Orange County NC Website
DocuSign Envelope ID: FC33DOBE- 4D4D- 45AF- 857C- 2498EBC91861 <br />Client #: 25609 <br />PENTENGI <br />ACORDT. CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM /DDYY) <br />10/04/2017 <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 <br />Greyling Ins. Brokerage /EPIC <br />3780 Mansell Road, Suite 370 <br />Alpharetta, GA 30022 <br />NAMEACT Katie Kresner <br />PHONE 770.552.4225 FAX 866.550.4082 <br />A/C, No, Ext : AIC, No <br />Katie.Kresner @greyling.com <br />-ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Nautilus Insurance Company <br />17370 <br />EACH OCCURRENCE <br />INSURED <br />Engineering Group, Inc. <br />INSURER 13: Great Divide Insurance Company <br />25224 <br />Ohio Security Insurance Company <br />INSURER C : Y p Y <br />24082 <br />4000 Miller Court West <br />4000 M <br />Norcross, GA 30071 <br />INSURER D: <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ® JEt° [�] LOC <br />OTHER: <br />INSURER E: <br />$2,000,000 <br />INSURER F: <br />$2,000,000 <br />COVERAGES CERTIFICATE NUMBER: 17 -18 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD /YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />ECP201603712 <br />10/08/2017 <br />10/08/2018 <br />EACH OCCURRENCE <br />$1,000,000 <br />PREMISES EaoNcurrence <br />$100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ® JEt° [�] LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS - COMP /OP AGG <br />$2,000,000 <br />$ <br />C <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />BAS1858312554 <br />10/08/2017 <br />10/0812018 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />A <br />UMBRELLA LIAB <br />EXCESS LIAB <br />[;JO <br />CCUR <br />LAIMS -MADE <br />FFX201603812 <br />10/08/2017 <br />10/08/201 <br />EACH OCCURRENCE <br />$5,000,000 <br />�( <br />AGGREGATE <br />s5,000,000 <br />DED I X RETENTION $O <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/MEMBER EXCLUDED? ® <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />WCA201603612 <br />10/08/2017 <br />10/08/2018 <br />X PER OTH- <br />E.L. EACH ACCIDENT <br />$1 000,000 <br />E.L. DISEASE - EA EMPLOYEEI <br />$1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />1 $1,000,000 <br />A <br />Professional Liab <br />Contractors Poll. <br />Liability <br />ECP201603712 <br />ECP201603712 <br />10/08/2017 <br />10108/2017 <br />10/081201 <br />10/08/2018 <br />Per Claim /Agg $1 M /$2M <br />PerCondition $1,000,000 <br />Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Excess Liability includes Professional Liability, Contractors Pollution Liability, and CGL. Professional <br />Liability in primary and Excess policies is claims -made. Aggregate Limits of $2,000,000 in primary CGL, PL <br />and CPL applies to all three coverage parts. Aggregate limit of $5,000,000 in Excess Liability applies to <br />CGL, PL and CPL. <br />Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Hillsborough, NC 27278 <br />AUTHORIZED REPRESENTATIVE <br />©1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S8720181M871590 KKRE1 <br />