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2019-647-E AMS - Carolina Restoration SDC water mitigation
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2019-647-E AMS - Carolina Restoration SDC water mitigation
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Last modified
10/25/2019 3:50:39 PM
Creation date
9/26/2019 9:30:10 AM
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Template:
Contract
Date
9/20/2019
Contract Starting Date
9/30/2019
Contract Ending Date
11/30/2019
Contract Document Type
Contract
Amount
$2,088.45
Document Relationships
R 2019-647 AMS - Carolina Restoration SDC water mitigation
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2019
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DocuSign Envelope ID: E3784150-6543-4F73-9335-68E9BB000372 <br /> AC"RE)" <br /> 709/10/2019 <br /> E(MMIDDIYYYY) <br /> kk�C" CERTIFICATE OF LIABILITY INSURANCE <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(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsements. <br /> PRODUCER CONTACT <br /> NAME: Amy Freeman <br /> Williamson Insurance&Financial Services Inc AXONE 919 567-9580 A"C Not: 919 557-99I7 <br /> 320 N Judd Parkway NE AEOOREss. am @williamson-insurance.com <br /> Suite 204 INSURERS AFFORDING COVERAGE NMC# <br /> Fuguay Varina NC 27526 INSURERA: Erie Ins Exchange 26271 <br /> INSURED INSURER B <br /> Carolina Restoration Services of NC Inc ENSURER C <br /> 3401 Gateway Centre Blvd INSURER D <br /> INSURER E <br /> Morrisville NC 27560 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 AODL SUBR POLICY NUMBER POLICY EFF POLICY <br /> LTR LIMEYS <br /> X COMMERCIAL GENERAL LUIBILITY EACH OCCURRENCE $ 1000000 <br /> CLAIMS-MADE FX7 OCCUR PREMISES a occurrenoe $ 10D0000 <br /> MED EXP(Any orre person) $ 5000 <br /> A Q44-0152051 08/01/2019 081D112020 PERSONAL&ADV INJURY $ 1000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2000000 <br /> POLICY X� I- <br /> J PRO Fx_1 LOC PRODUCTS-COMP+OPAGG $ 2000000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COEa accM8INEDSINGLE LIMIT <br /> ident $ 1000000 <br /> X ANY AUTO BODILY RJURY(Per person) $ <br /> A OWNED LEq <br /> AUTOS <br /> AUTOS ONLY AUTOS Q08-0140177 08/01/2019 0810112020 BODILY INJURY(Per accdenp $ <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Peracadent <br /> X UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 4000000 <br /> A EXCESSLIA6 CLAIM MADE Q32-0171383 08/01/2019 08/012020 AGGREGATE $ 40D0000 <br /> DED I X I RL'TENTION 0 $ <br /> WORKERS CO MP EN SA TON PER DTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANY PROPRIETOR:PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICERWEMBER EXCLUDED? F7 NIA <br /> (Ka ndatoryIn NH) E.L.DISEASE-EA EMPLOYEE S <br /> II yes,describe under <br /> DESCRIPTION OF OPERATIONS berdw E.L.DISEASE-POLICY LIMIT $ <br /> Bailees Coverage-I In Transit Limit Limit 2000000 Ded 500. <br /> A Blanket Leased Equipment 044-0152051 08/01/2019 08101R020 Limit 10000 Dad 500_ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space Is requiredl <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 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> 200 South Cameron Street AUTHORIZED REPRESENTATIVE <br /> Hillsborough INC 27278 `1 <br /> Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />
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