Orange County NC Website
Browse       Search
'4lll%. ® CERTIFICATE OF LIABILITY INSURANCE 5i2i2014) <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 CONTACT Jeff Edmonds <br /> NAME: <br /> Chappell Insurance Agency, Inc. PHONE (336)356-8087 AIX No:(336)356-9153 <br /> 209 S Main Street ADDRESS:Jeff @chappellinsuranceagency.com <br /> PO BOX 829 INSURERS AFFORDING COVERAGE NAIC# <br /> Dobson NC 27017 INSURER AAdmlral Insurance Company 4856 <br /> INSURED INSURERB:Hartford Underwriters Insuranc <br /> Pilot Environmental, Inc. INSURER C: <br /> PO BOX 128 INSURER D: <br /> INSURER E: <br /> Kernersville NC 27285 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL145201095 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 SUBR <br /> LTR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY//YYYY LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAG TO RENTED <br /> A CLAIMS-MADE PREMISES Ea occurrence $ 50,000 <br /> }[ OCCUR EI-ECC-19347-00 /17/2014 4/17/2015 MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 <br /> X POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NO pgWNED PROPERTY DAMAGE $ <br /> Per accident <br /> UMBRELLA LIAB__H OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION$ $ <br /> B WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? � NIA E.L.EACH ACCIDENT $ 1,000,000 <br /> (Mandatory in NH) ID#12644-00100 /17/2014 /17/2015 <br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> abpittman@ orangecountync.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Planning Department ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Abigaile Pittman <br /> 131 W Margaret Lane AUTHORIZED REPRESENTATIVE <br /> Suite 201 <br /> Hillsborough, NC 27278 <br /> Jeff Edmonds/JE1 =_ c----�- -v-- � <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025/2mncA)ni Tho A(`nPn Hama anA Innn ara ranicfararl mararc of Arrwn <br />