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DocuSign Envelope ID: C55312FA-A914-492C-8FAD-C8F94AB43B19
<br /> OWENS-1 OP ID: TL
<br /> ,4c0R1f) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 11/21/2016
<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 /> CONT
<br /> PRODUCER NAMEACT Benjamin T.Singleton,AAI
<br /> Senn Dunn-Raleigh PHONE FAX
<br /> 4700 Falls of Neuse Rd,St 190 (A/C,No,Ext):919-719-9570 (A/C,No): 919-719-9571
<br /> Raleigh,NC 27609-2521 ADDRESS: bsingleton @senndunn.com
<br /> Benjamin T.Singleton,AAI
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Builders Premier Insurance Co. 13036
<br /> INSURED Owens Roofing,Inc. INSURER B:Builders Mutual Ins.Co. 10844
<br /> Owens-Hart, LLC INSURER C:Crum &Forster Insurance 44520
<br /> 301 W. Cabarrus Street
<br /> Raleigh, NC 27601 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 001
<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 I WVD POLICY NUMBER
<br /> A INSD S POLICY EFF POLICY EXP
<br /> (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PCP000244005 05/01/2016 05/01/2017 DAMAGETO RENTED 100,000
<br /> PREMISES(Ea occurrence) $ �
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X Je r LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000
<br /> (Ea accident) s s
<br /> A X ANY AUTO PCA000733704 05/01/2016 05/01/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE
<br /> HIRED AUTOS AUTOS (Per accident)
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000
<br /> B EXCESS LIAB CLAIMS-MADE UMB002114404 05/01/2016 05/01/2017 AGGREGATE $ 4,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A WCP102219703 01/01/2016 01/01/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A Installation PCP000244005 05/01/2016 05/01/2017 Job Site 3,838,928
<br /> C Pollution 5M/5M PKC-104209 05/31/2016 05/31/2017 Disaster 11,516,784
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County is included as an additional insured with regards to general
<br /> liability as stated in the policy language with written contract prior to
<br /> any loss.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORAN131
<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 /> 131 West Margaret Lane
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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