Orange County NC Website
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? <br />INSR ADDL SUBRLTR INSD WVD <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 COMPENSATIONAND 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 AGGJECT <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 <br />PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY <br />(Per accident) <br />$ <br />OCCUR EACH OCCURRENCE <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $ <br />PER OTH-STATUTE ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMITDESCRIPTION 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.ACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />$ <br />$ <br />$ <br />$ <br />$ <br />The ACORD name and logo are registered marks of ACORD <br />9/29/2022 <br />(919) 469-2473 (919) 467-4987 <br />28665 <br />CT Wilson Construction Co, Inc <br />Attn: Charles Wilson III <br />150 Golden Drive, Suite 200 <br />Durham, NC 27705 <br />10677 <br />12572 <br />19489 <br />A 1,000,000 <br />X EPP 0149137 7/1/2022 7/1/2023 <br />500,000 <br />10,000 <br />1,000,000 <br />3,000,000 <br />3,000,000 <br />1,000,000A <br />X EPP 0149137 7/1/2022 7/1/2023 <br />15,000,000A <br />EPP 0149137 7/1/2022 7/1/2023 15,000,000 <br />0 <br />B <br />X EWC 0394380 7/1/2022 7/1/2023 1,000,000N1,000,000 <br />1,000,000 <br />C Rented/Leased Equip. S 2128637 7/1/2022 Limit 100,000 <br />D Prof/Pollution 0310-8347 7/1/2022 7/1/2023 Limit 1,000,000 <br />Operations of the Named Insured covered by the above referenced policies. <br />C Builders Risk (Quarterly Reporting) Policy No. S2128637 7/1/2022 to 7/1/2023 Limit $10,000,000 <br />Re: Orange Co. Health - 221-709. <br />Orange County, its officers, official agents, and employees as an additional insured on the General Liability and Automobile Liability if required by written <br />contract. A waiver of subrogation applies in favor of Orange County, its officers, official agents, and employees for the Worker Compensation policy if <br />required by written contract. Umbrella follows form. A 30 day notice of cancellation applies. <br />Orange County <br />P O Box 8181 <br />Hillsborough, NC 27278 <br />CTWILSO-01 LHAMLET <br />Alera Group4325 Lake Boone Trail, Suite 200Raleigh, NC 27607 <br />Lori F. Hamlet <br />lhamlet@trisure.com <br />Cincinnati Casualty Co. <br />Cincinnati Insurance Co. <br />Selective Insurance Co. of America <br />Allied World Assurance Company <br />X <br />7/1/2023 <br />X <br />X <br />X <br />X <br />X X <br />X <br />X <br />X <br />DocuSign Envelope ID: 1B50AF0F-E277-48C1-A2A4-F34475D3BB76