Orange County NC Website
DocuSign Envelope ID: C90160CC-06D7-4FE9-ABEB-A5DCFB2CB618 <br /> _�.--..,,, OP ID: DR <br /> de%CQRD" DATE(MMIDDIYYYY) <br /> �----- CERTIFICATE OF LIABILITY INSURANCE 04/18/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER Phone: 919-682-4814 NAMEACT Christine Barnett <br /> The Sorgi Insurance Agency Fax: 919 682-4906 PHONE 919-682-4814 Fax <br /> 16 Consultant Place Suite 102 INC,No,Ext): (ac,No): 919-682-4906 <br /> Durham,NC 27707 E-MAIL ESS:chris @sorgiinsurance.com <br /> James E.Sorgi,CIC PRODUCER TRIALAN <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Triangle Landscaping Inc. INSURER A:Erie Insurance Exchange 26271 <br /> Brad Lewis dba INSURER B <br /> 3582 Fletchers Way <br /> Stem, NC 27581 INSURERC: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP W LIMITS <br /> LTR INSR VD, POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY Q2726204479 03/26/2016 03/26/2017 DAMAGES( RENTED <br /> PREMISES(Ea occurrence) $ <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GE IL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY PRO JEGT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 750,000 <br /> A ANY AUTO Q032630379 03/26/2016 03/26/2017 (Ea accident) <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> X SCHEDULED AUTOS <br /> PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per accident) <br /> NON-OWNED AUTOS $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION X WC STATU- TH <br /> O - <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER <br /> Y/N <br /> X ANY PROPRIETOR/PARTNER/EXECUTIVE Q872600559 03/26/2016 03/26/2017 E.L.EACH ACCIDENT $ 100,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> A Contractor's equip Q272620479 03/26/2015 03/26/2017 Equipment 122,875 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> I-1 <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />