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DocuSign Envelope ID: DECF6679-6CE4-4F10-9268-935C4585D3D8
<br /> .----- 1 CTWIL-1 OP ID: LO
<br /> ACORL7' DATE(MMIDD/YYYY)
<br /> k.......----- CERTIFICATE OF LIABILITY INSURANCE 04/10/2017
<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 /> PRODUCER CONTACT Lori Hamlet
<br /> TriSure Corporation-KS PHONE FAX
<br /> 4325 Lake Boone Trail (A c,No,EXt):9l9-469-2473 (A/C,No): 919-467-4987
<br /> Suite 200 E-MAIL (hamlet @trisure.com
<br /> Raleigh,NC 27607 ADDRESS:
<br /> Sokolowski&Assoc., LLC INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Cincinnati Insurance Co. 10677
<br /> INSURED CT Wilson Construction Co, Inc INSURER B:Greenwich Insurance Co. 22322
<br /> Charles Wilson,Jr. INSURER C:Selective Insurance Co. 12572
<br /> PO Box 2011
<br /> Durham, NC 27702 INSURER D:
<br /> INSURER E:
<br /> _ INSURER F:
<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 SUBR POLICY EFF POLICY EXP W LIMITS
<br /> LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR EPP0149137 07/01/2016 07/01/2017 DAMAGE TO RENTED 100,000
<br /> PREMISES(Ea occurrence) $
<br /> X X,C,U MED EXP(Any one person) $ 10,000
<br /> PERSONAL S ADV INJURY $ 1,000,000
<br /> GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY X ' LOC PRODUCTS-COMP/OPAGG $ 3,000,000
<br /> OTHER: Emp Ben. $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO EBA0149137 07/01/2016 07/01/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS ON AUTOS (Per accident)
<br /> $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> A EXCESS LIAB CLAIMS-MADE EPP0149137 07/01/2016 07/01/2017 AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ -0- $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE EWC0394380 07/01/2016 07/01/2017 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 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Rent/Leased Equip S2128637 07/01/2016 07/01/2017 Limit 100,000
<br /> B Prof/Pollution Lia PEC0026780 07/01/2016 07/01/2017 Limit 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> C Builders Risk Policy No. S2128637 7/1/2016 to 7/1/2017 Limit $20,000,000
<br /> Operations of the Named Insured covered by the above referenced policies.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORA131X
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g tY ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Inspection Department
<br /> 131 West Margaret Lane AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278
<br /> ilial-A 1. Alma-
<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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