Orange County NC Website
Browse       Search
5THWA-1 OP ID:LJ <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(M30D/YYYY) <br /> 07/30/12 <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(iss)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 919-556-3698 CONTACT <br /> Hartsfield&Nash Agency,Inc. NAME: <br /> Post Office Box 1109 919-556-8758 aHCNE Ex!: A/C No <br /> Wake Forest,NC 27588 E-MAIL <br /> Lorie Borrelli,CIC,AAI ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> wsURERA:Hartford Insurance Company 29424 <br /> INSURED 5th Wall Building Diagnostics INSURER B:Lexington Insurance Co. <br /> Consultants LLC <br /> 9601 Bailywick Rd INSURER C: <br /> Raleigh,NC 27615 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 073012 REVISION NUMBER: <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 /> INSR TYPE OF INSURANCE POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD MMIDD LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,0 <br /> A COMMERCIAL GENERAL LIABILITY 22SBAVF0089 12/01111 12101112 PREMISES Ea occurrence $ 300,0 <br /> CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ 10,00 <br /> X Business Owners PERSONAL&ADV INJURY $ 2,000,00 <br /> GENERAL AGGREGATE $ 4,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,00 <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY (Ea� Ee SINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY Per accident) $ <br /> AUTOS AUTOS ( ) <br /> X HIRED AUTOS Ix <br /> NOWOVMED PROPERTY DAMAGE $ <br /> AUTOS Per acddent <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 <br /> A EXCESS LIAR HCLAIMS-MADE 22SBAVF0089 12/01/11 12101/12 AGGREGATE $ <br /> DED I X I RETENTION 10000 $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N T IT ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDE[ NIA <br /> E.L.EACH ACCIDENT $ <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> B Professional Liab 43926702 02112/12 02112/13 per occur 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Alheh ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Project reference: SportsPlex Swimming dool <br /> email contact:jethompson @co.orange.nc.us <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORAN131 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Asset THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Management Services <br /> Attn:Jeff Thompson AUTHORIZED REPRESENTATIVE <br /> 131 West Margaret Lane <br /> Hillsborough,NC 27278 u <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />