Orange County NC Website
A`°R °® CERTIFICATE OF LIABILITY INSURANCE F5ATE <br /> 9(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 CONTACT Kristen Davidson <br /> Greyling Insurance Brokerage PHONE (']70)552-4225 NC Na:(866)550-4082 AIC. <br /> 450 Northridge Parkway E-MAIL no ola@ re lin <br /> ADDRESS: err Y• Y g Y g.com <br /> Suite 102 INSURERS AFFORDING COVERAGE NAIC# <br /> Atlanta GA 30350 INSURERA.Valley Forge Insurance Company 0508 <br /> INSURED INSURER B:TranS ortation Insurance Co. 20494 <br /> Volkert, Inc. INSURERC:Catlin Insurance Company - 19518 <br /> 3809 Moffett Road INSURER D: <br /> P.O. BOX 7434 INSURER E: <br /> Mobile AL 36607 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:*13-14 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 ADDL SUB POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> AMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY P DREMISES Ea occurrence $ 300,000 <br /> A CLAIMS-MADE a OCCUR 5084967879 11/1/2013 11/1/2014 MED EXP(Any one person) $ 15,000 <br /> X Contractual Liability PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY X PRO LOC $ <br /> AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT 1,000,000 <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED 084967817 11/1/2013 11/1/2014 BODILY INJURY Per accident $ <br /> AUTOS AUTOS ( ) <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 <br /> B EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $ 10,000,000 <br /> DED I X I RETENTION$ C 5084967770 11/1/2013 1/1/2014 $ <br /> B WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) 084967722 1/1/2013 11/1/2014 E.L.DISEASE-EA EMPLOYE $ 500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> C Professional Liability D 196314-0714 7/28/2013 7/28/2014 per Claim $10,000,000 <br /> Aggregate $10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Re: Project #431512.16 - Transportation Best Practices Investigations <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Abigaile Pittman <br /> 131 W. Margaret Lane AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 <br /> Gregg Bundschuh/JERRY <br /> ACORD 25(2010/05) (D 1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025 i9olons)ni Tha Ar npin n-and Inn^pro rcnicfcrarl marirc of Arinp 1 <br />