|
DocuSign Envelope ID: DEE004B4-A2DB-42BB-8896-BA1873942328
<br /> ECSSOUT-01 MLEE
<br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY)
<br /> 3/18/2021
<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(ies)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 endorsement(s).
<br /> PRODUCER CONTACT Meg S. Lee,CIC
<br /> The Andersen Insurance Group PHONE FAX
<br /> 14026 Thunderbolt Place Suite 200 (A/C,No,Ext):(703)988-0900 102 (A/C,No):
<br /> Chantilly,VA 20151 AD AIL meg@theandersengrp.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Cincinnati Insurance Company 10677
<br /> INSURED INSURER B:Federal Insurance Company 20281
<br /> ECS Southeast, LLP INSURER C:Bankers Standard Insurance Company 18279
<br /> 14026 Thunderbolt Place
<br /> Suite 500 INSURER D:ACE American Insurance Company 22667
<br /> Chantilly,VA 20151 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 EXP LIMITS
<br /> LTR IN SD WVD MM DD MM DD
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR ENP0219991 12/1/2020 12/1/2021 DAMAGE TO RENTED 500,000
<br /> X PREMISES Ea occurrence $
<br /> X Contractual Liab MED EXP(Any oneperson) $ 10,000
<br /> X X C U PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JERCOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO EBA0559255 12/1/2020 12/1/2021 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED perr.citlentDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE 79891344 12/1/2020 12/1/2021 AGGREGATE $ 5,000,000
<br /> DIED I X I RETENTION$
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> YIN 71764167 12/1/2020 12/1/2021 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> A Excess Liability EXS0220000 12/1/2020 12/1/2021 Occ/Aggr 10,000,000
<br /> D Pollution Liability CPMG28192289 12/1/2020 12/1/2021 Inc/Aggr 10,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Project: River Park Phase II Improvements,228 Churton Street,Hillsborough,NC 27278
<br /> The Certificate Holder is included as an Additional Insured with respect to General Liability coverage where required by written contract.A Waiver of
<br /> Subrogation is granted under the Worker's Compensation policy where required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count North Carolina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O.Box 8181
<br /> Hillsborough, NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|