2020-178-E AMS - Nice and Green various locations

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DocuSign Envelope ID:833ADDEF-C928-43A0-948B-C1C81315523D ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 0212;20 a' THIS CERTIFICATE 15 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 pollcy(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 NAMEACT Martha Dickerson Lester Ins.Group,Inc.T1AThe Harper Agency PHHONH Ext: (336)227-3271 JAIC,FAX No; (336)222-9467 1037 S.Main 5t. E-MAIL mdickerson@lestergrp.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 Burlington NC 27215 INSURERA: Pennsylvania National Mutual Casualty Ins Co 14990 INSURED INSURERS: United States Liability Ins Company Nice and Green Commercial Floor Care Services,LLC INSURER C: AmGUARD Ins Co 42390 2108 Quakenbush Road INSURERD: INSURER E: Snow Camp NC 27349 INSURER F: COVERAGES CERTIFICATE NUMBER: CL201211144 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. I EXP �TR TYPE OF INSURANCE I p D POLICY NUMBER POLICY EFF MNUDOY ff LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 2,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) S 10,000 A GL90733918 01/31/2020 1110712020 PERSONAL BADVINJURY S 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER* GENERAL AGGREGATE S 4,000.000 X PRO LOC PRODUCTS-COMPIOPAGG s 4,000,000 rlPOLICY ❑ OTHER: AutomatiCAdditionallnsd $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea aodderi! ANYAUTO BODILY INJURY(Per person) S A OWNED X SCHEDULED AU9 0733918 11/0712019 11/07/2020 BODILY INJURY(Per acddent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Peraoofden! X 19 Underinsured motorist s 1,000,000 X UMBRELLA LIAR OCCUR E,� i,000,000 EACH OCCURRENCE $ B EXCESSLIA6 HCLAIMS-MADE CUP1562213 11/07/2019 11/0712020 AGGREGATE y 1,000,000 DED I J RETENTIONS $ WORKERS COMPENSATION X STATUTE EORH_ AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIE7CECU WE E.L EACH ACCIDENT $ 1,000,OD0 C OFFICERtMEMBER EXCLUDEDa NIA R2WCD77882 12/1412019 12/14/2020 (Mandatary in NH) E.LDISEASE-EAEMPLOYEE S 1,000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS belay I I I E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) J.P.Barnett 11 has elected to exclude himself from the Workers Compensation coverages. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 131 W Margaret Lane AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 �� /�•�t � ��,-.r�� ID 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD