Orange County NC Website
CERTIFICATE OF LIABILITY INSURANCE BATE{A05ro iAl <br /> 05t2EIt2014 <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 sloes not confer rights to the `a <br /> certificate holster in lieu of such endorsement(s). <br /> Nx <br /> PRODUCER ACT <br /> Aon Risk Services Southwest, Inc. NAME- <br /> PHONE <br /> TX Office ( fC ENO: (866) 283-7122 i ,Ha.I: 800-363-0105 <br /> 5555 San Felipe E-MAIL <br /> Suite 1500 ADDRESS* <br /> Houston TX 77056 USA <br /> iNSURER(S)AFFORDING COVERAGE NAIC• <br /> INSURED INSURER A: Travelers Property Cas Ce of America 25674 <br /> Deli Management, Inc. DBA Jason's Deli INSURER B: The Travelers Indemnity co. 25658 <br /> 2400 Broadway <br /> Beaumont TX 77702-1904 USA INSURERC: St Paul Fire & Marine Insurance Co. 24767 <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:57005WO1058 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_ Limits shown are as requested <br /> RR TYPE OF INSURANCE INS yUB POLICY { POLICY EFF POLICY EXP WvD LTR. MMIDDrYY M YYY1 LIMITS <br /> A X COMMERCIAL GENERALLENNUY TC23GLSAIS206SGITIL14 0 01/2014 OS OS 2015 EACH OCCURRENCE $5,000, <br /> SIR applies per policy terms & condi ions DAMAGE TO RENTED <br /> CLAEMS-MADE X�OCCUR PREMISES Ea ocnen<e $5,000, <br /> ar <br /> FLED EXP(Any ore pe ) $10,00 py <br /> PERSONAL&AIN INJURY $5,000, u7 <br /> t7 <br /> GENL AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $5,000,000 <br /> X POLICY ❑JET ❑LOC PRODUCTS-COMPXIP AGG $5,000, Q� <br /> OTHER: q <br /> A <br /> A AUTOMOBILE LIABILITY TC23 CAP-152136524-14 01/0112014 01/01/2015 COMBINED SINGLELIMTT $5,000, xs'a <br /> ace E <br /> x ANY AUTO BODILY IN.SIRY(Per person) <br /> ALL OWNED SCHEDULED BODILY WARY(Per se ) <br /> AUTOS AUTOS � <br /> HINHS AUTOS HON-OWNED PROPERTY DAMAGE <br /> AUTOS (per atudarm <br /> != <br /> C X UMBRELLA LIAB X OCCUR ZUP1SR687S914NF 01/0112014 01/01/2015 EACHOCCURRENCE $5,000, tj <br /> EXCESS LIAB CLAIMS-MADE SIR applies per policy terms & condi ions AGGREGATE $5,000,00 <br /> — x - <br /> • WORKERS COMPENSATION AND TC2KUBI52D655A14 <br /> 01/01/2014 01/01/2015 OTH- <br /> EMPLOYERS,LI..VITY YIN Workers COW AOS � IER <br /> • R ETD PARTNER NIA TRKUB152U654814 01/01/2014 01/01/2015 E.L EACH ACCIDENT <br /> $5.00,pFF MFRECCLU <br /> Gory in NH) Workers Carp AZ E.L.DISEASE-EA EMPLOYEE $5,000, <br /> IF ,dewibe under <br /> ES DESCRFrnON Of OPERATIONSbekaa I I I E.L.DMEASE4�OLICYLWT $5,000,00 <br /> A Bus Auto Damage n sAp-IS2D6536-14 01/01/2014 Ol/Oij2015 Comprehensive Ded. $z,50 <br /> Collision Ded. $2,S0 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES(ACORD 104,Addifiarud Remarks Schedule,may be attached it more spw*is rerrusedl <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY of THE ABOVE DESCRIBED POLWAES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. <br /> ORANGE COUNTY GOVERNMENT AUTHORIZED REPRESENTATIVE <br /> P 0 BOX 8181 <br /> SHERRI INGERSNLLrJd/1.lAR'►ISO � <br /> HILLSI30RDUGH NC 27278 USA <br /> ©19811-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />