Orange County NC Website
" 1 BAILLC DATE(MMIDD/YYYY) <br /> AC62> CERTIFICATE OF LIABILITY INSURANCE 12/12/2011 <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 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 /> PRODUCER CONTACT <br /> NAME: <br /> Commercial Lines-(800)768-2442 PHONE 336-378-4225 ac No): 336-378-4007 <br /> Wells Fargo Insurance Services USA,Inc. n DRESS: <br /> 300 N Greene Street,6th Floor INSURERS AFFORDING COVERAGE NAIC# <br /> Greensboro,NC 27401 INSURER A: Sentinel Insurance Company Ltd. 11000 <br /> INSURED INSURER B: Auto-Owners Insurance CO. 18988 <br /> BAI,LLC INSURER C: Hartford Fire Insurance Co. 19682 <br /> 1289 Fordham Road,Suite 102 INSURER D: <br /> INSURER E: <br /> Chapel Hill,NC 27514 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 3614211 REVISION NUMBER: See below <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 /> IN SR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMI POLICY EFF MM DD/YYXYY LIMITS <br /> LTR <br /> A <br /> GENERAL LIABILITY 22SBABL8246 11/11/11 11/11/12 EACH OCCURRENCE $ 1,000,000 <br /> X DAMAGE TO RENTED 1,000,000 <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> CLAIMS-MADE Fx�OCCUR MED EXP(Any one person) $ 5,000 <br /> PERSONAL&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 /> POLICYF7 PRO- LOC $ <br /> B AUTOMOBILE LIABILITY 48-952-310-00 9/21111 9/21/12 COMBINED SINGLE LIMIT <br /> Ea acci dent <br /> 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED $ <br /> P PEeOr RT DAMAGE nt AUTOS <br /> Comp:$500 Ded. $ <br /> A UMBRELLA LIAB X OCCUR 22SBABL8246 11/11/11 11/11/12 EACH OCCURRENCE $ 1,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 <br /> DED I X I RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION X WRY TATU- OTH- <br /> C AND EMPLOYERS'LIABILITY YIN 22WBCEG5582 11/11/11 11/11/11 100,000 <br /> ANY OFFICER/MEM ER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 <br /> If yes,describe under 500,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Orange County NC is included as an Additional Insured ATIMA for General Liability as required by contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 500 Valle Forge Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough,NC 27278-9502 <br /> AUTHORIZED REPRESENTATIVE <br /> The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) <br />