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Home My WebLink About2013-154 DEAPR - NW Poole Well Co for Irrigation well and hook-ups A$18,964 COMMERCIAL AUTOMOBILE CAU 042(12 08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION PRIMARYMON-CONTRIBUTORY COVERAGE WHEN REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement is subject to the terms, conditions,exclusions and any other provisions of the BUSINESS AUTO COVERAGE FORM or any endorsement attached thereto unless changes or additions are indicated below. Additional Insured For the purpose of this endorsement, paragraph c.of Section 11.A. 1.Who Is An Insured is replaced by the following: c. Any person or organization designated in the schedule below but only to the extent of the negligent sets or omissions of an"insured"under paragraph a. or b.of Section I LA 1.which cause liability to be imposed on such person or organization without fault on the part of such person or organization during work performed by you or for you for the person or organization designated below. With respect to the person or organization named in the Schedule below as an"insured", paragraphs a.and d, of Section IV.B.5.Other Insurance are primary and non-contributory to other coverage of the person or organization shown in the Schedule when a written contract specifically requires that this insurance be primary and non- contributory. The written contract must be currently In effect or become effective during the term of this policy and must be executed prior to the"accident"causing'bodily injury"or"property damage". Notwithstanding the above,the coverage for the person or organization named in the Schedule shall remain excess when a covered'trallerg is connected to a motor vehicle you do not own. SCHEDULE Name of Person or Organization: Brown and Caldwell PO Box 8045 Walnut Creek, CA 94596-1220 CAU 042(12 08) Includes copyrighted material of the Insurance Services Office,Inc.,with Its permission. Page 1 of 1 Copyright 2008 FCCI Insurance Group. COMMERCIAL GENERAL LIABILITY CGL 084(12 10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - ONGOING OPERATIONS AND PRODUCTS-COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM This endorsement is subject to the terms,conditions,exclusions and any other provisions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM or any endorsement attached thereto unless changes or additions are indicated below. A. Section 11—Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed In writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for"bodily injury',"property damage'or"personal and advertising injury'caused, In whole or in part by: 1. Your acts or omissions,or 2. The acts or omissions of those acting on your behalf in the performance of'your work"for the additional insured. Such person or organization is an additional insured for liability caused by your ongoing operations and the"products-completed operations hazard." B. All policy exclusions relating to you in the Commercial General Liability Coverage Form,including any exclusions added by endorsement,shall apply to the additional insured herein. C. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to"Bodily injury", "property damage?'or"personal and advertising injury" arising out of the rendering of,or the failure to render, any professional architectural,engineering or surveying services, including: 1. The preparing,approving,or failing to prepare or approve, maps, shop drawings,opinions,reports, surveys,field orders,change orders or drawings and specifications:or 2. Supervisory, inspection,architectural or engineering activities. D. This endorsement does not apply to any additional insureds scheduled by name on other additional insured endorsements attached to the Commercial General Liability Coverage Form. CGLO84(12iO) Includes copyrighted material of the Insurance Services Offices,Inc.with its permission. Page I of I Copyright 2010 FCCI insurance Group. ---� NWPOO.1 OP ID,CR CERTIFICATE OF LIABILITY INSURANCE DATE(05/16/13 16113""' 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 CONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(ft AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 endorsemen s. PRODUCER 919-772„0 T Jones Insurance Agency,Inc. PHHONE P O Box 407 919-779-4025 a N AIC No): Gamer,NC 27529 ADDRESS: Hal Averette,CIC,CWCA IHStT S AFFORDING COVERAGE NAIL# INSURER A:National Trust insurance Co 20141 INSURED N W Poole Well&Pump Co INSURER B:FCCI Insurance Company 10178 Mary Ann Letchworth INSURER C: P.O.Box 1958 INSURER D: Wendell,NC 27591 'INSURER E: INSURER P: 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 RESPPCT 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. ILTR TYPE OF INSURANCE POLICY NUMBER EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 DAMAGE TO RENTEU- A X COMMERCIAL GENERAL LIABILITY X CPP00049186 07101/12 07101/13 PREMISES Ea occurrence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL a ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2:000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,0 POLICY X PRO- LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY (Ea SINGLE LIMIT 1,000,00 Ea accident B X ANY AUTO X CA0005935 07/01112 07/01/13 BODILY INJURY(Per person) $ ` ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Par accident $ UMBRELLALIAB I X I OCCUR EACH OCCURRENCE $ 1.000,00 B EXCESS LIAR CLAIMS-MADE UMS00031454 07101112 07/01/13 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION X I WC STATU- I IOTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA 010•WCI IA 58147 07/01/12 07/01/13 EL EACH ACCIDENT $� 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 5iIIi+QQ If yes,descxibe under 500 Q0 DESCRti71ION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S + A Leased Equip CPP00049186 07/01112 07/01/13 Limit 100,00 Ded 50 I I i-1 I DESCRIPTION OF oPERATiONs i LOCATbNS i VENK:LES(Attach ACORD 101,Add/mW Remarks Schedtde,I more space is required) The below certificate holder is hereby additional insured as respects to General Liability and Auto Liability coverage per CGLOS41210 per CAU0421208 CERTIFICATE HOLDER CANCELLATION ORANGEI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County Govemment AUTHOraED REPRESENTAWE P.O.Box 8181 jr f Hillsborough,NC 27278 `�- 01988-2(110 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD