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DocuSign Envelope ID: 7AE8A4FO-DD4C-48AF-9407-33164957C9A2
<br /> ROOFC-1 OP ID:C5
<br /> ACC7R 1-3.. CERTIFICATE OF LIABILITY INSURANCE DATEIMMfDDIYYYY)
<br /> 04120!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 B EEN 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 NAME CT Cindy Smith
<br /> Southeastern Agency Group,Inc. PHONE 232-
<br /> 336- 0203 FAX
<br /> 1501 Higghwoods Blvd.,St#301 f1 VC.NQ.EMI: _IA1c,No 336-218-7487
<br /> Greensboro,NC 27410 cross*csmith ce�sagnc.com
<br /> Travis Ketron INSURER(S)AFFORDING COVERAGE NAIC
<br /> INSURER A:Builders Mutual Insurance Co. 10844
<br /> INSURED Roof Control Services of INSURER B:Colony Insurance
<br /> NC Inc INSURER C 104 Rand Park Dr -
<br /> Gamer,NC 27529 INSURERD:
<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 I TYPE OF INSURANCE INSR I U6� PMID Y EFF i Pwoo YY
<br /> INSR Wyp POLICY NUMBER fMMlOD1YYWl (MMlDOrYYYYI LIMITS
<br /> GENERAL UABIUTY
<br /> EACH OCCURRENCE S 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY CPP0061584 01101/2017 01/0112018 DAMAGEC(RENTED
<br /> PREM'SES(Ea occu co) $ 100,000
<br /> CLAIMS-MADE X J OCCUR MED EXP(Any one person) S 5,000
<br /> PERSONAL&ADV INJ,,IRY 5 1,000,000
<br /> GENERAL AGGREGATE S 2,000,000
<br /> GENL AGGREGATE LIMIT APPLES PER PRODUCTS•COMP/OP AGO S 2,000,000
<br /> POLICY X JE J I I LOC
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE L M T
<br /> (Ea accident) S 1,000,000
<br /> A X ANY AUTO _ PCA0010375- 01/0112017 0110112018 BODILY INJURY(Per person
<br /> ',. S
<br /> — ALL OWNED SCHEDULED BODILY INJURY(Per acodenl' $
<br /> _ AUTOS AUTOS
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS (PER ACCIDENT)
<br /> S
<br /> UMBRELLA LAB X OCCUR EACH OCCURRENCE 5 5,000,000
<br /> A EXCESS W1B ■' CLAIMS•MADE UMB0027820-
<br /> 01/01/2017 0110112018 AGGREGATE S 5,000,000
<br /> DED X RETENTIONS 10,000 ++ p
<br /> WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X 1TORY LIMITS I I ERI
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y f N WCP1030461- 01/0112017 0110112018 E L EACH ACC DENT s 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? © N I A
<br /> (Mandatory in NH) E L DISEASE=EA EMPLOYEE 5 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below EL.DISEASE POLICY LIMIT S 1,000,000
<br /> A 'Equipment CPP0061584.1 0110112017 01101/2018
<br /> B Pollution CSP306909 0313012017 03130/2018 Pollution 2,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more space Is required)
<br /> See page 2
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGEC
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 200 South Common St
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Travis Ketron
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
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