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04/07/2021
<br />Summit Insurance Group Inc.
<br />PO Box 2485
<br />Huntersville, NC 28070-2485
<br />License #: 7638156
<br />Nicole R. Talbert
<br />(704)659-2141 (704)659-2148
<br />nicole@sumins.com
<br />00008390-2445808 14
<br />Habitat For Humanity Orange County, NC, Inc.
<br />88 Vilcom Center Dr. Ste L110
<br />Chapel Hill, NC 27514
<br />Builders Mutual Insurance Company
<br />A CPP 0058155 08
<br />04/01/2021 04/01/2022X
<br />X
<br />X
<br />1,000,000
<br />100,000
<br />5,000
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />Builders Premier Insurance Company
<br />B PCA 0009233 08
<br />04/01/2021 04/01/2022
<br />X
<br />
<br />
<br />1,000,000
<br />Builders Mutual Insurance Company
<br />A MUB 0001005 04
<br />04/01/2021 04/01/2022XX
<br />X 10,000
<br />5,000,000
<br />5,000,000
<br />Builders Premier Insurance Company
<br />B PWC 1011231 08
<br />04/01/2021 04/01/2022
<br />X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />Travelers Casualty & Surety Company Of America
<br />C 107048172
<br />04/01/2019 04/01/2022Financial Services 1,000,000
<br />Additional insured status applies to the certificate holder under General Liability when required by written contract.
<br />Orange County
<br />PO Box 8181
<br />Hillsborough, NC 27278
<br />(NRT)
<br />Printed by NRT on April 07, 2021 at 01:16PM
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />INSR ADDL SUBR
<br />LTR INSD WVD
<br />DATE (MM/DD/YYYY)
<br />PRODUCER CONTACTNAME:
<br />FAXPHONE(A/C, No):(A/C, No, Ext):
<br />E-MAILADDRESS:
<br />INSURER A :
<br />INSURED INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)
<br />AUTOMOBILE LIABILITY
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />AUTHORIZED REPRESENTATIVE
<br />EACH OCCURRENCE $
<br />DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
<br />MED EXP (Any one person) $
<br />PERSONAL & ADV INJURY $
<br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
<br />PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT
<br />OTHER:$
<br />COMBINED SINGLE LIMIT $(Ea accident)
<br />ANY AUTO BODILY INJURY (Per person) $
<br />OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS
<br />HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY
<br />(Per accident)
<br />$
<br />OCCUR EACH OCCURRENCE $
<br />CLAIMS-MADE AGGREGATE $
<br />DED RETENTION $
<br />$
<br />PER OTH-STATUTE ER
<br />E.L. EACH ACCIDENT $
<br />E.L. DISEASE - EA EMPLOYEE $
<br />If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />COMMERCIAL GENERAL LIABILITY
<br />Y / N
<br />N / A
<br />(Mandatory in NH)
<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 />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 />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 />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DocuSign Envelope ID: C9845433-1FBA-481B-B3F4-F46E6FEA8974
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