2019-036-E AMS - Intellicom Millhouse cabling

Browse Search

DocuSign Envelope ID:3BC29991-ADE7-4DO3-8BB2-OF5968C8146D A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/11/02/2018 Y) 018 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 have ADDITIONAL INSURED provisions or 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 Steven Stacy NAME: Pelnik Insurance PHONE (g19)459-8000 FAX (866)714-3576 A/C No Ext: A/C,No 100 Ridgeview Drive E-MAIL Steve.Stacy@Pelnik.com ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# Cary NC 27511 INSURERA: Selective Ins Co of America 12572 INSURED INSURER B: Builders Mutual Insurance Co 10844 INTELLICOM INC AND PLC COMMUNICATIONS,INC INSURERC: 2902 S MIAMI BLVD STE C INSURER D: INSURER E: DURHAM NC 27703-9042 1INSURER F: COVERAGES CERTIFICATE NUMBER: CL1832816358 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. TR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To_7CLAIMS-MADE � OCCUR PREM SES Ea occurrence)l $ 500,000 MED EXP(Any one person) $ 15,000 A X Includes Contractual Liab. S 2162397 04/01/2018 04/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY Fx_1 PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 3,000,0170 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S 2162397 04/01/2018 04/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY (Per accident) Auto Elite Pac $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE S 2162397 04/01/2018 04/01/2019 AGGREGATE $ 6,000,000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBEREXCLUDED? ❑ NIA PWC101038003 04/01/2018 04/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Employee Dishonesty/Crime Limit 100,000 A Leased/Barrowed Equipment S 2162397 04/01/2018 04/01/2019 Limit 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD