Warren-Hay Mechanical Contractors, Inc. - clean, treat HVAC system at ES

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DocuSign Envelope ID: C41A43F4-7FOE-4678-B143-E34641EC9603 ��® ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/29/2016 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 Crystal Ireland NAME: y Business Insurers of Carolinas PHONE (919)968-4611 FAX (919)968-8991 (A/C No E#1: (A/C,No): 800 Eastowne Drive, Suite 208 E-MDREAIL SS:cireland @business-insurers.com AD PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA:Penn National Ins. Companies 14990 INSURED INSURER B:Bridgefield Casualty Insurance 10335 _ Warren-Hay Mechanical Contractors Inc INsuRERc:Philadelphia Insurance Comp 18058 Sheet Metal Duct Suppliers LLC INSURERD: PO Box 818 INSURER E: Hillsborough NC 27278 INSURERF: COVERAGES CERTIFICATE NUMBER CL161514307 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CX90726312 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG_$ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AX90726312 12/31/2015 12/31/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) Endorsements $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ UL90726312 12/31/2015 12/31/2016 $ WORKERS COMPENSATION X I STATUTE I I EOTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory in NH) 0196-40173 12/31/2015 12/31/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 • C PHSD1108639 12/31/2015 12/31/2016 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION abarnes @orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE J Knauff, IV/IRELOI 7 P-27-- - __,- ;,/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S025/7014011