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DocuSign Envelope ID:3B5EFA61-95FF-432C-8D9C-9ECE68C8BOF7 RACAN-1 OP ID: CB
<br /> ,4Ca�o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 05/22/2019
<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(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 /> PRODUCER 631-424-3300 CONTACT Colleen Brosnahan
<br /> Robert C. Bill Associates,Inc NAME:
<br /> 150 Broadhollow Road Suite 307 (�C,NNo,Ext):631-424-3300 (AIC No):AX 631-427-0105
<br /> Melville, NY 11747 E-MAIL CBrosnahan@robertcbillassociates.com
<br /> Robert Bill ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Zurlch American Insurance Co. 27855
<br /> INSURED INSURER B:Great American Insurance
<br /> Racanelli Construction South,
<br /> Inc. INSURER C:
<br /> 1091 Pemberton Hill Road
<br /> Suite 102 INSURER D:
<br /> Apex,NC 27502-4265
<br /> INSURER E:
<br /> 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 DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTRMM DD YYY MM
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE X OCCUR GL05918594-13 01/31/2019 01/31/2020 DAMAGETORENTED 300,000
<br /> X X PREMISES Ea occurrence $
<br /> X Ded:$100,000 MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY X PRO-
<br /> POLICY LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: Emp.Ben. 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> Ea accident $
<br /> ANY AUTO BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED Perr.c.-Z) MAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X AUC5918559-13 01/31/2019 01/31/2020 AGGREGATE $ 25,000,000
<br /> DED X RETENTION$ 10,000
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> WC5918595-13 01/31/2019 01/31/2020 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Al N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,0�0,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> A Pollution/Professi X X EOC 5965874-11 01/31/2019 01/31/2020 Occ/Agg 5,000,000
<br /> B Property X X IMPE16478602 12/31/2018 12/31/2019 Limit 714,417
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County is included as additional insured if reqquired byy written
<br /> contract per endorsement form#U-GL-1175-F CW&U-GL-1461-A CW to the
<br /> extent provided therein,subject to policy terms limitations and exclusions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGEC
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PO Box 8181
<br /> Hillsborough, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> /�/-�-�
<br /> I FL,1
<br /> /�f/
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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