2019-641-E DEAPR - Summey Portable Restrooms waste disposal restroom trailer

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DocuSign Envelope ID: E7280C15-9FB3-4lA8-848B-04166A2932E2 DATE(MM/DDIYYYY) ACOR7> CERTIFICATE OF LIABILITY INSURANCE 64. , ' _ 05/06/2019 THIS CERTIFICATE IS SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NDT 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 OF PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cetificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS 1AAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does nc It confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Amy Miles Piedmont Iriad Insurance Agency PHONN xt (336)282-5555 O No).(336)282-5781_ E-MAIL c 7 Battlegroundam tia e n com Ct, Suite 224 AooRess; Y_�p g _ Y� Greensboro, NC 27408 INSURER(S)AFFORDING COVERAGE NAICp INSURERA. Erie Indemnity Company_ INSURED INSURER B: Harold Sunrmey Jr INSURERC: 2805 Miller Rd INSURERo Hillsborough, NC 27278-8487 INSURERE INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-70826 REVISION NUMBER: 5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSI ANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE IS SUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONCITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T - ADDL- ---- SUER) - - - - - - POLICY EFF POLICY EXP LTR I TYPE OF INSL RANCE I�NSp�yyp r POLICY NUMBER {MMfDDfVYYYI,{MMIDDIYYYYI LIMITS A COMMERCIAL GENE ZAL LIABILITY Y Q35-1221163 01/23/2019 11/12/2019 EACH OCCURRENCE - $ _ 1L000 OOO CLAIMS-MADE Xi,OCCUR DAMAGE TO RENTED. � � PREMISESSEa_occ,urrencel._—,$ 1 OOO OOO MED EXP(Any one person) $ 5 000 _... __. z._.—_. PERSONAL&ADV INJURY $ 1 000 OOO GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE .._ $ 2,000,000_ X POLICY[ _I PRO- [ ,J LOC I PRODUCTS COMPIOPAGG $ 2,000,000_ $OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A Q11-1240037 ',,11/1212018 111/12/2019 LE_aaccident) _ $ 110001000 ANY AUTO BODILY INJURY(Per person) t$ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS -- - HIRED NON-OWNED ',, PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY j LPer acadenq____ _.___-,___$_- Underinsured mo $ 1000000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENT ON$ $ WORKERS COMPENSATIO',L PER OTH- AND EMPLOYERS'LIABILC Y ,,f N ! .STATUTE,.__ ER _ ANY PROPRIETOR/PARTNE LEXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUC ED? ❑ N I A (Mandatory in NH) E L DISEASE EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERAT ONS below E L.DISEASE-POLICY LIMrT $ DESCRIPTION OF OPERATIONS,LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Gove•nment is listed as additional insured as it pertains to the General Liability as per written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHo ZEDREPRESENTATIVE---- LMC ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by LMC on May 06,2019 at 01 49PM