Orange County NC Website
Browse       Search
Hc.,urtu �+tK �NGATE OF LIABILITY INSURANCE DATE27 /2012 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER ?TH S012 <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 NAME: Sue Alford <br />John Hackney Agency of Rocky Mount PHONE <br />252.442.3186 <br />AX <br />950 Country Club Road A/c, No. E.11: <br />ADDRESS: sal ford @jharm. com (A/C NO):252.451.9400 <br />P. 0. Box 7807 <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />Rocky Mount, NC 27804 -0807 INSURER A: Selective Ins. Co.of Southeast 39926 <br />200 Powelll l Dr. <br />INSURED F oorc eInc. INSURER B: Hartford Accident & Indemnity 22357 <br />Suite 103 INSURER C: <br />INSURER D: <br />Raleigh, NC 27607 INSURER E: <br />INSURER F : <br />Cf]VFROrFS rcorlrinw�rr•.uu�.��.- ._��i.�. _ .... .. . <br />�...,•... ...., ....., vow RCV10"IY IVVIVIOCK: <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 />LTR <br />TYPE OF INSURANCE <br />INSR <br />WVD <br />POLICY NUMBER <br />MM/DD/YYYY <br />-POLICY EXP_ <br />(MM /DD/YYYY) <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />X <br />52002943 <br />11/01/2011 <br />11/01/2012 <br />EACH OCCURRENCE <br />$ 11000, 000 <br />PREMISES (Ea occurrence) <br />$ 300,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X PRO- <br />JECT LOC <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />X HIRED AUTOS X AUTOS NED <br />AUTOS <br />X <br />S2002943 <br />11/01/2011 <br />11/01/2012 <br />(Ea accident) <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY Per accident <br />( ) <br />$ <br />(Per accident) <br />$ <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />X <br />52002943 <br />11/01/2011 <br />11/01/2012 <br />EACH OCCURRENCE <br />$ 11000,000 <br />AGGREGATE <br />$ 11000,000 <br />DED X RETENTION $ 0 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN N <br />ANY <br />OFFICER/MEM ER EXCLUDED? ECUTIV� <br />N/A <br />X <br />22WBCEG1705 <br />11/01/2011 <br />11/01/2012 <br />- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Ref: Orange County Jail Renovations <br />RECD F E B 2 9 2012 <br />v �atse -ZVT GUKU GVKPUKATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of RD <br />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 />Orange County NC <br />AUTHO REPRESENTATIV <br />200 S. Cameron Street <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />v �atse -ZVT GUKU GVKPUKATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of RD <br />