2020-923-E AMS - Bordeaux Construction change amendment 3

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DocuSign Envelope ID:658A459F-A778-460E-9BE2-7EF08EAF03B2 ---o"I BORDCON-02 MAIRINGTON lYCCIP E31I DATE IMMIDDIYYYYI 04 � CERTIFICATE OF LIABILITY INSURANCE 1 211 812 01 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 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(les)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 CONTACT Melanie A.Airington Trisure,an Alera Group Company PHONE. e,Ext:(919y 469-2473 ,No:(919)467-4987 4325 Lake Boone Trail,Suite 200 Raleigh,NC 27607 AE L .rrlairin ton risure.com MAI INSURERS AFFORDING COVERAGE NAIC# _ INSURER A:Charter Oak Fire Insurance Company The 25615 INSURED INSURER 8:Travelers Prop" Casualty Company of America 25674 Bordeaux Construction Company,Inc. INSURER C:Phoenix Insurance Company The 25623 #101 135 E Martin St INSURER D: Raleigh,NC 27601 ON SURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 7 U 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 POLICDY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 11000,000 CLAIMS-MADE x vccuR CO2F979366 12/31/2019 1213112020 DAMAGE TO-RENTED 300,000 $ X Contractual Liab MED EXP oneperson) $ 10,000 PERSONAL&ADV INJURY 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY 177�,-71 j LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 x ANYAUTQ 81021-173833 12/31/2019 12/31/2020 BODILY INJURY Per on S OWNED X SCHEDULED � AUTOS ONLY AUTOS BODILY INJURY Per smWeit S x AUTOS ONLY x AUTOS ONLY 01 aacEcRide DAMAGE $ x Comp$500 x Coll$500 $ B X UMBRELLA LIAR x OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE CUP4I0009166 12/31/2019 12/31/2020 AGGREGATE s 10,000,000 DED I x I RETENTION$ 10,006 t C WORKERS COMPENSATION x PER OTH- AND EMPLOYERS LIABILITY STATUTE UB8J493303 12/31/2019 12/31/2020 11000,000 AA14Y PROPRIETgORIPARTNERIEXECUTIVE Y 1 N E.L.EACH ACCIDENT $ (Mandatory In Nj ExCLUOEo7 N 1A E.L.DISEASE-EA EMPLOYE S 11000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLIL:Y LIMIT DESCRIPTION OF 0PERATIONS I LOCATIONS I VEHICLES (ACOR0 101,Additional Remarks Schedule,may be attached If morespace Is required) Leased)Rented Equipment 6607F242185(The Charter Oak Fire Insurance Co.)NAIC#2561512131119-12131120 LeasedlRented Equipment Limit $160,000 Operations of the Named Insured covered by the above referenced policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count Attn: Risk Manager THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD