|
DocuSign Envelope ID: 3B5C5DA3-15D1-4BF1-B3BC-63FB8209599D
<br /> q�+- BORDE-2 OP ID: MA
<br /> /iq_ DATE(MMIDDIYW1)
<br /> CERTIFICATE OF LIABILITY INSURANCE 12/05/2016
<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 Ileu of such endorsement(s).
<br /> PRODUCER NAME:ACT Melanie A Airington
<br /> TriSure Corporation-HS PHONE FAX
<br /> 4325 Lake Boone Trail (NC,No,Ext):919-469-2473 (Aic,No): 919-467-4987
<br /> Suite 200 E-MAIL SS:mairingtonctrisure.com
<br /> Raleigh, NC 27607
<br /> Smelcer&Associates INSURER(S)AFFORDING COVERAGE NAIC it
<br /> INSURERA:Phoenix Insurance Company 25623
<br /> INSURED Bordeaux Construction Company, INSURER B:The Charter Oak Fire Ins Co 25615
<br /> Inc. INSURER C:Farmington Casualty Co 41483
<br /> #101
<br /> 135 E Martin St INSURER D:Travelers Indemity Co.of Amer. 25666
<br /> Raleigh, NC 27601 INSURER E:Columbia Casualty Company 31127
<br /> INSURER F:Hanover American Ins Co 36064
<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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMfiS
<br /> LTR INSD WVD POLICY NUMBER (MMIDDIYY) (MMIDDT0Yrfl
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR DTCO2F979366PHX15 12/31/2015 12/31/2016 PREM SES(Ea oc urence) $ 100,000
<br /> E X Professional Liab CPB591886004 03/12/2016 03/12/2017 MED EXP(Any one person) $ 10,000
<br /> Limit$5,000,000 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X pi LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Emp Ben $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> _(Ea accident) $ 1,000,000
<br /> B X ANY AUTO DT8102F979366COF15 12/31/2015 12/31/2016 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X X NO $
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE
<br /> (Per accident)
<br /> X Comp$500 X Coll$500 $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 14,000,000
<br /> D EXCESSLIAB CLAIMS-MADE DTSMCUP2F979366IND15 12/31/2015 12/31/2016 AGGREGATE $ 14,000,000
<br /> DED X RETENTION $ 10000 $
<br /> WORKERS COMPENSATION X STATUTE ERA
<br /> AND EMPLOYERS'LIABILITY
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N DTFUB2F97936615 12/31/2015 12/31/2016 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<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 Leased/Rented QT6607F242185TIL15 12/31/2015 12/31/2016 Limit 150,000
<br /> F Builders Risk IH6A50106101 12/31/2015 12/31/2016 Limit 15,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> 1
<br /> CERTIFICATE HOLDER _CANCELLATION
<br /> ORA8181
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> a County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Oran
<br /> g ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Risk Manager
<br /> P 0 Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|