|
DocuSign Envelope ID:038AA2A6-7F79-44E1-8EFB-45387C88C836
<br /> L ;uSign'Envelope ID:D62F2210-0C4B-4230-A651-1AABDDF342CE
<br /> SUNRCON OP ID:CB
<br /> A. ' DATE
<br /> CERTIFICATE LIABILITY INSURANCE NC 071271 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 pollcy(les) 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 CONTACT
<br /> The Sorg! Insurance Agency Phone:919-682-4814 NAME; Christine Barnett
<br /> 9 PHONE FAX
<br /> 16 Consultant Place Suite 102 Fax:919-682-4906 c No,Exq: 919-682.4814 (ac,No): 919-6132 490-6
<br /> Durham, NC 27707DDRESS:chris @sorgiinsurance.com
<br /> Rodney Allison
<br /> INSURER(S)AFFORDING COVERAGE NAIC f
<br /> INSURERA:Erie Insurance Exchange 26271
<br /> INSURED Sunrise Contracting INSURER B:Builders Mutual Insurance Co;
<br /> Services LLC
<br /> 4603 Hillsborough Rd Ste H INSURER C:
<br /> Durham, NC 27705 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 ADUL SUBK POLICY EFF POLICY-EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDDrYYYYI IMMIDDIYYYY) LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY 4381350687 02/13/2016 02/13/2017 DAMAGE to RENTED
<br /> PREh115ES(Ea occurrence) $ 2,000,000
<br /> CLAIMS-MADE X OCCUR •MED'EA'(My one.person) $ 10,000
<br /> PERSONAL&ADV INJURY ,$ 2,000,000
<br /> • GENERAL AGGREGATE $ 4,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> ) -1.POLICY^PE0. LOC '$
<br /> .AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accident) $ 1,000,000
<br /> A ANY AUTO 0010141609 02/13/2016 02/13/2017 BODILY INJURY(Per person) $
<br /> ALL
<br /> OWNED X zOEDULED
<br /> BODILY INJURY.(Per accident) $
<br /> AUT
<br /> AOSWNED. PROPERTY HIRED AUTOS Peracnt) $ -
<br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAR CLAIMS-MADE 0261370214 02/13/2016 02/13/2017 AGGREGATE $ 5,000,000
<br /> DED RtIENTION $ $
<br /> WORKERS COMPENSATION X W ST 7U OTH
<br /> AND EMPLOYERS'LIABILITY "YIN TORY LPMRS ER
<br /> B ANYPROPRIETORIPARTNERIEXECIJIIVE WCP2545512 11/18/2015 11/18/2016 E.LEACHACCIDENT $ 1,000,000
<br /> OFFICER IEMBEREXCLUDED?' N NIA
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,600
<br /> Iryes,describe under
<br /> DESCRIPTION OF OPERATIONS below E,L.DISEASE—POLICY LIMIT_$ 1,000,000
<br /> A nland Marine Q381350687 02/13/2016 02/13/2017 Contr.Equ 41,500
<br /> A "Special Form' PROPERTY 02/13/2016 02/13/2017 Rental Eq 25,000
<br /> DESCRIPTION OF OPERATIONS I 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 /> a CCUn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange ry ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> 01988-2Q1,OACORD.CORPORATION. All rights reserved. •
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|