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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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />12/27/2024
<br />Bankers Insurance,LLC
<br />4509 Creedmoor Rd.Suite 201
<br />Raleigh NC 27612
<br />Leigh Ann Broadway
<br />919-267-3080 800-899-0146
<br />lbroadway@bankersinsurance.net
<br />License#:6387078 Cincinnati Insurance Company 10677
<br />JACOGLA-01 Accident Fund Insurance Company of America 10166JacobsGlassCompany,Inc
<br />4915 Hillsborough Rd
<br />Durham NC 27705
<br />1362649035
<br />A X 1,000,000
<br />X 500,000
<br />10,000
<br />1,000,000
<br />3,000,000
<br />X X
<br />Y Y EPP0366683 12/31/2024 12/31/2025
<br />3,000,000
<br />A 1,000,000
<br />X
<br />Y Y EBA0366683 12/31/2024 12/31/2025
<br />A X X 5,000,000YEPP036668312/31/2024Y 12/31/2025
<br />5,000,000
<br />B XYWCP10011993712/31/2024 12/31/2025
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Equipment-Leased/Rented
<br />Equipment-Stored
<br />Equipment
<br />Y
<br />Y EPP0366683 12/31/2024 12/31/2025 Limit
<br />Limit
<br />Deductible
<br />175,000
<br />1,500,000
<br />1,000
<br />The General Liability,Automobile Liability and Umbrella Liability policies include an automatic Additional Insured endorsement that provides Additional Insured
<br />status to Orange County,its officers,official agents,and employees,only when there is a written contract that requires such status,and only with regard to work
<br />performed by or on behalf of the named insured.The Workers Compensation policy provide a Blanket Waiver of Subrogation when required by written contract,
<br />except as prohibited by law.The General Liability policy includes an endorsement providing that 30 days'notice of cancellation will be given to the Certificate
<br />Holder by the Insurance Carrier.
<br />Designate Orange County
<br />300 West Tryon Street
<br />PO Box 8181
<br />Hillsborough NC 27278
<br />Docusign Envelope ID: 02C4068C-67C7-4DC3-B691-D67D7C2A0973
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