2020-051-E AMS - Carolina Restoration Services Seymour Center bathroom repair

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DocuSign Envelope ID: F86D014C-7DCC-42B5-83DE-B006EA690E74 DATE (MM/DD/YYYY) ,4�v►�o CERTIFICATE OF LIABILITY INSURANCE 09/10/2019 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 endorsement(s). PRODUCER Phone: 919-463-5300 Fax: 919-463-5301 CONTACT ISU-Lipstone Insurance Group ISU-LIPSTONE INSURANCE GROUP PHONE FAX 208 NEW EDITION CT we No F. 919-463-5300 A c No: 919-463-5301 E-MAIL CARY NC 27511 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA :GuideOne National Insurance Company 14167 INSURED CAROLINA RESTORATION SERVICES OF NC INC INSURER :Builders Mutual Insurance Company 10844 3401 GATEWAY CENTRE BLVD INSURER MORRISVILLE NC 27560 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 6974 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE Il OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurence) MED.EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO POLICY 1:1 JECT [] LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS r $ NON-OWNED PROPERTY DAMAGE $ AUTOS (per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DIED I RETENTION$ $ PER B WORKERS COMPENSATION WCP002324919 03/16/19 03/16/20 STATUTE ERH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YINE.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory in NH) yes,describe under D E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS below ,000,000 A Contractors Pollution Liability ENV562000993-00 02/03/19 02/03/20 $5,000,000 Per Pollution Condition $5,000,000 Policy Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 South Cameron Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Attention: Steven S. Lipstone ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD