|
DocuSign Envelope ID: DB7861A7-7465-4A17-A9DE-51CF3E64EDA0
<br /> �e CERTIFICATE OF LIABILITY INSURANCE DA1/TE(17/2020)
<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 be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Martha Aycock, AAI, CISR
<br /> NAME: y
<br /> Jake A Parrott Insurance Agency Inc A/CNNo Ext: (252)523-1041 FAX,
<br /> (AIC NU: (252)523-0195
<br /> 2508 N HERRITAGE STREET E-MAIL ADDRESS:mP P arrott@ arrottins.com
<br /> PO BOX 3547 INSURERS AFFORDING COVERAGE NAIC#
<br /> KINSTON NC 28502 INSURER A:EMCASCO INSURANCE COMPANY 21407
<br /> INSURED INSURER B:EMPLOYERS MUTUAL CASUALTY CO 21415
<br /> REDMILL LANDSCAPE & NURSERY, INC. INSURERC:UNION INSURANCE CO OF PROVIDENCE 21423
<br /> 4517 RED MILL RD INSURER D:
<br /> INSURER E:
<br /> DURHAM NC 27704-9455 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2019-2020 MASTER 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR IN SD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> � OCCUR DAMAGE TO RENTED
<br /> A CLAIMS-MADE
<br /> PREMISES Ea occurrence $ 300,000
<br /> $250 PD DED PER CLAIM X Y 2D93305 12/1/2019 12/1/2020 MED EXP(Any one person) $ 5,000
<br /> PERSONAL &ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY � PEA ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> A X ANYAUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED X Y 2E93305 12/1/2019 12/1/2020 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIREDAUTOS AUTOS Per accident
<br /> Medical payments $ 2,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED RETENTION $ 2J93305 12/1/2019 12/1/2020 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> C (Mandatory OFFICER/MEMBER EXCLUDED? Y 2H93305 12/1/2019 12/1/2020
<br /> ( ry ) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A PESTICIDE OR HERBICIDE 2D93305 12/1/2019 12/1/2020 Included under GLcoverage
<br /> APPLICATOR COVERAGE Form Number CGO157 (7/98)
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER IS INCLUDED ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY, ON A PRIMARY &
<br /> NON-CONTRIBUTORY BASIS, INCLUDING ONGOING & COMPLETED OPERATIONS, VIA WRITTEN CONTRACT IN FORCE WITH THIS
<br /> REQUIREMENT INCLUDED. CERTIFICATE HOLDER IS INCLUDED ADDITIONAL INSURED WITH RESPECT TO AUTO LIABILITY,
<br /> VIA WRITTEN CONTRACT IN FORCE WITH THIS REQUIREMENT INCLUDED. WAIVER OF SUBROGATION APPLIES IN FAVOR OF
<br /> ADDITIONAL INSURED WITH RESPECT TO GENERAL & AUTO LIABILITY & WORKER'S COMPENSATION, VIA WRITTEN CONTRACT
<br /> IN FORCE WITH THIS REQUIREMENT INCLUDED. EXCESS LIABILITY IS FORM FOLLOWING. EXCLUDED OFFICERS IN W/C
<br /> COVERAGE: BILL SPARROW SR, BILL SPARROW JR, & MARGIE SPARROW
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> jdail@orangecountync.gov
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> ORANGE COUNTY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 4710 WEST TEN ROAD ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> EFLAND, NC 27243
<br /> AUTHORIZED REPRESENTATIVE fJ
<br /> Allen Parrott/ASHLEY F
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(201401)
<br />
|