2018-547-E DEAPR - Bartlett Tree tree work

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DocuSign Envelope ID: 2BEDCB08- D20D- 4C77- AF97- E4A01El lCBOF ACQRa� DATE;MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/11/2018 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: 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 York International Agency, LLC Attn: bartlettcert@yorklnti.com 500 Mamaroneck Avenue, Suite 220 CONTACT NAME: _ PHONE FAX 914- 376 -2200 31 e1Jz E -MAIL DUnE INSURERS AFFORDING COVERAGE NAIC H Harrison NY 1052$ IN SURER A + Travel ers P rqpe rty & C a s Lia Ity Co Of 25674 $1,600,000 INSURED INSURERB - Travelers Indemnity Company 2565$ The F.A. Bartlett Tree Expert Company 1290 East Main Street INSURER C : $10,000 - Stamford CT 06902 INSURER D : GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY El J E E C T [--] IOC OTHER: m, INSURER E: $5,000,000 PRODUCTS - COMP(OP AGG INSURER F $ COVERAGES CERTIFICATE NUMBER:. 902150896 REVISION NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE=D TO THE INSURER 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 LTR TYPE OF INSURANCE INSD "VD. POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MWDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR Con"chlyl LLO Y TC2J- GLSA- 1005A129- TIL -17 1211(2017 12/1/2018 EACH OCCURRENCE $1,600,000 DAMAGE TO RENTED PREMISES Ea occurrence 51,000,006 X MED EXP (An r ana! on) $10,000 PERSONAL &ADV INJURY $1,000,600 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY El J E E C T [--] IOC OTHER: GENERAL AGGREGATE $5,000,000 PRODUCTS - COMP(OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO AUTOOSVNED AUTOS HIRED AUTOS X NON•OWNED AUTOS TC2J- CAP- 1D05A130- TIL -17 17/1/2017 12(112018 Ea aeal 1717 $2,060,000 BODILY INJURY (Per person) S x BODILY BODILY INJURY (Peracdclent) $ PROPERTY DAM C Per accident $ $ —• UMBRELLA LIAB OCCUR EXCESS LIAB f_ ^.,. CLAIMS -MADE DED RETENTIONS EACH OCCURRENCE $ AGGREGATE M` $ $ B g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? � (Mandatory EnNH) yes, describe under M DESCRIPTION OF OPERATIONS below NIA TC2Et-U13- 1005A105 17 TRk- UB-1005A117 -17 r 121112017 121112017 1TJ1(2018 1211(2018 PER OTH- X STATUTE ER E.LEACHACCIDENT $1,006,000 E.LDISEASE - EAEMPLOYE •-- $1,000,000 E,L, DISEASE: - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Orange County is included as additional insured With respect to Commercial General Liability and Automobile Liability for Work performed by The F,A, Bartlett Tree Expert Company. CERTIFICATE HOLDER CANCELLATION Orange County 6823 Millhouse Road Chapel Hill NC 27516 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2014 ACCIRD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD