2020-168-E AMS - BIRS SDC roof repair

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DocuSign Envelope ID:00583176-E4FA-448B-88D4-42DFOFC2EC50 i i i DATE(MMIDDNYYY) AC4 Ro CERTIFICATE OF LIABILITY INSURANCE 4/1 212 0 1 9 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 t 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 cCNTACT Lynne A.Meyer,CIC,CPIW,AINS Marsh&McLennan Agency LLC PHONE FAX 3625 N. Elm Street 33fi 346-1302 AVC.No 212-fi117-B534 Greensboro NC 27455 ,4DDARESS L nne.Me er marshmma.cam {§ 1NSURER 8 AFFORDING COVERAGE NAIC# 1 INSURERA:Builders Premier Insurance Company 13036 111 INSURED 13IRSINCI INSURER B:Builders Mutual Insurance Company 10844 SIRS, Inc. Mr. Raven Broeker INSURER c:Columbia Casualty Company 31127 PC Box 36197 INSURER D Greensboro NC 27416-6197 INSURERE: INSURER F COVERAGES CERTIFICATE N UM BER:379236999 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 t 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. INS ADDL SU8R POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICYNUMBER MMIODrYYYY M DDIYYYY A Xr COMMERCIAL GENERAL LIABILITY PCP000383200 511/2019 W112020 EACH OCCURRENCE $1,000,000 DAMAGE TO RE T CLAIMS-MADE FRI OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENV AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 POLICY jR a LOC PRODUCTS•COMPIOP AGG $2.000,000 OTHER: A AUTOMOBILE LIABILITY PCA0018423 5/112019 5/1/2020 COMBINED SINGLE LIMIT S 1,000,000 Ea ecGdent )( ANY AUTO BODILYI INJURY(Perpsrson) S OWNED SCHEDULED BODILY INJURY(Par accident) S AUTOS ONLY AUTOS x HIRED Ix NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per ac�denl Cam !Coll Dad S 1,00011,000 B X UMBRELLA LIAR X OCCUR MUB000123660 511/2019 5/1/2020 EACHOCCURRENCE $5,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTIONS $ A WORKERS COMPENSATION 3VV0100029008 5/1/2019 5/1/2020 X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y� NIA E.L.EACH ACCIDENT $1,000,000 OFF ICERIME MBER EXCLUD I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Rental Equipment PCP000363200 51112019 611=20 Limit $160,000 C E&OlPollution CE0691855996 5/112019 6/1/2020 Limit $1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Irmare space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange Coun}}� PO Box851S�I AU ORIZEDREPRESENTATIV Hillsborough NC 27278 I� a 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD