Orange County NC Website
DocuSign Envelope ID: FC3A78ED-426C-4495-821A-F3395259C5BC <br /> ® DATE(MMIEUYYYY) <br /> A 4C"R IJ CERTIFICATE OF LIABILITY INSURANCE <br /> 1011012a17 <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 INSURERS), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> th is certificate does not confer rights to the certificate holder in lieu of such end orsement(s). <br /> PRODUCER NAME:CT Charlie Dickerson <br /> Tile InSUranCe PTDS, Inc. PHONE (919)294-Fi613 LA No' (866)294-947a <br /> 1210 Cole Mill Road nDo%"Ess: chadte@lnsuranceprosonllne.com <br /> Suite 101 INSURER(S)AFFORDING COVERAGE NA{O4 <br /> i <br /> Durham NC 27705 INSURERA: Erie Insurance Company 26271 <br /> INSURED INSURER B: Erie Insurance Company 26271 <br /> Fortress Fencing,LLC INSURERC: <br /> Po Box 1377 INSURER D: Flagship City IRS Co 36W <br /> Carfboro,NC 27610-3377 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 FCR 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, _ I <br /> rA <br /> L POLICY EFF POLICY EXPLIMITS <br /> TYPE OF INSURANCE POLICY NUMBER MM'DDIYIYYY MMfoDIYYYYCOMMERCIAL GENERAL LI ABILnY EACH OCCURRENCE $ 1000000 <br /> CIAIMS-MADE �OCCUR PREMISEs(Eeoccurrence $ 1000000M€D EXP(AAn one person) $ 5000 <br /> N N Q38-2250720 02J2212017 02122/2018 PERSONAL&ADV INJURY $ 1000000 <br /> aEEN'L AGO RErDG--A�-T�1E LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 <br /> L <br /> POLICY JPERC ®LOC PRODUCTS-COMPIOPAGG $ 2000000 <br /> $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY Ea®Bcclde0i51 GLE LIMIT $ 1000000 <br /> ANY AUTO BODILY INJURY(Perperserl) $ <br /> B OWNED SCHEDULED N N Q02 2240032 02/22/2017 02/22/2018 BODILY INJURY(Peracniderd) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY [Paraccidmt) <br /> UMORELLALiAB X OCCUR EACH OCCURRENCE $ 1000000 <br /> C X EXCEssuAB X CLAIMS MADE N N WC1 M0007808-2014A 03109/2014 03/09/2015 AGGREGATE $ 1000000 <br /> DED X RETENTION <br /> WORKERS COMPENSATION SFA UTE ER <br /> RTH- <br /> AND EMPLOYERS'LIABILITY <br /> A14YPROPRI€TORIPARTNEMEXECUTIV€ Y❑ NIA N i $7-59QQ217 a31Q 12d'I7 031091201� E.L EACH ACCIDENT <br /> $ 1000000 <br /> D Olandalofy in BER <br /> EXCLUDED? N E,L.DISEASE-EAEMPLOYE $ 1000000 <br /> (hlandalary m NH] <br /> II yas,descn6e uneer E,L,DISEASE-POLICY LIMIT $ 1000000 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ORANGE COUNTY DEAPR ACCORDANCE WITH THE:POLICY PROVISIONS. <br /> PO BOX 8181 <br /> AUTHORIZED REPRESENTATIVE <br /> NC 27278 <br /> Fax: Email: 0 1988-20115 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <br />