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DocuSign Envelope ID: 1A2F6F38-EEE5-4EO8-B32B-FD2AF5679B8C
<br /> OP ID:DL
<br /> CERTIFICATE OF LIABILITY INSURANCE BAT€ 71120171I
<br /> 1110017
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEN, 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(les)most be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statemenl on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endarsernent s,
<br /> PR41SUCER CgNTRCT - -
<br /> Tyson Insurance Services,Inc. NAME: Kirk Brown
<br /> 2609 N Duke St Suite 102 PHON€
<br /> P.v.Box 16734 E"' ;�°earl;9t_9-471-8222 -— w N_a:919 471-68fl7
<br /> Durham,NC 27704- AgeREss.kbrown9tysoninsurance.com
<br /> Diane S.Long PRODUCER B
<br /> Q,AtF,RID# ROWBRO _
<br /> _ INSURER S AFFORDING COVERAGE 1 NAIG#
<br /> INsuftEq Rroyylt Brothers Plumbing and — NSURERa;Builders Premier Insurance Co. 10844
<br /> 28 20Heating Company
<br /> Su
<br /> 2820 INSURERu: nders MutualCo..Roxboro Road Mutul I C 10844
<br /> — ..
<br /> INsuRER c:Admiral Insurance Co.
<br /> Durham,TIC 27704 _ 44318
<br /> INSURER D:Travelers Property/GasLlal —r_-- 36161 ----
<br /> INSURER E:
<br /> INSURER r: ---— --
<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 /> CER riFICATE MAY BE ISSUES] 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 /> POU
<br /> LTR TYPE OF INSURANCE ;----1 POLICY NUMBER MM gel E P Ip®ilk LIMITS
<br /> EACHLIABILITY - - - - -
<br /> EACH OCCURRENCE $ 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY PCPGODO055 00 12/3112016 1213112017�D AG '�ENTE -- --
<br /> ��`I aR€IUISFS €�Occur ente 5- 300,04L3
<br /> CLAIMS MADE L-!!%-J Occun MEo EXP IwFv one persar,} s J 10,00
<br /> X contractual Hatt. PERSONALSADVINJURY S 1,000,00
<br /> x Deductible$600. GEN1 RALAGGREGATE S 2,000,00
<br /> GEN'L AGGREGAT'IE LIMITAPPLIES PER PRODUCTS-GOMPIOP AG_G S 2,000,00
<br /> POLICY X f PRO- F- LOG $
<br /> AVTOMOBILE LIA131UTY I COMBINED SINGLE LIMIT
<br /> A X ANY Aura PCA000694206 12131/2096 12131/2017 (Faamdert) s 1,000,00
<br /> BODILY INJURY(per person)
<br /> X ALL OWNED AUTOS $
<br /> SeHEnuL€o nuTos
<br /> BODILY INJURY(Per aueeni)..s .—..
<br /> PROPERTY DAMAGE
<br /> HIRED AUTOS (PER ACCIDENT) $
<br /> X NON-OWNED AUTOS J - -
<br /> X Deductible -0- ] --- -
<br /> - s
<br /> X UMORELLA LIAR X I OCCUR EACH OCCOnRENCE $ 5,000,00
<br /> EXCESS LIAR CLAIMS-MACE ,AGGREG ATE $_ 5,000,00
<br /> A UMBfl010121 0$ 12/3112016 12131/2017 -
<br /> DEDUCTIBLE �
<br /> RETENTION s 10,000
<br /> WORKERS COMPENSATION Y)N RY LIMIU T_ _
<br /> AND EMPLOYERS'LIABILITY
<br /> B ANY PROPRIETOROPARTNEWEXECUTiVE WCP0044355 08 12/31/2018 1 W3112017 E-L EACH ACCIDENT $.. 1,000 00
<br /> OFFICER)MEMBErd EXCLIJDED7 N 1 A - r
<br /> [Mandatary in es,descflM!unde
<br /> r nder a E.L.DISEASE-F-A EMPLOYEE s _ 1,000,000
<br /> yy
<br /> DESCRIPTION OF OPERATIONS bdloar E.L.DISEASE-POL=LIMIT 5 1,000,00
<br /> C Pollution Liab, FEI-ECC 22903-01 08103/2017 08103/2018 Occ/Aggr. 2',000,00(
<br /> D Third Party Crime 96SE8201 01/20/2017 01120/2018 100,000 5000.ded.
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS)VEHICLES(Attach ACORD 101,Additional RalnarRs Schedulo,Ir more space Is requlrady
<br /> email to;acooper@orangeaountync.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 OF DELIVERED IN
<br /> P.O.Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Diane S.Long ,
<br /> 01988-2009 ACORD CORPORATIQN. AI right reserved,
<br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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