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DocuSign Envelope ID: CF08811 B -991 E- 4A3C- 87AA- FE61013F9A61
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MLUDDIYYYY)
<br />121112017
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on
<br />• this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Marsh & McLennan Agency LLC
<br />4700 Falls of Neuse Rd, St 190
<br />Raleigh NC 27609 -2521
<br />CONTACT Arlene Nunn
<br />PHONE Arlene 9-9588 FAx 212 - 607 -5560
<br />EAIj� 1_... ' NO. 60
<br />E-MAIL
<br />E- MAIL ,, Arlene.Nunn@marshmma.com
<br />INSUREKS) AFFORDING COVERAGE
<br />NAIC
<br />INSURERA:Selective Ins Co of S Carolina
<br />19259
<br />INSURED MCQUE -1
<br />INSURERB :Builders Mutual Ins. Co.
<br />10$4
<br />INSURER C:
<br />$500,000
<br />McQueen Construction, Inc.
<br />Harvey McQueen
<br />619 Patrick Road
<br />,._�.
<br />INSURER D:
<br />$15,000
<br />INSURER E :
<br />Bahama INC 27503
<br />$1,000,000
<br />INSURER F:
<br />$3,008,000
<br />PRODUCTS - COMPIOP AGG
<br />COVERAGES CERTIFICATE NUMBER- 1714287487 RFVISaDN NHMBF_R-
<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 />INSD
<br />SUB
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMfDDPYYYY
<br />POLICY EXP
<br />MMfDD15'YYY.
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />I S1785111
<br />1/24/2017
<br />1/24/2018
<br />EACH OCCURRENCE
<br />$1,000,000
<br />I7AMA E TO RENTED
<br />PREMISES Ea occurrence
<br />$500,000
<br />MED EXP Any one person)
<br />$15,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER
<br />� IA LOC
<br />POLICY PEO
<br />OTHER:
<br />PERSONAL & ADV INJ U RY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$3,008,000
<br />PRODUCTS - COMPIOP AGG
<br />$3,000,000
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ALITOSDONLY SCHEDULED D
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />59785111
<br />1/24/2017
<br />1124/2018
<br />Ea accident N L LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Peraccident)
<br />PROPERTY 0AMA E
<br />Per accdent
<br />$
<br />$
<br />A
<br />X UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />51785111
<br />1/24/2017
<br />112412018
<br />EACH OCCURRENCE
<br />$6,000,000
<br />AGGREGATE
<br />$6,000,000
<br />DED X RETENTIONSO
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑
<br />0 FFiCERIM E M BER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N fA
<br />WCP1022838
<br />9/2412017
<br />1!2412018
<br />X STATUTE ER
<br />E.L EACH ACCIDENT
<br />_.
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />-
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additiona'll Remarks Schedule, may be attached If more space is required)
<br />w.crc r rrl%.sn f r= nV1,.V Gm r..APf1.tLLA I IUN
<br />Orange County Purchasing
<br />200 S Cameron Street
<br />Hillsborough NC 27278
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />® 1988 -2015 ACORD CORPORATION. All rights reserved..
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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