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DocuSign Envelope ID:AD41 E8C7-FC41-4249-A9C6-849589FOC1 56 UMAGE-1 OP ID: SB
<br /> ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY)
<br /> 06/30/2021
<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 endorsements .
<br /> PRODUCER 336-232-0211 CONTACT Sandra Berry
<br /> Southeastern Agency Group,lnc. PHONE 336-232-0211 FAX 336-218-7487
<br /> 1501 Highwoods Blvd.,St#402 (A/C,No,EXt): (A/C,No):
<br /> Greensboro,NC 27410 ADDRIEss:sberry@sagnc.com
<br /> Travis Ketron
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Builders Mutual Insurance Co. 10844
<br /> INSURED INSURER B:Pennsylvania National 14990
<br /> UMA Geotechnical Construction Inc. Everest National
<br /> Sequoia Holdings Inc. INSURERC:
<br /> PO Box 1070 Hudson Excess
<br /> Kernersville,NC 27285 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 /> INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS
<br /> C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE � OCCUR CF3GL00067-201 01/31/2021 01/31/2022 DAMAGE TO RENTED 100,000
<br /> PREMISES Ea occurrence $
<br /> X Ded$5000 MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PR71 O- LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO AU9 0744159 01/31/2021 01/31/2022 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED L $
<br /> NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> D X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE HXS 1000230 03 01/31/2021 01/31/2022 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N WCP106263901 01/31/2021 01/31/2022 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 /> B Inlande Marine CL90744159 01/31/2021 01/31/2022 R&L Equip 250,000
<br /> D Cyber APP172289157 05/30/2021 05/30/2022 Cyber 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Contract: Metal &White Goods Retaining Wall Repair
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGEC
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange Count Solid Waste THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> g Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> and Recycling
<br /> PO Box 8181
<br /> AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278 Travis Ketron
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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