2017-681-E AMS - Seegar Fence Mayo Street repair

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DocuSign Envelope ID: FD9947AB-B386-4468-AFDD-4088AF7B1812 0 CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDfSYYYy 7/25,!2017 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 CNROME:NTACT Susan Denton John Hackney Agency of Rocky Mount PHONE, 252)442-3186 rc. 1-94DD H o a N41:{asay 45 950 Country Club Road ADDRESS:sdenton @jharm.com P. 0. Box 7807 _ INSURER{S)AFFORDING COVERAGE NAIL# Rocky Mount NC 27804-0807 INSURERA.SeleetiVe Insurance Co. of America 1-- INSURED INSURER B:Accident Fund National Ins. Co. x12304 Seegars Fence Co. Inc. of Durham INSURER C PO Sox 61378 INSURER D: _INSURER E: Durham NC 27715 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1772503047 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 INSURANCE ADDLiSUBR POLICY NUMBER MMJDDY EYY PMIbbfYY P LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1$ 1,000,000 � PREMISES RENTED $ A CLAIMS-MADE I A I OCCUR PRREMISES S Ea occurrence)- 100,000--............... X 52174309 08/01/2817 08/01/2018 MED EXP(Any one person) $ 10,000 _. PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,0001 POLICY JECT l LOC PRODUCTS-COMP/OP P_A_G_G $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 52174309 08/01/2017 08/012018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS x AUTOS Per accident _.._.-._ Medical P21yrrentS $ X UMBRELLA uAB x OCCUR EACH OCCURRENCE $ 51000,000 EXCESS LIAR CLAIMS4AADE AGGREGATE $ 5,000,000 52174341 08/01/2017 08/01/2010 DED RETENTION$ $ WORKERS COM PEN SATION A I PER OTH- AND EMPLOYERS'LIABILITY .._.... .STAT_UTE __ ER .-_..- . YIN ANY PROPRIETORIPARTNERIEXECUTIVE NIA B El.EACH ACCIDENT _ _ $ 500,400 OFFICErUMEMBER EXCLUDED? ri [MandatoryinNH) AICV61,471175 00/01/2017 08/01/2018 E-L.DISEASE-EAEMPLOYEE;S _500,000 S yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Equipment. Floater 1 B2174309 08/01/2017 013/01/2018�1 RentedlLeasedequipment $ 125.007 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORb 10t,Additional Remarks Schedule,may be attached it more space is required) The certificate holder is included as additional insured insured with respects to general liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Susan Denton1CCB GU 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014{01) The ACORD name and logo are registered marks of ACORD INS025{201401}