Orange County NC Website
DocuSign Envelope ID: B83FADFB-AC4E-42A8-B4DC-14D962AB9A4B <br /> A��" CERTIFICATE OF LIABILITY INSURANCE DATEiMMR7DIYYYYy <br /> 4/12/2019 <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 rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTT T Lynne A.Meyer,CIC,CpIW,AWNS <br /> Marsh McLennan Agency LLC P"�E .336-346-1302 FAArxc Na,212-607-B534 <br /> 3625 N.. Elm Street E-MAIL <br /> Greensboro NC 27455 ADDRESS: Lynne.Meyer@marshmma.com <br /> INSURERS AFFORDING COVERAGE NAIC R <br /> INSURER A.Builders Premier Insurance Company 13036 <br /> INSURED BIRSINCI INSURER B:Builders Mutual Insurance Cam a ny 10844 <br /> BIRS, Inc. INSURER C:Columbia Casualty Company 31127 <br /> Mr. Raven Broeker <br /> PO Box 36197 INSURER D: <br /> Greensboro NC 2 74 1 6-61 97 INSURERE- ' <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:379236999 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 5wvD UBR POLICY NUMBER MMIDDNYYY MMMDNYYY LIMITS <br /> LTR <br /> A x COMMERCIAL GENERAL LIABILITY PCP000363200 5/1/2019 5/1/2020 EACH OCCURRENCE $1,000.000 <br /> CLAIMS-MADE T I OCCUR PREMISES a omumance $100,DD0 <br /> MED EXP(Arty one person) $5,000 <br /> PERSONAL a ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> 71 POLICY[K JECT LOC PRODUCTS-COMPIOPAGG S2,000,000 <br /> OTHER, Is <br /> A AUTOMOBILE LIABILITY PCA0018423 5/1/2019 5/1/2020 CflMBiNED SINGLE LIMIT $1,000,000 <br /> Ea accdent <br /> x ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Paraccidemy $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OV4NEO PROPERTY DAMAGE $ <br /> AUTOS ONLY ALTOS ONLY Per accident <br /> CompXcll Ded 51,00011,000 <br /> 8 X UMBRELLA LLRETENTION <br /> X OCCUR MUB000128600 5/112019 511/202D EACHOCCURRENCE $6.000,000 <br /> EXCESS LIARCLAIMS-MADE AGGREGATE $5,000,000 <br /> DED x S in nnn 13 $ <br /> A WORKERS COMPENSATION 1 PWC100029008 5/1/2019 5/1/2020 x STATUTE OETH- <br /> AND EMPLOYERS'LIABIUTY Y 1 N <br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $1,000.000 <br /> OFFIC ERIM EM SER EXC LU DED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Rental Eq-pmeni PCP000363200 5/1/2019 5111202D Umlt $160,000 <br /> C E&OIPoIkJtiun CE0591855996 5/1/2019 1 51112020 L" I $1,000,000 <br /> DESCRIPTION OF OP E RATIONS I LOCATIO NSI VEHICLES IAC ORD 101,Additional Remarks Schedule,may be attached if more space Is requ Ired) f <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 /> ACCORDANCE WFTH THE POLICY PROVISIONS. <br /> Orange County <br /> PO Box 85181 <br /> Hillsborough NC 27278 A x}IORI2EDREPRESENTATi <br /> IJRs,� le <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />