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DocuSign Envelope ID: DF078B63-CCED-42B9-8016-A67D8F6DF779
<br /> ACORO OP ID: DL
<br /> �- CERTIFICATE OF LIABILITY INSURANCE 7OT1/04/2022
<br /> E(MMDD(YYYY)
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H . 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 /> PRODUCER CONTACT
<br /> Diversified Insurance NAME: Kirk Brown
<br /> Solutions LLC PHONE FqX
<br /> 9-8222 1NC,No E, x1 9.1 g-47 A c No: 919-471-6607
<br /> P.0.Box 15734 E-MAIL L —L
<br /> Durham,NC 27704- ADDRESS: kbrown a)diverseins.com
<br /> Diane S.Long PRODUCER BROWBRO
<br /> CUSTOMER ID q;
<br /> _ INSURER(51 AFFORpING COVERAGE=
<br /> Heating Company, Inc. NAIC#
<br /> SU INRED Brown Brothers , Inc.Plumbing and INSURER A:Builders Premier Insurance Co. 110844
<br /> - -- -
<br /> 2820 N. Roxboro Road INSURER e:Builders Mutual Insurance Co. �10844
<br /> Durham, NC 27704 INSURERC:Hiscox Pro 44318
<br /> INSURERD:Tra-yelers Property/Casualty 36161 _
<br /> INSURER E;
<br /> -
<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 REOUIREMENT, 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 SUBR
<br /> LTR TYPE OF INSURANCE F POLICY NUMBER MM/DDIYYYY MM DDrYYYY LIMITS
<br /> GENERAL LIABILITY
<br /> - EACH OCCURRENCE $ 1,000,006
<br /> A - X COMMERCIAL GENERAL LIABILITY X IPCP0000055 13 12/31/2021 12/3112022 DAMAGE r0 RENTED-----
<br /> PREVISES Ea occurrence_ $ 300,000
<br /> CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 10,a00
<br /> contr
<br /> X Deductible hab. PERSONAL&ADV INJURY $ I-000,000
<br /> X Deductible$500. _ -� -- - --
<br /> '�- GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:. POLICY X : PRO- PRODUCTS-COMPP AGG_ $ 2—aaa00, ,aaa
<br /> - - IO $ -LOG $
<br /> AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT
<br /> {£a accident) 5 1,Oa0,000
<br /> A LXX-.
<br /> ANY AUTO PCA0006942 11 12/31/2021 12/31/2022
<br /> BODILY INJURY{Per person} $
<br /> ALL OWNED AUTOS
<br /> SCHEDULED AUTOS
<br /> 6001LY INJURY(Per accident) $
<br /> X HIRED AUTOS PROPERTY DAMAGE
<br /> (PER ACCIDENT) $
<br /> X NON-OWNED AUTOS
<br /> X Deductible -0- -
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5,a00,000
<br /> EXCESS LIAB - .. _
<br /> ___ CLAIM_S-MADE MUg0004308 03
<br /> S 12131/2021 12131/2022 AGGREGATE g 5,000,0-
<br /> DEDUCTIBLE .. $ '.. - -- -
<br /> 00
<br /> X RETENTION S 10,000 - --
<br /> WORKERS COMPENSATION $
<br /> AND EMPLOYERS'LIABILITY X WC STATU- O FIR
<br /> TORY LIMITS ER
<br /> B ANY PROPRIETORWARTNERIFXECUTIVE YfN N 1 A WCP0044355 13 12/31/2021 12/31/2022 E.L.EACH ACCIDENT $ 1,aOa,aOQ
<br /> OFFICERIMEMBER EXCLUDED?
<br /> (Mandatory in
<br /> I(yes,describe under FL DISEASE-EA EMPLOYEE_$ 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C PollutionlProfess. ANE226643821 06103/2021 06/03/2022 OcclAggr. 2,000,000
<br /> D Third Party Crime 1. 106446766 01/2012022 01/20/2023 2,000,000 10,000 Ded-
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks schedule,if more space is required)
<br /> Orange County, North Carolina is an Additional Insured, per attached forms.
<br /> Email to: abarnes oran ecount nc. ov
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANC07
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Orange County Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: Angel Barnes ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 300 W Tryon St, BIdg.B, 3rd FI
<br /> P.O. Box 8181 AUTHORIZED REPRESENTATIVE
<br /> Hillsborough, NC 27278 Diane S. Long P
<br /> XL
<br /> ©1988-2009 ACORD CORPORATION. All rights rese ed.
<br /> ACORD 25(2009109} The ACORD name and logo are registered marks of ACORD
<br />
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