Orange County NC Website
INSRADDLSUBRLTRINSRWVD <br />DATE (MM/DD/YYYY) <br />PRODUCER CONTACTNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) <br />COMMERCIAL GENERAL LIABILITY <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />INSURER(S) AFFORDING COVERAGENAIC # <br />Y / N <br />N / A <br />(Mandatory in NH) <br />ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADEOCCUR <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GENERAL AGGREGATE$GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG$ <br />$ <br />PRO- <br />OTHER: <br />LOCJECT <br />COMBINED SINGLE LIMIT $(Ea accident) <br />BODILY INJURY (Per person)$ANY AUTO <br />OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS <br />AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) <br />$ <br />OCCUR EACH OCCURRENCE$ <br />CLAIMS-MADE AGGREGATE$ <br />DEDRETENTION$$ <br />PEROTH-STATUTEER <br />E.L. EACH ACCIDENT$ <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT$DESCRIPTION OF OPERATIONS below <br />POLICY <br />NON-OWNED <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 POLICY PROVISIONS. <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 />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(ies) 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 />this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDERCANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE <br />The Phoenix Insurance Company <br />Auto-Owners Insurance Company <br />Owners Insurance Co <br />Travelers Property & Casualty Co of Ame <br />Travelers Casualty Insurance Co of Amer <br />12/06/2018 <br />Morrow Insurance Agency, Inc. <br />800 Beverly Hanks Centre <br />Hendersonville, NC 28792 <br />828 693-5396 <br />Jennifer Gordon <br />828-694-51568286935496 <br />jgordonmorrowinsurance.com <br />Bryant-Durham Electric Co., Inc. <br />PO Drawer 2597 <br />Durham, NC 27715 <br />25623 <br />18988 <br />32700 <br />25674 <br />19046 <br />AX <br />X <br />x <br />XXDTCO3G369324PHX1810/01/201810/01/20191,000,000 <br />300,000 <br />10,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />C <br />X <br />X Drive Oth Car <br />XX <br />XX499996880010/01/201810/01/20191,000,000 <br />B XX <br />X10000 <br />XX499996880110/01/201810/01/201915,000,000 <br />15,000,000 <br />E <br />N <br />XUB9K8020041826G10/01/201810/01/2019X <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />D <br />D <br />LEASED/RENTED EQ <br />INSTALLATION FLOA <br />QT6305C518476 <br />QT6305C518476 <br />10/01/2018 <br />10/01/2018 <br />10/01/2019 <br />10/01/2019 <br />$200,000/$1,000 DED <br />$2,000,000/$1,000 DED <br />** Supplemental Name ** <br />First Supplemental Name applies to all policies - Name Printed on DEC Page: Bryant-Durham Electric Co., <br />Inc. <br />First Supplemental Name applies to all policies - Bryant Durham Alarm Co, Inc. <br />First Supplemental Name applies to all policies - Bryant Durham Services, Inc. <br />(See Attached Descriptions) <br />Orange County <br />Attn: Risk Management <br />200 South Cameron Street <br />PO BOX 8181 <br />Hillsborough, NC 27278 <br />1of 2#S204087/M197755 <br />BRYAN13Client#: 39456 <br />JLG1of 2#S204087/M197755 <br />DocuSign Envelope ID: BDDD3E3C-EA04-4405-8C16-DB2B52070C72