2017-195-E Planning - Hillsborough Plumbing Company Inc. to install RPZ at Brookhollow pump station

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DocuSign Envelope ID: 93098A2A-6990-46FE-8E24-D3170617D942 A�RI DATE(MM/DD/YYYY)® CERTIFICATE OF LIABILITY INSURANCE 5/11/2017 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). PRODUCER CONTACT NAME: Colonial Insurance Agency Hillsborough PHONE// o EA; (919)732-2191 _(A/C, No): (919)732-2192 E-MAIL ADDRESS: PO Box 490 INSURER(S)AFFORDING COVERAGE NAIC# HILLSBOROUGH NC 27278 _INSURER A:Owners 32700 INSURED INSURER B: Hillsborough Plumbing Company Inc INSURERC: 1020 Nc Highway 57 INSURERD: INSURER E: Hillsborough NC 27278-8987 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1751102196 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED , A CLAIMS-MADE X OCCUR 300 000 PREMISES(Ea occurrence) $ X 35203246 5/14/2017 5/14/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER Premises/Operations $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 4725694701 5/14/2017 5/14/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) Uninsured/Underinsured $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 4725694700 5/14/2017 5/14/2018 $ WORKERS COMPENSATION J STATUTE ....J EOTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) 35041871 5/14/2017 5/14/2018 E L D I S E A S E E A E M P L O Y E E $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 A Leased & Rented 35203246 5/14/2017 5/14/2018 Limit 50,000 Equipment Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is additional insured with respects to General Liability by signed written contract before a loss. CERTIFICATE HOLDER CANCELLATION areinert @orangecountync.go SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE CARLA MOORE/CARLA _ "r `` :a � )' rwi'" ✓�: .2?. '. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025omam)