Orange County NC Website
DocuSign Envelope ID:5F4478A8-0CA6-4CAC-86F9-CE35131 CD734 <br /> A�° DATE(MM/DD/YYYY) <br /> ® CERTIFICATE OF LIABILITY INSURANCE 6/22/2017 <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 /> CONTACT <br /> PRODUCER NAME: Mitzi Hines <br /> NFP Corporates Services(SE), Inc. PHONE FAX <br /> (C,No,EXt):704-200-9399 (A/C,No):704-973-9501 <br /> 1901 Roxborough Rd, Ste 300 <br /> Charlotte NC 28226 ADDREss:mitzi.hines@nfp.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Zurich North America 16535 <br /> INSURED BAKEROO INSURER B:American Guarantee&Liability 26247 <br /> Baker Roofing Company, Baker Renewable Energy, LLC INSURERC:XL Insurance 37885 <br /> Mercury Realty, LLC; JPB Holdings LLC; Baker South INSURER D:Zurich America Insurance 16535 <br /> Roofing Company, Inc.;Angel Wings 8 LLC <br /> P 0 Box 26057 INSURER E: <br /> Raleigh NC 27611 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:349453952 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 SUBR POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE INSR WVD POLICY NUMBER <br /> (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> A GENERAL LIABILITY Y GL00174014-03 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PR S( RENTED <br /> PREMISES(Ea occurrence) $300,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 <br /> X Contractual Liab PERSONAL&ADV INJURY $1,000,000 <br /> X XCU Included GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> 7 POLICY X Tai X LOC $ <br /> D AUTOMOBILE LIABILITY BAP0174013-03 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT 1,000,000 <br /> (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> X HIRED AUTOS X AUTOS (Per accident) $ <br /> X Comprehensiv X Collision PD Deductible $1,000 <br /> B X UMBRELLA LIAB X OCCUR AUC5525043-05 7/1/2017 7/1/2018 EACH OCCURRENCE $10,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 <br /> DED X RETENTION$10,000 $ <br /> A WORKERS COMPENSATION WC0174015-03 7/1/2017 7/1/2018 X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N I A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> ALease&Rented Equip CPP0174646-03 7/1/2017 7/1/2018 Per Item 150,000 <br /> C Builders Risk MBR0174648-03 7/1/2017 7/1/2018 Any One Project 3,000,000 <br /> Crime-Client Coverage ELU139752-17 7/1/2017 7/1/2018 Per Occurrence 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Orange County is additional insured under the General Liability for work performed by the named insured for such additional insured, if <br /> required by contract signed by an authorized representative of the named insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> P.O. Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> Aolloz' <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />