Orange County NC Website
190081 <br /> A DATE(MM YY) <br /> CERTIFICATE OF LIABILITY INSURANCE 2718!2014 2014 <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 oNT CT <br /> NAME: Lucretia Mills <br /> Commercial Lines-(919)676-8834 PHONE 800-868-8834 nIC No;866-332-3051 <br /> Wells Fargo Insurance Services USA,Inc. ADDRESS: lucretia.mills @wellsfargo.com <br /> 8540 Colonnade Center Drive,Suite 111 INSURER(S) AFFORDING COVERAGE NAIC# <br /> Raleigh,NC 27615 INSuRERA: Chartis Specialty Insurance Company 26883 <br /> INSURED INSURER B: National Union Fire Ins.Co.of Pittsburgh,PA 19445 <br /> Waste Industries LLC INSURER C: Commerce&Industry Insurance Company 19410 <br /> 3301 Benson Drive,Suite 601 INSURER D: New Hampshire Insurance Co. 23841 <br /> INSURER E: <br /> Raleigh NC 27609 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 7293523 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 /> INSR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDY MM DCD/YYYY LIMITS <br /> ' LTR <br /> A X COMMERCIAL GENERAL LIABILITY X EG13112875 7/1/2013 7/1/2014 EACHOCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE OCCUR PREMISES Ea occu D nca $ 1,000,000 <br /> MED EXP(Any one person) $ 25,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- �LOC PRODUCTS-COMP/OPAGG $ 1,000,000 <br /> OTHER: <br /> B AUTOMOBILE LIABILITY CA 4954059 7/112013 7/1/2014 E�aen SINGLE LIMIT $ 1,000,000 <br /> X ANY AUTO Liability coverage BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED Only BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS X AUTOS Par.ccident $ <br /> C UMBRELLA LIAR rl OCCUR BE081085714 7/1/2013 7/1/2014 EACH OCCURRENCE $ 10,000.000 <br /> X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000,000 <br /> DIED FxTRIETENTION$ 10,000 $ <br /> D WORKERS COMPENSATION WC62790604 7/1/2013 7/1/2014 X STATUTE ERH <br /> AND EMPLOYERS'LIABILITY y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT $ <br /> OFFICER/ME MNH)BER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> (Mandatory In <br /> if yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> County of Orange is included as additional insured with respect to General Liability. <br /> CERTIFICATE HOLDER CANCELLATION <br /> County of Orange SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Department of Financial Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 181/200 S.Cameron St. <br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE <br /> The ACORD name and logo are registered marks of ACORD 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) <br /> (This c tjft.te replaces cerik t.#6225614 issued m 612012013) <br />