2016-732-E DSS - Dickerson Fencing Co fence installation

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DocuSign Envelope ID:CDB26ED1-82FE-487A-872C-345E8A833228 DATE(MMIDDIYYYY) AC"Rv CERTIFICATE OF LIABILITY INSURANCE 10/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT rate Ewald NAME: SIA Group Inc. PHONE ztg (910)455-7576 {arc,No):(910)455-7481 827 Gum Branch Road -MAIL carts@sia rou com ADDRESS: g P INSURERS)AFFORDING COVERAGE NAIL N Jacksonville NC 28540 INSURERA: National Trust Insurance INSURED INSURER B:The Hanover Insurance Company Dickerson Fencing Co. , Inc dba Dickerson Fencing and INSURERC:_ _ 202 N Hoover Road INSURERD: Lisa Tilley INSURER E: _ Durham NC 27703-2302 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1592404659 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ fLTR TYPE OF INSURANCE AOOL SUBR POLICY NUMBER MMIL�6IYYYY MM)DDIYY Y LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X i OCCUR PREM SES(Ea occurrence) $ 100,000 X Y CPP0011769 10/24/2015 10/24/2016 MEDEXP(Anycneperson) $ 5,000 PERSDNAL E AC)V INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X PRO POLICY —1 � -] LOC PRODUCTS-COMP OPAGG $ 2,00Q,O- JECT OTHER: Employee Benefits $ 11 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO _ BODILY INJURY(Perperson) $ ALL OWNED - SCHEDULED AUTOS X Y CA0017095 10/24/2015 10/24/2016 BODILY INJURY(Peraccident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 . RETENTION$ 10,000 UMBOOI1508 10/24/2015 10/24/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORiPARTNERlEXECUTIVE E.L.EACH AG_C_ID_ENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? I� N I A A (Mandatory in NH) y 01Dt4C15A71429 10/24/2015 10/24/2016 E_L.DISEASE-EA EMPLOYE $ - 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bell I E.L.DISEASE.-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Orange County is included as additional insured on the general and auto liability per forms CGLO88 and CAU058. Waiver of subrogation applies in favor of the additional insured with regards to workers compensation (WC000313) , general liability (CGLO88) , and auto liability (CAU014) per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tammy Comar ACCORDANCE WITH THE POLICY PROVISIONS. P.O. sox 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Diana Evans/CHARLH �y J 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S625 r2n1401 ti