|
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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:
<br />CONTACT
<br />(A/C, No):
<br />FAX
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):
<br />PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />ER
<br />OTH-
<br />STATUTE
<br />PER
<br />LIMITS(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />POLICY EFF
<br />POLICY NUMBERTYPE OF INSURANCELTR
<br />INSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />$PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-
<br />JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />X
<br />10/01/18
<br />Certificates Atlanta
<br />5,000,000
<br />Suite 400
<br />200 Glenridge Point Parkway
<br />PO Box 8181
<br />Contractors Pollution
<br />06/05/2019
<br />2,000,000
<br />5,000
<br />10/01/18
<br />10/01/19
<br />2,000,000
<br />X
<br />5,000,000
<br />X
<br />404-439-8000
<br />X
<br />10,000
<br />XOOG27239420
<br />Each Incident/Agg
<br />10/01/19
<br />5,000,000
<br />Hillsborough, NC 27278
<br />10/01/19
<br />10/01/18
<br />A
<br />U5L00010318
<br />1-404-439-8000
<br />X
<br />5,000,000
<br />Orange County, to the extent required per attached endorsements is an additional insured.
<br />10/01/18
<br />LITTLE ROCK, AR 72202-1412
<br />Orange County
<br />404-439-8001
<br />1320 BROOKWOOD DR. STE H
<br />MWTB314124
<br />04/01/18
<br />CertificatesAtlanta@integrogroup.com
<br />X
<br />2,000,000
<br />RENTOKIL NORTH AMERICA, INC. (REN469)
<br />SOLITUDE LAKE MANAGEMENT, LLC
<br />5,000,000
<br />MWC314123
<br />OGLG27240331X
<br />Atlanta, GA 30342
<br />ALLIANZ UNDERWRITERS INS CO
<br />ACE PROP & CAS INS CO
<br />B
<br />OLD REPUBLIC INS CO
<br />ACE AMER INS CO
<br />X
<br />B
<br />5,000,000
<br />10/01/19
<br />56353395
<br />56353395
<br />D
<br />N
<br />X
<br />C
<br />2,000,000
<br />36420
<br />20699
<br />USA
<br />24147
<br />22667
<br />5,000,000
<br />Tina.Woodard@integrogroup.com_ATL
<br />10/01/19
<br />5,000,000
<br />dba Integro Insurance Brokers
<br />Integro USA Inc.
<br />DocuSign Envelope ID: EE23F468-2756-49BC-81A9-835B92D0E90E
<br />ocesscGENERAL AGGREGENERAL AGGRE
<br />PERSONAL & ADVPERSONAL & ADssIn PrIn MED EXP (Any on
|