2010-171 AMS - Owens Roofing DA and Annex

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CERTIFICATE OF LIABILITY INSURANCE DAT 11112D/YYYY ) 1 / 12 / 10 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 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 endorsements . C11T CT PRODUCER 919 -719 - 9570 NAME . BettyS . Bullock Senn Dunn - Raleigh 919 - 719 - 9571 A/C o EXt • 919 - 821 - 0082 F� No ) * 919 - 821 = 0085 4505 Falls of Neuse Rd , St 650 E -MAIL ADDRESS : owens roof in aol . com Raleigh , NC 27609 - 2521 PRODUCER Benjamin T . Singleton , AAI CUSTOMER ID : OWENS - 1 INSURER(S ) AFFORDING COVERAGE NAIC # INSURED Owens Roofing , Inc . INSURER A : Pennsylvania National Mutual 301 West Cabarrus St . INSURERB : Stonewood Insurance Co . 11828 Raleigh , NC 27601 = 1712 INSURER C : INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER . 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 , ILTR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 11000700 A X COMMERCIAL GENERAL LIABILITY CX90639485 05/01 / 10 05/01 / 11 PREMDAMAGE ORENTED 100 , 00 PREMISES Ea occurrence $ CLAIMS - MADE F OCCUR MED EXP (Anyone person ) $ 10100 A X Blanket Add Insd CX9063485 05/01 / 10 05/01 / 11 PERSONAL & ADV INJURY $ 1 , 000 , 00 GENERAL AGGREGATE $ 2 , 000100 GEN ' L AGGREGATE LIMIT APPLIES PER : PRODUCTS - COMP/OP AGG $ 2 , 000100 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000100 A X ANY AUTO AU90639485 05/01 / 10 05/01 / 11 ( Ea accident) BODILY INJURY ( Per person ) $ ALL OWNED AUTOS BODILY INJURY ( Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ A X HIRED AUTOS ( Per accident) A X NON-OWNED AUTOS $ A X Comp-Various Ded $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4 , 000100 EXCESS LIAB CLAIMS- MADE AGGREGATE $ 41000 , 00 A UL90639485 05/01 /10 05/01 / 11 DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS ' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/ PARTNER/EXECUTIVE Y / N WC100 0002387 - 2009A 01 /01110 01 /01 / 11 E . L. EACH ACCIDENT $ 1 , 000100 OFFICER/MEMBER EXCLUDED? ❑N N / A ( Mandatory in NH ) E . L. DISEASE - EA EMPLOYE $ 11000100 If yes , describe under DESCRIPTION OF OPERATIONS below E . L. DISEASE - POLICY LIMIT $ 1 , 000700 A Pollution Liab RCPL E 002561 =00 03,03/ 10 0110 ,111 11000 , 000 21000100 A Builders Risk CX90639485 05/01110 05/01 / 11 11026 , 098 1000 De DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101 , Additional Remarks Schedule , if more space is required ) Project : DA and GSA Roofs CERTIFICATE HOLDER CANCELLATION ORA8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN County of Orange ACCORDANCE WITH THE POLICY PROVISIONS . PO Box 8181 Hillsborough , NC. 27278 [AUTHORIZEDREPRESEQNTATIVE © 1988 = 2009 ACORD CORPORATION . All rights reserved , ACORD 25 ( 2009/ 09 ) The ACORD name and logo are registered marks of ACORD