|
DocuSign Envelope ID: lA2F6F38-EEE5-4EO8-B32B-FD2AF5679B8C
<br /> OP ID:DL
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE 111071201 YYI
<br /> ��1a7r2Q17
<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 CERTI'FICATI=HOLDER.
<br /> IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the policy(les) 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 nut Confer rights to the
<br /> certificate holder in lieu of such endorsernent(s).
<br /> PRODUCER CONTACT
<br /> Tyson Insurance Services,Inc. NAME: Kirk Brown--
<br /> PHONE
<br /> 2609 N Duke St Suite 102 AJC ,,Ext)g919 471-8222 _ FACX Ne:919 471 $Gfl7
<br /> P.O-Box E•MAII kbrown t SoninsuranCe.vom.
<br /> Durham,NCC 27 277Ud- nDaREss:
<br /> Diane S.Long PUSTTO RID n_BROW13RO
<br /> — -- -- __ INSURE%$)AFFORDING COVERAGE - ,FIAIGp
<br /> IrssuftED Brown Brothers Plumbing and INSURER A:Builders Premier Insurance Co. 10844
<br /> Heating Company — - --
<br /> Z820 N.Roxboro Road INSURER s:Builders Mutual Insurance Co, 10,844
<br /> Durham, NC 27704 INSURER C:Admiral Insurance Co.
<br /> _ 44318
<br /> INSURER D:Travelers Prop"Icasualty 36161
<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. NO'IWiTHSTANDING 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 /> IL7R TYPE OF INSURANCE
<br /> UU POLICY NUMBER MM/DD?YYYT Mi011liDDNYYY LIMITS
<br /> GENERAL LIABILITY "EACH OCCURRENCE $ 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY �PCP0000055 08 1213112016 12/31/2017 �b�€h'E -
<br /> � PREMISESEaec.u�rence3 5 300,UQ
<br /> CLAIMS-MADE I��E OCCUR - A1EU EXP[Amone parson $ 10,00
<br /> X contractualliab. PERSONALS ADVINJ_UR_Y $ 1,000,00
<br /> We
<br /> X Uctitlle g5Q0, GENERAL AGGREGATE _ f 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 21000,00
<br /> POLICY X-]PRO- LOC -
<br /> AUTOMOBILE LIA101-n-Y I COMBINED SINGLE LIMIT 8 1,0Q0,00
<br /> A X ANY AUTO PCA0006942 06 12/31/2016 12/31/2017 (F.accideni)
<br /> X ALL OWNED AUTOS BODILY INJURY(Per pemn) 5
<br /> SCHEDULED AUTOS
<br /> BODILY INJURY(Per acdclant) $
<br /> _._.
<br /> X HIRED AUTOS
<br /> PROPCRTY DAMAGE
<br /> {PER ALGID€NT) $
<br /> X NON•OWNEDAUTOS T) 5
<br /> X Deductible -0-
<br /> s
<br /> X UMORELLA I" =]ILAIMS-MAIJE
<br /> EACH OCCURRENCE S 5,000,00
<br /> 6JLCES3LFA8 r';G'
<br /> .eraATE g 5,000,00.
<br /> A UMBO010121 08 12/3112016 1213112017
<br /> DEDUCTIBLE i $
<br /> X RETENTION 5 10,0t1U S
<br /> WORKERS COMPENSATION WC STFlTU- OTYi-
<br /> AND EMPLOYERS'LIABILITY _ X T Y061`
<br /> B ANY PROPRIETORIPARTNERrEkFCUTIIE YIN VVCP0044365 08 1213112016 12/31/2017 E.L.EACH ACCIDENT s 1,000,00
<br /> (1.FFIGEiiRrkEMBER EXCLUf1FD7 N I A
<br /> IMandalory in NH) C.L.DISEASE-EA EMPLOYFE1 S 1,000,00(
<br /> II yes,descnbe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 11000100
<br /> C Pollution Liam. FEI-ECG-22903-01 08/0312017 03/03/2018 QeclAggr. 2,000,001
<br /> D Third Party Crime 1495SES201 01/2012017 01/2012018 100,000 5000,ded.
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IANach ACORD 101,AddAlonai Remarks Schedule,it more apace Is required)
<br /> email to;arooper@orangecountync-.gov
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANC07
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.D.Box 8181
<br /> Hillsborough, NC 2727$ AUTHORIZED REPRESENTATIVE
<br /> Diane S.Long ,
<br /> 01988-2009 ACORD CORPORATION. AI righ# reserved.
<br /> ACOItD 25(200,4109) The ACORD name and logo are registered marks of ACORD
<br />
|