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HomeMy WebLinkAbout2023-268-E-Orange Soil & Water Dept-Wilkerson Grading-Stream debris removal for streamflow rehabilitation assistance program-state program fundingDocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A 6/21/2023 6/21/2023 6/26/2023 6/26/2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 endorsement(s). 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. (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSR 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-TORY LIMITSWC STATU- LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD 06/16/2023 The Ballard Agency 105 W King St. Hillsborough NC 27278 Lee Hammond 919-732-2158 lee@ballardagency.com Wilkerson Grading LLC 318 Rabbit Lane Hillsborough NC 27278-9181 Erie Insurance Exchange A Q42 3051319 06/30/23 06/30/24 1,000,000 1,000,000 5,000 1,000,000 2,000,000 2,000,000 A Q06 1830727 06/18/23 06/18/24 1,000,000 A Q90 3000934 06/30/23 06/30/24 100,000 500,000 100,000 Orange County and Orange Soil & Water Conservation District are additional insureds for general liability when required by written contract. Orange County 300 West Tryon St. PO Box 8181 Hillsborough NC 27278 DocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A Estimate Date 02/20/23 Estimate No. 876 Name/Address Orange County Soil and Water Attn: Jessica Perrin Brock Wilkerson Wilkerson Grading, LLC 318 Rabbit Drive Hillsborough, NC 27278 Description Amount Tapp Property- Stream debris removal equipment time and labor 10,436.00 McBroom Property- Stream debris removal equipment time and labor 11,644.00 Sales Tax Total brockcw@embarqmail.com www.wilkersongrading.com **Not responsible for underground utilities **Payment due when services are rendered $22,080.00 Wilkerson Estimate, Attachment EDocuSign Envelope ID: 64740727-FBD3-4EC7-9B08-A46AEAE2CC1A