Orange County NC Website
Browse       Search
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY) <br /> 05/02/13 <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(les)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 C AC Robert Kuchefski <br /> Hoffman Insurance Services,Inc. PHONE FAX <br /> 141 Linden Street 877-235 0406 ext.145 A/C o. 781-235.6665 <br /> PO Box 9002 E-MAIL DD <br /> robertk@ho8maninsurenoe.00m <br /> Wellesley,MA 02482-9002 PRODUCER <br /> Phone:781-235-0067 CUSTOMER ID <br /> Fax:781-235-6865 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Philadelphia Indemnity Company <br /> Nancy Alton INSURERS: <br /> 3917 Marklyn Place I SURER C: <br /> INSURER D: <br /> Hillsborough NC 27278 INSURER E <br /> INSURER F: <br /> COVERAGE$ CERTIFICATE NUMBER: 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 ADDL S R POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER /DD n <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> A x COMMERCIAL GENERAL LIABILITY V 8171 05/1412013 05/14/2014 PREMISES E occur $100,000 <br /> X <br /> CLAIMS-MADE OCCUR MED EXP(Any,one arson $1,000 <br /> Prof Llab Ind PERSONAL&ADV INJURY $11000,000 <br /> GENERAL AGGREGATE $2,000,0W <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000,000 <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Par person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per accident) <br /> $ <br /> NON-OWNED AUTOS <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE <br /> RETENTION <br /> WORKERS COMPENSATION WC STATUS OTH- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA <br /> A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> Kra,describe under E.L.DISEASE-POLICY LIMIT $ <br /> DCRIPTION OF OPERATIONS-below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Policy#: 8171 1 Master Polley#: PHPK969370 <br /> Program Information: ACF (e.g.ACE)1 Member#: T74618 <br /> For a complete listing of coverage forms,please visit to <br /> NOTE:All premium is fully earned at inception of policy <br /> CERTIFICATE HOLDER See erclosedforAdditionalInsured CANCELLATION <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 /> AUTHORIZED REPRESENTATIVE <br /> Pa- <br /> ©1988-2009 ACORD CORPORATION, All rights reserved. <br /> ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD <br />