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2020-674-E-Planning-In-Water Services Company
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2020-674-E-Planning-In-Water Services Company
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Entry Properties
Last modified
7/7/2021 8:51:07 AM
Creation date
7/7/2021 8:50:48 AM
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Template:
Contract
Date
9/30/2020
Contract Starting Date
9/30/2020
Contract Ending Date
10/1/2020
Contract Document Type
Contract
Amount
$10,000.00
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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <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 be endorsed.If SUBROGATION IS WAIVED,subject to <br />the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />CONTACTPRODUCERNAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />PRODUCER <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED INSURER A : <br />INSURER B : <br />INSURER C : <br />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 />ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSR WVD <br />GENERAL LIABILITY EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCOMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence) <br />CLAIMS-MADE OCCUR MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $ <br />PRO-$POLICY LOCJECT <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person)$ <br />ALL OWNED AUTOS BODILY INJURY (Per accident)$ <br />SCHEDULED AUTOS PROPERTY DAMAGE $(PER ACCIDENT)HIRED AUTOS <br />$NON-OWNED AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE $OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br />$DEDUCTIBLE <br />$RETENTION $ <br />WC STATU-OTH-WORKERS COMPENSATION TORY LIMITS ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09) <br />Travis Ketron <br />OP ID: FD <br />09/21/2020 <br />Sandra Berry <br />Southeastern Agency Group,Inc. <br />1501 Highwoods Blvd., St # 402 <br />Greensboro, NC 27410 <br />Travis Ketron <br />336-218-7470 336-218-7487 <br />sberry@sagnc.com <br />INWAT-1 <br />In Water Services Co, Inc <br />3683 Southeast School Rd <br />Greensboro, NC 27406 <br />WC Assigned Risk/Travelers <br />Berkley Fire & Marine 38911 <br />Pennsylvania National 14990 <br />1,000,000 <br />C X AU9 0676239 09/24/2020 09/24/2021 <br />X <br />X <br />C X ded 250/500 <br />X <br />A 6JUB-02E36278-8-20 09/24/2020 09/24/2021 1,000,000 <br />1,000,000 <br />1,000,000 <br />B Rented and Leased MIM 1016903-53 09/24/2020 09/24/2021 Limit 300,000 <br />Equipment Ded 1,000 <br />Orange Lake Project <br /> <br /> <br /> <br />ORANGEC <br />Orange County Planning and <br />Inspections Department <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />DocuSign Envelope ID: B57CB43A-4474-4C08-B164-B90774C3FC80
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