2016-684-E AMS - Triangle Landscaping, Inc. for water valve box extensions, concrete donut rings

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DocuSign Envelope ID: CEBE392A-5867-4D11-B672-64E40DB4322F OP,ID: DR CERTIFICATE F LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/18/2016 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 Phone: 919-682-4814 corlracT Christine Barnett The Sorgi Insurance Agency PHONE FAX 16 Consultant Place Suite 102 Fax: 919-682-4906 (JC.No,Ext):919-682-4814 (ac,No): 919-682-4906 Durham, NC 27707 E-MAIL Chris sor iinsurance.com James E.Sorgi,CIC PRODUCER @ g CUSTOMER ID#:TRIALAN INSURER(S)AFFORDING COVERAGE NAIC# INSURED Triangle Landscaping Inc. INSURER A:Erie Insurance Exchange 26271 Brad Lewis dba 3582 Fletchers Way INSURER B Stem, NC 27581 INSURER C INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 INSR WVD POLICY NUMBER JMMLDDY/YYYY) (MM/DDYr�), LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY Q2726204479 03/26/2016 03/26/2017 DAMAGES(RENTED PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO Q032630379 03/26/2016 03/26/2017 (Ea accident) 750,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WCSTATU- 0TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER X ANY PROPRIETOR/PARTNER/EXECUTIVE Q872600559 03/26/2016 03/26/2017 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Contractor's equip Q272620479 03/26/2015 03/26/2017 Equipment 122,875 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 1-4 amykrovrrort ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD