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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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />7/15/2021
<br />Jones Insurance Agency,Inc.
<br />820 Benson Road
<br />Garner NC 27529
<br />Heidi Morse
<br />919-772-0233 919-779-4025
<br />morseh@jones-insurance.com
<br />Selective Insurance Company of the Southeast 39926
<br />RESTORP-01 Accident Fund General Insurance Company 12304RestoreProReconstruction,Inc
<br />106 Capitola Drive
<br />Durham NC 27713
<br />Tokio Marine Specialty Insurance Company 23850
<br />446777352
<br />A X 1,000,000
<br />X 500,000
<br />X $0 deductible 15,000
<br />1,000,000
<br />3,000,000
<br />X
<br />S2453198 1/8/2021 1/8/2022
<br />3,000,000
<br />A 1,000,000
<br />X
<br />X X
<br />S2453198 1/8/2021 1/8/2022
<br />A X X 5,000,000S24531981/8/2021 1/8/2022
<br />5,000,000
<br />X 0
<br />B X
<br />N
<br />WCV6195992 9/29/2020 9/29/2021
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />C
<br />C
<br />A
<br />Professional Liab-$5,000 Ded
<br />CPL -$5,000 Deduct
<br />Leased/Rented Equipment
<br />PPK2225517
<br />PPK2225517
<br />S 2453198
<br />1/8/2021
<br />1/8/2021
<br />1/8/2021
<br />1/8/2022
<br />1/8/2022
<br />1/8/2022
<br />Professional Liab
<br />Pollution-Per Claim
<br />Leased/Rented Eqpt
<br />2,000,000
<br />2,000,000
<br />150,000
<br />•The General Liability policy includes an additional insured endorsement that provides additional insured status for ongoing operations and products and
<br />completed operations and a waiver of subrogation endorsement that provides waiver of subrogation status to the certificate holder and other entities when there
<br />is a written “insured contract”between named insured and certificate holder that requires such status.•The General Liability policy contains an endorsement
<br />providing primary and non-contributory status when a written “insured contract”requires such status.
<br />•The Auto Liability policy includes an additional insured endorsement that provides additional insured status and a waiver of subrogation endorsement that
<br />provides waiver of subrogation status to the certificate holder and other entities when there is a written “insured contract”between named insured and certificate
<br />holder that requires such status.•The Auto Liability policy contains an endorsement providing primary and non-contributory status when a written “insured
<br />contract”requires such status.
<br />See Attached...
<br />Orange County Asset Management Coordinator
<br />PO Box 8181
<br />Hillsborough NC 27278
<br />DocuSign Envelope ID: 8114697F-F41C-43F1-AFE2-ADC7016F0955
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