Orange County NC Website
DocuSign Envelope ID: B6103DC0-CF8C-49CD-9CA8-FD1B3B315C92 <br /> DATE(MMIDDNYYY) <br /> `� CERTIFICATE OF LIABILITY INSURANCE 1011012018 <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: 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 conditivns of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: Arlene Nunn <br /> Marsh&McLennan Agency LLC PHONE 919-719-9588 Fox Ne;212-607-6560 <br /> 4700 Falls of Neuse Rd, St 190 (AfC.IL <br /> Raleigh NC 27609-2521 DD ess: Ariene.Nunn@marshmma.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Selective Insurance Company of SC 19259 <br /> INSURED MCQUE-1 INSURERB:Builders Mutual Insurance Company 10844 <br /> McQueen Construction, Inc. <br /> Harvey McQueen INSURER C: <br /> 619 Patrick Road INSURER D:......_�u-�___. <br /> Bahama NC 27503 INSURERE; <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:939118414 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 /> INSR ADDL sUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER _ _ D D❑ YY <br /> A X COMMERCIAL GENERAL LIABILITY 51785111 1/2412018 11242019 EACH OCCURRENCE $1,000,D00 <br /> CLAIMS-MADE I " l OCCUR PREM SES Ea occurrence $500,000 u ` <br /> MED EXP(Any one Person) $15,000 <br /> PERSONAL&ADV INJURY $1,000;000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 <br /> POLICY®JPEC� M LOC PRODUCTS-COMPIOPAGG $3,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 51785111 1/2412018 1/2412019 OOMBINEO SINGLE LIMIT $1,000,000 <br /> Ea sechdant <br /> J( ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY ccki nt <br /> $ <br /> A X UMBRELLA LIAR X OCCUR 51785111 112412018 1/24/2019 EACH OCCURRENCE $6,000,000 <br /> EXCESS LIA6 CLAIMS-MADE AGGREGATE $6,000,000 <br /> DED I X RETENTION 3 <br /> B WORKERS COMPENSATION WCP1O22835 1/24/2018 1/2412019 x P€R OTH- <br /> AND EMPLOYERS'LIABILITY Y r N STATUTE ER <br /> ANYPROPRIETORIPARTNER1ExECUTNE ❑ NIA <br /> E.L.EACH AOCIDENT $1,000,000 <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1.000,000 <br /> IF yyes,describe under <br /> DESCRIPTION OF OPERATIONS helves E.L.DISEASE:-POLICY LIMIT $1,000 D00 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may he atLached 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 /> ACCORDANCE WITH THE PCLICYPROVISIONS, <br /> Orange County Purchasing <br /> 200 S Cameron Street AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 <br /> @ 1988.2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACID RD <br />