2018-124-E Planning - JB Tree Service Efland sewer tree removal

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DocuSign Envelope ID: 1428BDDA -8FA0- 4081- BF73- 3D02B42684EB AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 04104/2018 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: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 Knight Insurance 110 Saone Square Street, Suite 7 Hillsborough, NC 27278 CONTACT NAME: PHONE 919- 245.1020 FPC N.)! 919- 245 -1010 E D)Ress: knightinsurance @raleigh.twcbe.com INSURERS AFFORDING COVERAGE NAIL# INSURER A: Northfield Insurance Company LIMITS INSURED Jeffrey Bracken dba JB Tree Service 7410 INC Hwy 86N Hillsborough, NC 27278 INSURERS: Travelers Property Casualty Co Of America COMMERCIAL GENERAL LIABILITY INSURERC: Integon National Insurance Company INSURER D: INSURER E : EACHOCCURRENCE INSURER F: COVERAGES CERTIFICATE NUMBER; 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 TYPE OF INSURANCE INrD BURR POLICY NUMBER POLICY MIUDi EFF PIOLDI DY E1tYPY LIMITS A, x COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR WS317090 08101/20/7 08/0112018 DAMAGE TO RENTED PREMISES E® accurrence $ 1{10 000 MED EXP Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L. AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JET F1 LOC PRODUCTS- comp/op AGG s 2,000,000 s OTHER: C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidehl s 1,000,000 BODILY INJURY (Par parson) $ 1,000,000 ]� ANY AUTO 20022322193 09123117 03127118 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ 1000,000 r PROPERTY DAMAGE 11,000,000 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LUIS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS" LIABILITY ANYPROPRIETORtPARTNERfEXECUTIVE Y� Mandatary In NH EXCLUDED? (Mandatory 1 MIA 6JUB- 1K2381.3-0-18 - 031091201$ 0310912019! PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $600,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 191, Additional Remarks schedule, maybe attached if more space Is required) Orange County is listed as additional insured on the General Liability policy. CERTIFICATE HOLDER CANCELLATION Orange County Planning and Inspection Department PO Box 8181 131 W Margaret Ln Hillsborough, INC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE SMITH THE POLICY PROVISIONS. AUTHORIZEO REPRESPNTATNP 01988 -2015 ACORD CORPORATION. All ri+ahts reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD