Orange County NC Website
. ,,,,.++~ ti:.: pATE {MM!DD!YYYYj <br />,act~~rc~ CERTIFIC~4TE C3F LtAB1LtTY INSURANCE Q,,,~,2Q,~ <br />~. <br />THES CERTIFICA7£ 15 iSSllED AS A~f~ASTER QF IptFdRN1AT10N ONI.Y AND GONFERS NC? RIGNTS UPAM rNE CERTiFICATE HOLQER. TH1S <br />CERTiFiCATE D~}ES NOT AFF1RDhAT1VElY OR NEGATIVE~Y A~AEND, EXTENO C3R ALTER TNE CS?VERAGE A~FOf2DED BY THE POUClES <br />g~~pyy. Tk11S CER71FtGATE OF tN3URANCE DflES MOT COP13TiTt1TE A CONTRACT B6TWEEN TNE ISSUING iNSURER(5), AUTHORIZED <br />REPRESENTAtIVE OR PRUOUCER, AND THE CER71FtCATE MOIDER. <br />iMFAR3AMT, if th~e cercifisate ftolder is an A£}DITi4NAL if~8tlRED, tris poitcY{i~s~ must he endarse+d, K SUBROCiATiON IS WA4VED~ suirject to fhe <br />Letrns and condit`sons of the polacy, certain polici~s may require an endorsement A staCemEnt an this eertiCcate does nr~t canter righfs tcs the <br />cerkificate holder in liea of such endorsemettt~s}. co{aTnc7 <br />NAStE .... .. .. . ........ <br />P53(XOtSGER ~~FkiOF+AE ._..... .... __ .... ~~ FA% <br />ta;C. No. Exti. .... (AfC, No) .... -.. <br />`'jGl}SC' riii:Sf1 ~..ADORESS;.. ._..... ......... ..... ..... .... .... <br />INSURER{S) AFfOR[NNG COVERAGE , _ .. NA~~ ~ <br />d~3~iYair~rn~Sl=N,qE: _ _ - 23?79 <br />4I~, "L7Ei{.~3 ---... bNSUR£RA : .... f8i3CR .... ... . ... . <br />~ <br />=ta~.;~i~,i tlat~~n~tde insu _ <br />SNSUREU ....... __.... ........... __. .. 1NSURERH . .._.._. ..._... ........__ .__.. ;_ __.. ...... <br />INSURER C : ... _.. _ ...... .. .... _. ... _.. ... ...._ . . ... ......... . .... <br />Ri az (2~ . d... ~ ,:.~, <br />- IN5LiRER LS .. . ...... . _. _.. ........ . .._. __.... <br />_;S".F~ ~+3f;Cu! ~J€:y~7F ... . _ ._._ .. ,. <br />., ' INSURER E ......_. _........ ......... ___ .. . . .... __ <br />CY- ; (t y tf.F~f: ~E'r~f .. _._. . <br />.l3C€ i 17t~3'€ NC Zi27'U Y.rSURER F. '~. <br />GOVERAGES CER7IFIGATE NUMBER: REViSION NUMBER: <br />TNtS :S iCi ^ERT}PY THAT TNE POL!C~E`a '.J~ iNS~RANCE L4ST:i7 SEI~Ob~t HAUE BEEN ISSUED TG THE ;.NSURED NAA3EC A0t3~VE F{)R 'i-iE ?O~lt.Y ~''F'kifl€) <br />tN~ C. t; E{?- NGtiTW!"Fi~TANf?4"~iv ANV hEGll(RENsE;+iT. 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NC <br />5(}fi Va1Eey Forge~Raap <br />Hiiisb~r~ugh AIG 2727$ <br />SHC1Ult1 ANY OE TFiE ABOVE DESCRIBED a0~1C~E5 BE CANCELLEQ BEfORE <br />TH£ EXPIRATION QATf TFIEREOf, NdTlCE WiLI 8E DELIVE~ IM <br />pCCORDANCE UV1TN TWE POCICY PROVtSIQNS. <br />AU*tiQRtZEiS REPRESEhkTAIiVE <br />~ <br />Scot? Et~aridge <br />-- f-~'f9$S ~ <br />q~p#~d ~5 (241DJa5) Tt~e AGt3RD name and logo are registered mafks ot <br />Ai{ rights res~rved. <br /> <br />