2016-691-E AMS - W.L. Bishop Construction Company for Whitted complex flooring upgrades

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DocuSign Envelope ID: EFA03109-4B44-47A5-81 C8-B2143EC99265 BISHOPI OP ID: SB CC:P CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `••..■ 11/29/2016 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). CONT PRODUCER NAMEACT Tara J.Smithwick First Insurance Services,Inc. P.O.Box 13687 PHONE,EXt):919-941-0549 FAX No): 919-941-0135 RTP,NC 27709 E-MAIL Tara J.Smithwick ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company A 12572 INSURED WL Bishop Construction Co INSURER B:Builders Mutual Insurance Co A 10844 2211 Leah Road Hillsborough, NC 27278 INSURERC: 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. IN SR TYPE OF INSURANCE I POLICY EFF POLICY EXP INSD WVD POLICY NUMBER /Y LIMITS (MM/DD YYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X S 1991921 09/04/2016 09/04/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 (Ea accident) , , A X ANY AUTO S 1991921 09/04/2016 09/04/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X N PROPERTY DAMAGE ON-OWNED AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 1991921 09/04/2016 09/04/2017 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/" B ANY PROPRIETOR/PARTNER/EXECUTIVE WCP1020372 EXCLUDE 09/04/2016 09/04/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) MIKE&WILLIAM BISHOP E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Contractors Equip S 1991921 09/04/2016 09/04/2017 Limit 75,000 Leased/Rented Deductibl 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is additional insured for General Liability if required by written/executed contract, before a loss. CERTIFICATE HOLDER CANCELLATION ORANGCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oran g ty ACCORDANCE WITH THE POLICY PROVISIONS. 131 W. Margaret Lane,Ste 301 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 6 - f -� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD