2019-765-E AMS - Seegars Fence boiler fence enclosure

Browse Search

DocuSign Envelope ID: F2F9AD46-A8C2-4670-93E9-3ACCCBC6F498 CERTIFICATE OF LIABILITY INSURANCE DATEtMI%UDDIYYYYI 10r141zv1 a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT Susan Denton NAME.: John Hackney Agency of Rocky Mount AIC No Ext: (252)442-3186 A�Na; (252)451-9400 950 Country Club Road E-MAIL sdenton@jharm.com ADDRESS: P O.Box 7907 INSURER{S)AFFORDING COVERAGE NAIC it Rocky Mount NC 27804-0807 INSURERA: Selective Insurance Co.of America(A)rated 12572 INSURED INSURER B: Accident Fund National Ins.Co of America(A)rated 12305 Seegars Fence Co.Inc.of Durham INSURER C: PO Box a1378 INSURER D: INSURER E: Durham NC 27715 INSURERF: COVERAGES CERTIFICATE NUMBER: CL197204216 REVISION NUMBER: THIS IS TO CE RTI FY THAT TH E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER]aD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES CRI8ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUS ION S AND CONDITIONS OF SUCH POLICIES.L[MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A LJUL bUtIN POLICY Err POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDrMY MMIDDf"YY LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1,000.000 CLAIMS-MADE FSJ OCCUR PREMISES Ea occurrence S 500,060 MED EXP(Any one parson] S 15,000 A X XCU is not excluded Y Y S2174309 08/01/2019 =0112020 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMITAPPLIESPER: GENERALAGGREGATE S 2,000,000 POLICY[E jEC'T F1 LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINE ld D SINGLE LIMIT s '1.000,000 I Ea accenl ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S2174309 D810112019 D810112020 BODILY INJURY(Per a=Went) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accldeM IX 1 $ x UMBRELLA LIAB X OCCUR EACH OCCURRENCE s 5,000,000 A EXCESS LIAR CLAIMS-MADE S2174341 0810112019 D810112020 AGGREGATE $ 5,000,000 DED I XI RETENTION S 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETORIPARTNERIEHECUTIVE M NIA WCV8147075 D8101/2v19 08101r2020 E.L.EACH ACCIDENT $ 1,ODO,OOt1 OFFICERIMEMBER EHCI.UDFD? 1,DDv,000 {Mandatory in NHI E.L.DISEASE-FA EMPLOYEE $ If yes,describe under 1,D00,000 DESCRIPTION of OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Equipment Floater Rented/Leased $125,000 A S2174309 08/01/2019 08/01/2020 Equipment ❑ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The certificate holder is included as additional insured with respects to general liability as required by written contract. The policies are written on a primary& non-oontributory basis with a waiver Of subrogation In favor of the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DES CWEE❑POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACOR❑