2018-601-E AMS - Tibbens construction Animal Services concrete

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DocuSign Envelope ID:9FEC6301-F398-45CF-9D09-3986A662D45C MAR'KT-1 OP ID:ME CERTIFICATE OF LIABILITY INSURANCE ❑ATE(MM1oDryvyY) 02/2212018 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(les)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 Ileu of such endorsements, PRODIECER NAME CT All United Insurance Agency All United Insurance Agency Co PHONE 6§-484-866'6 FAx 9716-B Rea Road,#123 e �My_._..,-- -- IAIC,Net:866-362-9807 - Charlotte,NC 28277 E-MAIL - All United Insurance Agency Co AnDRESS: --- _- -_-_-- INSURERI%AFFORDING COVERAGE NAIC# _ INSURER A_Nautilus Insurance Company -6041 INSURED Mark Tibbens DBA INSURES B: - -- --.. Mark Tibbens Construction - -- 849 MoDse Tracks Train ->HrysuRi iz c; Cedar Grove,NC 27231 INSURER D: INSURER E: 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 IN ADD L SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDNYYY. MMIDDfYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A }( COMMERCIAL GENERAL LIABILITY NN900982 0112312018 09123/2019 PREMISESa occurrence _ $ 100,00 _ CLAIMS-MADE Fx-1 OCCUR MED EXP(Any one person) $ rs,Da PERSONAL&AOV INJURY _S 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIESPER; PRODUCTS-COMPIOPAGG S 1,000,00) X POLICY PRO} _ LOC _-.— S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT acddenl) 1,000,000 Ea __ 13 x ANY AUTO B109698J 12/07/2017 1210812018 BODILY INJURY(Per person) $ ALL OWNED SCHEOULED AUTOS AUTOS BODILY INJURY(Per acddenl) S NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PER ACCIDENT)S UMBRELLA DAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE OEO RETENTION S $ _ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN _._ T RY --- ANY PROPRIETORIPARTNER)EXEcUTIVE E.L-EACH ACCIDENT S OFFICER}MEM8ER EXCLI.IDED7 N/A - --- (Mandatory In NH) ❑ E.L.DISEASE-EA EMPLOYEE S II yes,describe under - -- DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT S D Inland Marine IMP E239265 0712612017 0712612018 Misc Tool 20,00 Rented E 200,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IAttach ACORD 101,Additional Remarks Schedule,if more space's required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 tY ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE D 9988-2010 ACORD CORPORATION. All rights reserved. ACORD 29(2010105) The ACORD name and logo are registered marks of ACORD