Orange County NC Website
~ ) ® <br />ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYl'1') <br />02/21/2011 <br />THI~ RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on-this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br /> <br />PRODUCER ~ CONTACT ' <br />NAM <br />Ken B LaWSOn .fir. PHONE aC No <br />dba Lawson Insurance Group EMAIL <br />ADDRESS: <br />-6512-101 SIX FOCICS Rd. INSURERS AFFORDING COVERAGE NAIC # <br />Raleigh, NC 27615 ""''`REVISION*** INSURERA: Nationwide Mutual Insurance Compan <br />wsuRED INSURER e : EastGUARD Insurance Company <br />ProNet Systems, Inc INSURER c <br />3200 Glen Royal Road INSURER D: <br />SUlte 107 INSURER E <br />Raleigh, NC 27617 ~ INSURER F <br />.,...~~ roorrrrr+nr~ rut~en~o• REVISION NUMBER: <br />vTHIS,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 />INSR <br />LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM UY EFF MM/DDY EXP LIMITS <br /> GENERALUaeIUTY ACP2232994383 02/22/2011 02/22/2012 EACHOCCURRENCE $1,~~0,00~ <br /> DAMAGE TO RENTED 100 000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ~ <br /> CLAIMS-MADE a OCCUR MEDEXP(Anyone erson) $5,660 <br /> PERSONAL 8 ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 <br /> X POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY ACP2232994383 2/22/2011 02/22/2012 COMBINED SINGLE LIMIT <br />Ea accident 1,000,~~0 <br />A ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br /> X ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS BODILY INJURY (Per axident) $ <br /> <br />NON-OWNED PROPERTY DAMAGE $ <br /> <br />X <br />HIRED AUTOS <br />X <br />AUTOS Per accident <br /> <br /> UMBRELLA LIAB X OCCUR ACP2232994383 - 02/22/2011 02/22/2012 EACH OCCURRENCE $4,000,000 <br /> <br />A EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATION PRWC119466 04/03/2011 04/03/2012 WC STATU- X OTH- <br /> <br />B AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />E.L. EACH ACCIDENT <br />$ 500,000 <br /> OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) N / p` <br />E.L. DISEASE - EA EMPLOYE <br />$ 500,000 <br /> If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 500,000 <br />A <br />Business Services Bond 7900357870 05/21/2010 05/21/2011 $25,000. Bond Limit <br />3rd Part <br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Orange County is included as additional insured where applicable. <br />rvoTrrrrnTC urv nco CAAICFI 1 ATIC)N <br />Orange County <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />P. O. BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Hillsborough, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTAT <br />' ~ ' <br />f,~„j-J` 13$8-2010.'~1CORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />