2016-681-E AMS - Pickard Roofing Company, Inc. to remove gutters for fascia board repairs

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DocuSign Envelope ID:8ACECC22-FA6C-4199-B37B-E8B08A81 BA4E ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/17/2016 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 Kate Ewald NAME: SIA Group Inc PHONE (910)455-7576 FAX (910)455-7481 (A/C,No,Ext): (A/C,No): 827 Gum Branch Road E-MAIL rou certs @sia ADDRESS:certs@siagroup.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville NC 28540 INSURERA:PA National Mutual Cas Ins Co 14990 INSURED INSURER B: Pickard Roofing Co. , Inc. INSURER C: PO Box 76 INSURER D: INSURER E: Durham NC 27702 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15123007070 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 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ CL90644169 1/1/2016 1/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 7.8_, LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Property damage-single limit $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS AU90644169 1/1/2016 1/1/2017 BODILYINJURY(Peraccident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) Uninsured motorist combined $ 1,000,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 UL90644169 1/1/2016 1/1/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Leased/Rented Equipment CL90644169 1/1/2016 1/1/2017 Per item 250,000 Maximum Limit 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as Additional Insured for general liability, as per written contract. CERTIFICATE HOLDER CANCELLATION jeff @5thwallbdc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Diana Evans/SUSANS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7m4m i