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DocuSign Envelope ID: DEDD4569-55A7-4D92-BAOF-43E09E7A4835 BISHOP1 OP ID: SF
<br /> AC DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 08/11/2017
<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 /> PRODUCER NAME:ACT Tara J.Smithwick
<br /> First Insurance Services,Inc. PHONE FAX
<br /> P.O.Box 13687 (A/C,No,Ext):919-941-0549 (A/C,No): 919-941-0135
<br /> RTP, NC 27709 E-MAIL
<br /> Tara J.Smithwick ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Selective Insurance Company A 12572
<br /> INSURED WL Bishop Construction Co INSURER B:Builders Mutual Insurance Co A 10844
<br /> 2211 Leah Road INSURER C
<br /> Hillsborough, NC 27278
<br /> INSURER D:
<br /> 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X S 1991921 09/04/2017 09/04/2018 DAMAGE TO RENTED 500 000
<br /> PREMISES(Ea occurrence) $ ,
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY X Fire,-- X LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO S 1991921 09/04/2017 09/04/2018 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS O
<br /> N -OWNED PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS (Per accident) $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAB CLAIMS-MADE S 1991921 09/04/2017 09/04/2018 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 0 $
<br /> WORKERS COMPENSATION X
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N WCP1020372 EXCLUDE 09/04/2017 09/04/2018 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER in NH)EXCLUDED? MIKE&WILLIAM BISHOP E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> (Mandatory in NH)
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT _$ _-! 1,000,000
<br /> A Contractors Equip S 1991921 09/04/2017 09/04/2018 Limit 75,000
<br /> Leased/Rented Deductibl 1,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County is additional insured for General Liability if required by
<br /> written/executed contract, before a loss.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGCO
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 131 W. Margaret Lane,Ste 301
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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