|
INSR ADDLSUBRLTRINSR WVD
<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 EFF POLICY 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 COVERAGE NAIC #
<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-MADE OCCUR
<br />MED EXP (Any one person) $
<br />PERSONAL & ADV INJURY $
<br />GENERAL AGGREGATE $
<br />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 />OWNED SCHEDULED 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 />DED RETENTION $
<br />$
<br />PER OTH-STATUTE ER
<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 />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />CERTIFICATE HOLDER CANCELLATION
<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 />828-694-5156 8286935496
<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 />X X DTCO3G369324PHX18 10/01/2018 10/01/2019 1,000,000
<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 />X X 4999968800 10/01/2018 10/01/2019 1,000,000
<br />B XX
<br />X 10000
<br />XX4999968801 10/01/2018 10/01/2019 15,000,000
<br />15,000,000
<br />E
<br />N
<br />X UB9K8020041826G 10/01/2018 10/01/2019 X
<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 />1 of 2#S204087/M197755
<br />BRYAN13Client#: 39456
<br />JLG1 of 2#S204087/M197755
<br />DocuSign Envelope ID: A5151355-999B-413E-A0E3-C722EE592B4B
|