2017-380-E AMS - Warren-Hay Mechanical Contractors Inc. to replace roof top unit at Seymour Center

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DocuSign Envelope ID:A9727DCA-8BA0-4433-8835-A8F70B3CA970 ® DATE(MM/DD/YYYY) CERTIFICATE I 12/19/2016 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 Cr stal Ireland NAME: y Business Insurers of Carolinas (a/c°,No,ExtJ: (919)968-4611 (AC,No):(919)968-8991 800 Eastowne Drive, Suite 208 ADDRESS:cireland @business—insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INsuRERA:Penn National Ins. Companies 14990 INSURED INSURER B:Bridgef ield Casualty In_su_ran ce 10335 !, Warren-Hay Mechanical Contractors Inc INSURER C: Sheet Metal Duct Suppliers LLC INSURER D: PO Box 818 INSURER E: Hillsborough NC 27278 INSURERF: COVERAGES CERTIFICATE NUMBER:CL16121917124 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 I ADDLISUBR POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSD!WVD POLICY NUMBER (MM/DD/YYYY)I(MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A ■ CLAIMS-MADE !, X OCCUR PR E TO RENTED 100,000 PREMISES(Ea occurrence) $ CX90726312 12/31/2016! DIED EXP(Any one person) $ 10,000 12/31/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT X LOC ', ' PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X !ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AX90726312 12/31/2016 12/31/2017 BODILY INJURY(Per accident), $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) - Endorsements X UMBRELLA LIAB X OCCUR ! EACH OCCURRENCE $ 3,000,000 ' EXCESS LIAB A CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTIONS UL90726312 12/31/2016 12/31/2017 $ WORKERS COMPENSATION '.. X PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE )',N/A B E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N _- - -- ---- (Mandatory in NH) - - 0196-90173 12/31/2016 12/31/2017 E L DISEASE EA EMPLOYEE $ 500,000 If yes,describe under ! '�, -- --- ---- ---- --___-- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Leased/Rented Equipment CX90726312 12/31/2016 12/31/2017 LIMIT $50,000 DEDUCTIBLE $500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION abarnes @orangecountync.gov 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 J Knauff, IV/IREL01 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)