Orange County NC Website
Browse       Search
DocuSign Envelope ID:484DA2FF-FF69-4942-ABE7-lC7B9FE1C133 OP ID: DL <br /> 1A4C7ORO CERTIFICATE OF LIABILITY INSURANCE 7MIDD/YYYY)(M <br /> 122/2020 <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 /> r';EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> ,PORTANT: 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 Irnay 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 NAME: Kirk Brown <br /> Diversified Insurance — <br /> Solutions LLC PHONE FAX E:t:919-471-8222 FJC No;919-471-6607 <br /> P.0.Box 15734 ADDRESS: kbrown diverseins.com <br /> Durham,NC 27704- PRODUCER <br /> Diane S.Long cu T M D#;BROWBRO <br /> INSURERS AFFORDING COVERAGE NAIL W <br /> INSURED Brown Brothers Plumbing and INSURER A:Builders Premier Insurance Co. 10844 <br /> Heating Company, Inc. INSURER B:Builders Mutual Insurance Co. 10844 <br /> 2820 N. Roxboro Road INSURER C:HISCOX Pro .44318 <br /> Durham, NC 27704 <br /> INSURER D:Travelers Property/Casualty .36161 <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 /> VN7 R TYPE OF INSURANCE POLICY NUMBER MM�DlYYYY MMIDDfYYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY PCP0000055 12 12/3112020 12/31I2021 PREMISES Ea occurrence $ 300,00 <br /> CLAIMS-MADE rx-1 OCCUR MED EXP(Any one person) $ 10,00 <br /> X contractual liab. PERSONAL&ADV INJURY $ 1,000,00 <br /> X Deductible$500. GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY X PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 <br /> (Ea accident) <br /> A X ANY AUTO IDCA000694210 12/31/2020 '12/31/2021 <br /> BODILY INJURY(Per person) $ <br /> X ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> X HIRED AUTOS (PER ACCIDENT) $ <br /> X NON-OWNED AUTOS $ <br /> X Deductible -0- $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S,000,OO <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00 <br /> B MUBOID04308 02 12/31/2020 12/31I2021 <br /> DEDUCTIBLE $ <br /> X RETENTION $ 10,000 $ <br /> WORKERS COMPENSATION X WC STATUS Y LIMITS E83 <br /> AND EMPLOYERS'LIABILITY 1,000 00 <br /> B ANY PROPRIETORIPARTNER/EXECUTIVE YIN NCP0044355 12 12/31/2020 12/31/2021 E.L.EACH ACCIDENT I $ <br /> OFFICER/MEMBER EXCLUDED? N I A 1,000,000 <br /> (Mandatory in NH) E-L,DISEASE-EA EMPLOYEE $ <br /> Ir yes,describe under E.L DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS below _ <br /> C Pollution/Profess. ANE226643820 06/0312020 0610312021 Occ/Aggr. 2,000,000 <br /> D Third Party Crime 106446766 01/20/2021 01/2012022 100,000 5000.ded <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) <br /> .Job: Orange County-300 W.Tryon Street <br /> Orange County, North Carolina(owner)is additional insured per the attached <br /> Forms. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANC07 <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 /> Attn: County Manager <br /> 200 S.Cameron St. AUTHORIZED REPRESENTATIVE <br /> P.O. Box 8181 Diane S. Long =� <br /> Hillsborough,NC 27278 (, <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />