Orange County NC Website
DocuSign Envelope ID:4469B057-D1AA-45FE-A32F-766286B600AF <br /> JFWILKE-01 CLUCAS <br /> '4C�/Za CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 312912019 <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 INSUREII 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 rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Cathleen Lucas <br /> NAME: <br /> Summers Thompson Lowry, Inc. PHONE FAX <br /> 2113 Cameron Street (AIC,No,Ext):(919)969-5311 (Arc,No):(919)9424221 <br /> IL <br /> Suite 219 AI DARESS:cathy@stlinsure.com <br /> Raleigh, NC27605-1370 INSURER(S)AFFORDING COVERAGE NAIC* <br /> INSURERA:The Charter Oak Fire Insurance Corn pany 25615 <br /> INSURED INSURERB:The Travelers Indemnity Company 25658 <br /> J.F.Wilkerson Contracting Co. Inc. INSURERC:The Travelers Property Casualty Insurance Company of America 255674 <br /> P.O. Box 183 INSURERD:St Paul Surplus Lines Insurance Company <br /> Morrisville, NC 27560 <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD MMIDDNYYY MMIDDNYYY <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR C06B354615 4/1/2019 4/1/2020 DAMAGE TO RENTED 300,000 <br /> X PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PEP GENERAL AGGREGATE $ 2,000,000 <br /> POLICY T JjECT M LOC PRODUCTS-COMPIOPAGO $ 2,000,000 <br /> OTHER $ <br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accdent $ <br /> X ANY AUTO ON209577 4/1/2019 1/1/2020 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 ( eracadent) $ <br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 <br /> EXCESS LIAB <br /> CLAIMS-MADE CUP71<4053651926 4/1/2019 1/1/2020 AGGREGATE $ <br /> DIED I X I RETENTION$ 10,000 aggregate $ 6,000,000 <br /> C WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> YIN U B2J 614794 4/1/2019 111/2020 500,000 <br /> ANY PROPRI Rf NIA RfEXECUTIVE ❑ E L.EACH ACCIDENT $ <br /> OFFICERfMEMBMBER EXCLUDED? <br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under 500,000 <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ <br /> A Installation floater 660613715799 4/1/2019 1/1/2020 pump houses only 250,000 <br /> D Comm Pollution CC41M94021-18 4/1/2018 1/1/2020 Each Poll Condition 1,000,000 <br /> DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Blanket additional insured endorsement applies to general liability,to include completed operations, as regarded by written contract. <br /> Project: Efland Sewer to Mebane Phase 2 Extension,Orange County,NC <br /> Owners's Contract No.: CIP 30044 <br /> Engineer's Project No.: 16.01904 <br /> hfleming@orangecountync.gov,dale.schepers@mcgillengineers.com <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 /> Orange County, NC(owner)&McGill&Associates(Eng) ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 West Margaret Lane <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />