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DocuSign Envelope ID:05BAC521-A573-4502-9361-CAFO7F6BEC40
<br /> ROOFC-1 OP ID: CS
<br /> A�CCAR© ID
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE
<br /> 0412012017
<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(fes)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 /> CONTACT
<br /> PRODUCER NAME: Cindy Smith
<br /> Southeastern Agency Group,Inc. PHONE 33E-232-0203 FAX
<br /> 1501 Highwoods Blvd.,St#301 lac,No.Ea11; lac,no 336-218-7487
<br /> Greensboro,NC 27410 EMAIL
<br /> ADDRESS:csmith@sagnc,COm
<br /> Travis Ketron
<br /> INSURER(S)AFFORDING COVERAGE NAIC M
<br /> INSURER A:Builders Mutual Insurance Co, 10844
<br /> INSURED Roof Control Services of INSURER a:Colony Insurance
<br /> NC Inc
<br /> 104 Rand Park Dr INSURER C:
<br /> Gamer,NC 27529 INSURER 0:
<br /> INSURERS: __.._. _.. ._.._
<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 4RIOD
<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 ADDL.SUER POLICY EFF 'POLICY EXP
<br /> LTR 'NSF) wvn POLICY NUMBER IIMMIDDPYYYY) (MM!DDIYYYY1 LIMITS
<br /> GENEtALUABIUTY EACH OCCURRENCE S 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY CPP0061584 01/0112017 01/0112018 DAMAG es(es 7ED-
<br /> PREM SES(Es oCCVrterice) s 100,000
<br /> CLAIMS-MADE OCCUR MED EXP(Any one person) S 5,000
<br /> ,,,_„,;_,•,,,,, _.:___„
<br /> PERSONAL EADVINJJRY S 1,000,000
<br /> — _ _,w GENERAL AGGREGATE 5 2,000,000
<br /> GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO. 5 2,000,006
<br /> POLICY I Jl jF a I-1 LOC 5
<br /> AUTOMOBILE UAeIUTY COMBINED SINGLE D:M•.T 1 000
<br /> [Eo ectldanl) •S , ,000
<br /> A X ANY AUTO PCAOOi0375- 01/01/2017 01/01/2018 BODILY INJURY(Perpers n; S
<br /> ALL OWNED SCHEDULED BODILY INJURY Per acC 0nt` S
<br /> AUTOS AUTOS I V
<br /> HIRED AUTOS AUTOS ED (PER PAC ICDENTMIGE 5
<br /> 3
<br /> -
<br /> UMBRELLA UAB X OCCUR EACH OCCURRENCE S 5,000,000
<br /> A — EXCESSLIAB CLAIMS-MADE UMB0027820- 01(01/2017 01/01/2018 AGGREGATE S 5,000,000
<br /> DED I X I RETENTIONS 10,000 p 5
<br /> AND EMPLOYERS'LIAEIUTY y I N X(TORY LIMITS I ER
<br /> A YPROP ITCJRTNER/E ECUTVE © CP1030461- 01/01/2017 01/0112018 E.L,EACH ACCIDENT S 1,000,000 AF EREA NIA
<br /> (Mandatory In NH) E DISEASE-EA EMPLOYEE 3 1,000,000
<br /> D SC RdPTaIlO uOF OP
<br /> ERATIONS belay _ E.L.DISEASE•POLICY LIMIT S 1,000,000
<br /> A Equipment CPP0061584.1 01/01/2017 01/01/2018
<br /> B Pollution CSP306909 03/30/2017 03/3012018 Pollution 2,000,000
<br /> DESCRJPTON OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101,AddlIlonsl Rama,Schedule,IT more span Is required)
<br /> See page 2
<br /> •
<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 AUTHORED REPRESENTATIVE
<br /> Travis Ketron
<br /> 1
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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