2022-053-E-Emergency Svc-4C Central Carolina Cleaning Company Inc-Temporary Decedant Storage

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DocuSign Envelope ID:3E565475-78AO-4C5D-AD10-C7A559DA7C44 ® DATE(MM/DD/YYYY) ACCO o CERTIFICATE OF LIABILITY INSURANCE 2/2/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CON I AG I NAME: Alexandra Lysik Cavik Insurance LLC PHONE 9103981044 A/ IA C,No,Ext: (A/C,No): PO Box 465 ADDRESS: alexandraMAIL @cavikinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Kure Beach NC 28449 INSURER A: GuideOne National Insurance Company INSURED INSURER B: Progressive Insurance 4C Central Cleaning Company Inc DBA Final Passage Transport INSURER C: Builders Mutual Ins Co 3434 Edward Mills Rd INSURER D: INSURER E: Raleigh NC 27612 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE NclOCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A D70876213AEM 01/10/2022 01/10/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 x POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Pollution Liability/Mold $ lmill occ/2mill agg AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B AU TOS OWNED ONLY AUTOS SCHEDULED 06349300 12/04/2021 12/04/2022 BODILY INJURY(Per accident) $ /► HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Per accident) x UMBRELLA LAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LAB HCLAIMS-MADE R74405211AEM 01/10/2022 01/10/2023 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION ��// - AND EMPLOYERS'LIABILITY Y/N )C STATUTE ER NY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑Y N/A 4N787891 01/20/2022 01/20/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Emergency Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE AU*mk,,"L+9s+idc- Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD