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DocuSign Envelope ID: D561B1AE-DF34-4907-AD06-AOEB37BBE427 RACAN-1
<br /> OP ID:JIM
<br /> ,acoRO CERTIFICATE OF LIABILITY INSURANCE FDATEDDN
<br /> 12/10/2020 Y)
<br /> 020
<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(lies) 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 endorsements .
<br /> PRODUCER 919-467-8126 CONTACT John W.Miller,Jr.,CPCU,CIC
<br /> NAME:
<br /> The Adcock Agency, Inc. PHONE 919-467-8126 FAX 919-467-8175
<br /> 215 E.Chatham St.Suite 120 (A/C,No,Ext): (A/C,No):
<br /> Cary,INC 27511 n DRIESS:jmiller@adcockagency.com
<br /> John W.Miller,Jr.,CPCU,CIC
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Builders Mutual Insurance Co.
<br /> INSURED Racanelli Construciton South, INSURER B:Nautilus Insurance Co
<br /> Inc
<br /> 1091 Pemberton Hill Rd Ste 102 INSURERC:
<br /> Apex,NC 27502-4269 INSURER D:
<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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PCP0004622 06/01/2020 06/01/2021 DAMAGE TO RENTED 300,000
<br /> Y PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY El JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Emp Ben. 100,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO Y CAP0032961-00 06/01/2020 06/01/2020 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE Y MUB0014173-00 06/01/2020 06/01/2021 AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ 10000
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N PWC1014309-00 06/01/2020 06/01/2021 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> (Mandatory in NH)EXCLUDED? N/A 1,000,000
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> B Pollution CPL2032243-10 06/05/2020 06/01/2021 Pollution 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Commercial General Contractor building new and upfit projects in the Tr
<br /> ianggle area. The Certificate holder and their consultants are added as an
<br /> addtional insured for work performed by the insured under GI, auto, and
<br /> excess. There is a waiver of subrogatin for the holder in regards to
<br /> workers compensation..
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGCO
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O. Box 8181
<br /> Hillsborough, NC 27278 AUTHORIZED—REPRESENTATIVE
<br /> w
<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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