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DocuSign Envelope ID:C7ABE99F-89B4-4BB8-9782-923F44F48F53 <br /> PICKROO-01 SJOHNSON <br /> .4,C"C: DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 12/16/2016 <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 Cindy Shumpert <br /> Davis-Garvin Agency,Inc.-SC PHONE FAX <br /> One Fernandina Court (A/C,No,Ext):(803)732-6331 (A/C,No): (803)407-5400 <br /> E-MAIL arvin.com t erdavis <br /> hum <br /> Columbia,SC 29212 ADDRESS:cs p @ 9 <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Carolinas Roofing&Sheet Metal Contractors SIF 20006 <br /> INSURED INSURER B: <br /> Pickard Roofing Company,Inc. INSURER C: <br /> 825 E Trinity Ave INSURER D: <br /> Durham, NC 27704 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 INSD S W POLICY EFF POLICY EXP <br /> NSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYW) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE RETED <br /> CLAIMS-MADE OCCUR PREMISES O(Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS ■ AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X PER 0TH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> Y N <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE NN/A CRS0000057 01/01/2017 01/01/2018 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 1 000 000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Job: Old Court House-Hillsborough <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County NC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> Z//- <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />