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DocuSign Envelope ID:553450D4-EEF4-4CCC-AB6C-lE554E332AD8
<br /> �1 OP ID,DL
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> DATE 12/27120Y7
<br /> 1212712Q11
<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; It 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 CONTACT
<br /> Tyson Insurance Services,Inc. NAME Kirk Brown
<br /> 2609 N Duke St Suite 142 PRONE.uea n:919471-8222 _ we -071-6607
<br /> P.0.Box 16734 A o l
<br /> Durham,NC 2770$- ESS;kwn #ysoninsurance.com Diane S.Long PRODUCER
<br /> STOMER ID N;BROWBRO
<br /> INSURERS AFFORDING COVERAGE _ NAICI0
<br /> INSURED Brown Brothers Plumbing and INSURER A:Builders Premier Insurance Co. 10844
<br /> Heating Company INSURER B:Builders Mutual Insurance Co. 10844 ----
<br /> 2820 N,Roxboro Road
<br /> Durham,NC 27704 INSUfto ft c;Admiral Insurance Co. 44318
<br /> (NSURERD:Travelers Property/Casualty 36151
<br /> INSURER E: -
<br /> INSURER F:
<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 /> TN_SR TYPE OF INSURANCE POLICY EFF POLICY E P w
<br /> LTft POLICY HUMBER MM;D61VY. MMIDONYYY) LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00
<br /> A X COMMERCIAL GENERAL LIABILITY PCPO000055 09 1213112417 1213112018 Ely
<br /> PREMISE Ea Occurrence $ 300,00
<br /> CLAIMS-MADE LA_j OCCUR MED EX P(Any one person) 3 - 10100
<br /> X Contractual slab. PERSONAL&ADV INJURY S 1,000,00
<br /> X Deductible$540. GENERAL AGGREGATE $ 2,000,00
<br /> _GENT AGGREGATE LIMIT APPLIES PER: PRODUCT$-COMPIOP AGG S 2,000,00
<br /> POLICY )( PRO LOC S
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> A X ANY AUTO PCA0006942 07 1213112017 12/3112018
<br /> X [Ea ecc dent, -
<br /> - ALL OWNED AUTOS BODILY INJURY(Per person) $
<br /> SCHEDULEDAUTOS
<br /> BODILY INJURY(Per wxldenl) $
<br /> PRO -
<br /> X HIREDAUTOS (PERPACCIDENAT)SGE $
<br /> X NON OWNED AUTOS $
<br /> X Deductible -0-
<br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 '•
<br /> EXCESS LIAO CLAIMS-MADE AGGREGATE $ 5,000,00
<br /> B — - IMUB0004308 00 12131/2017 12/3112018 - -
<br /> DEDUCTIBLE S
<br /> X RETENTION $ 10,000 S
<br /> WORKERS COMPENSATION X YJG BTATU- TT"_
<br /> AND EMPLOYERS'LIABILITY IR
<br /> B ANY PROPRIETORlPARTNER;EXECUTIVE YIN WCP004435509 1213112017 1213112018 E.L.EACH ACCIDENT $ 1,000,00
<br /> OFFIUERIMEMBEREXCLUDED? NIA
<br /> (MandaloryinNHl I E.L.DISEgSE-EAEMPLDYEE $ 1,000,00
<br /> U If desc,ibu under SGRiPTIION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,00
<br /> C Pollution Liab. FEI-ECC-22903-01 0810312017 0810312018 OcclAggr. 2,000,00
<br /> D lThird Party Crime 106446766 0112012018 01/2012019 100,000 5000.ded
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addillonal Remarks Schedule,If more space Is required)
<br /> email to;acooper @orangecountync.gov
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANCO7
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> tY ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P,O.Box 8181
<br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATiV r
<br /> Diane S.Lang
<br /> 0 1988-2009 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
<br />
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