2017-636-E DEAPR - Fire Safe Chimney Sweep to repair, renovate chimney

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DocuSign Envelope ID: 3038F92E-742A-4AA4-BDCE-980F4D400885 ACO °R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/30/2017 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 Robbin Street NAME: Veracity Insurance Solutions, LLC. PH (801)(801)763-1375 (A/C,No):(601)763-1379 260 South 2500 West, Suite 303 ADQIESS,street @veraoityins.cora INSURER(S)AFFORDING COVERAGE NAIL# Pleasant Grove UT 84062 _ INSURERA:Endurance American Specialty INSURED INSURERS Fire Safe Chimney Sweep INSURER C: 4127 Hidden View Drive INSURER D: INSURER E: Mebane NC 27302 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1751133749 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 ADDL SUBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD. POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS MADE X OCCUR PREMISES(a occurrence) $ 100,000 CBC20002230500 4/22/2017 4/22/2018 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECPRO-T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABIUTY COMBINED SINGLE UMIT ,(Ea accIdent) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I ERH ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? L j N I A (Mandatory In NIi) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance Only. Covers liability arising out of the operations of the named insured, subject to all policy terms, conditions and exclusion. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. ■ Hissborough, NC 27278 AUTHORIZED REPRESENTATIVE A Stafford/ADMINS O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)