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DocuSign Envelope ID: 9FAC751D -4B6F- 458E - 8281- 8BD3AF6AB3C1
<br />___ -11
<br />BISHOP1 OP ID: SF
<br />ACORO�
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(M9/20 18
<br />04/19/20 8
<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 />First Insurance Services, Inc.
<br />P. O. Box 13687
<br />CONTACT Tara J. Smithwick
<br />HONE / Ext :919- 941 -0549 A No): 919- 941 -0135
<br />E -MAIL
<br />ADDRESS:
<br />RTP, NC 27709
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />09/04/2018
<br />INSURER A: Selective Insurance Company A
<br />12572
<br />INSURED WL Bishop Construction Co
<br />INSURER B: Builders Mutual Insurance Co A
<br />10844
<br />2211 Leah Road
<br />$ 10,000
<br />Hillsborough, NC 27278
<br />INSURER C:
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE� X LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />INSURER D:
<br />INSURER E:
<br />$ 3,000,000
<br />INSURER F:
<br />$
<br />A
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />DDL
<br />INSD
<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 1XI OCCUR
<br />Chapel Hill, NC 27516
<br />S 1991921
<br />09/04/2017
<br />09/04/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE� X LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRODUCTS - COMP /OPAGG
<br />$ 3,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />S 1991921
<br />09/04/2017
<br />09104/2018
<br />COMBINED SINGLE LIMIT 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 />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />S 1991921
<br />09/04/2017
<br />09104/2018
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 0
<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 />WCP1020372 EXCLUDE
<br />MIKE & WILLIAM BISHOP
<br />09/04/2017
<br />09/04/2018
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Contractors Equip
<br />Leased /Rented
<br />S 1991921
<br />09104/2017
<br />09104/2018
<br />Limit 75,000
<br />Deductibl 1,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: 1526 Eubanks Rd.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ORANCSW
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Orange Count
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />g y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Solid Waste Management
<br />PO Box 17177
<br />AUTHORIZED REPRESENTATIVE
<br />Chapel Hill, NC 27516
<br />ACORD 25 (2014/01)
<br />© 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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