Agenda - 02-19-2013 - 6a - Laserfiche WebLink

Browse Search

Jan. 29. 2013 12:22PM TYSON INS No. 0608 P. 1 (10 ID, CE DATE MN� CERTIFICATE OF LIABILITY INSURANCE 41129/13 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURERR(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the poligy(Ies) mint be endorsed. If SUBROGATION IS WAIVED, subject' to the terms and condltlans of the vIi � policy, certain policies may require an endorsement A statement on this GeErtificate does not confer ilghts to jhe certificate holder in lieu of such endoErsemen s . PRODUCER �'�„�►�, CGN A T Tyson Insurance Services, Inc. NAME: - - I 3814 -A North Duke Street A/C N F P. O. Box 15734 E -MAIL Auc Nn Durham, NC 27704- ADDR.ESSW C rmOn C. EIIYa T uMER I *• NANTCAF INSURED Nantucket Cafe, Inc. P. C. Box 2655 Chapel Hill, NC 27515 INSUREdR(SI AFFORDING COVERAGE 1111SURER A ! The Harford Mutual Ins- Co. INSURERS :First Benefits Insurance Co. INSUAF.R : Travelers Propertqqasualty INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TWIS IS TQ CERTIFY THAT THE PdLICIES OF INSURANGE LISTED BELOW HAVE BEEN IS�SLiED TO THE INSUR INDICATED. NOTyW1THSTANp1NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY SE ]$SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE OCCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN R TYPI~ OF INSIJIRANCE POLICY NUMBER MOLICY EF POLICY GENERAL LIABII�I"('Y A X COMMERCIAL GENERAL LIABILITY 8136767 07104112 07/04/13 C►IMS^MADE OCCUR GEN'G AGGREGATE [ IMIT APPLIES PFR; Pi3LlG"Y PR11r- LOG AUTOMOBILE LIABILITY C X ANY AUTO BA- 4C67080$- 12-BEL ALL OWNED AUTOS SC14EDULED AUTOS X HIRED AUTOS X NQN•OWNED AUTO$ UMBRELLA LIAB X OCCUR EXCESS UAD IX CLAIMS -MADE A 7958244 DEDUCTIBLE RETENTION $ WORKEM COMPENSATION AND EMPLQYEW UAWLITY B ANY PRQPRrETOPJPARTNER1E ECUTIVE YIN WC -64,x,1 -2012 OFFICE IMEMBER F,.XCLUDEDI N/A (Mandabory In NH) If d RIIPTION of OPERATIONS below 11119/12 1 11/19/13 J 07i04112 I 07/04i13 08141/12 1 061411'13 [?E.3CdRIPTION OF OPERATIONS 1 LOCATION 91 VLWIGLES (Attsch AQOFkD 10 IT Add igonal Remarks Schedule, If more spaCa It required) CERTIFICATE HOLDER CANCELLATION SENICEN Senior Center of Orange County fax # 91 9- 245-2018 Attn: Alvonra Baldwin 103 meadewl,ands Dr. AUTHORIZED REPRESENTA Hillsborough, INC 27278 Carrnon C. Ellis 0 1958 -2449 ACCRD CORPORATION. All rights reserved. The AGORD name and logo are registered mark* of ACCRD ►ICs ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT NTH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE 10000,00 PREMI E Ea p reen S 500,0oo IVIED FXP (Any one par$Qn) S 51O0 PERSONAL & A0V INJURY S 1 1000,00 CENE AL AGGREGATE 2,400,00 PRODUCTS - COMPIOP AGO S 111000,00 S COU15INED SINGLE LIMIT 1,004 B0 (Ea accld8n�j �° � BODILY INJURY (Per person) $ BODILY INJURY (Per awlden� $ PROPERTY DAMAGE S (Per accddont) S S EACH OCCURRENCE 10040200 AGGREGATE S WC STATU- IETR-- EACH ACCIDENT 1)0D0x00 E. L. DISEASE - EA EMPLOYEE S 1100010 E.I.. DISEASE- POLICY LIMIT S 11000poo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIFtA -nQN DATE THEREOF, NOTICE VALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2049109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIFtA -nQN DATE THEREOF, NOTICE VALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2049109)