Orange County NC Website
AUTOA-1 OP ID: MK <br /> Al OJQO DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 05/22/2014 <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 <br /> NAME: <br /> Insurance Service Center,Inc. PHONE FAX <br /> 8833 Gross Point Rd.Ste.206 A/c No Ext: AIC No): <br /> Skokie,IL 60077-1859 E-MAIL <br /> Jack L.Rosen,CIC ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Sentinel Insurance Co. Ltd. 11000 <br /> INSURED Autoagent Data Solutions, LLC. INSURER B:Hartford Accident&Indemnity 10448 <br /> 8312 NW 8th Way INSURER C: <br /> Boca Raton, FL 33487 <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A COMMERCIAL GENERAL LIABILITY 83SBMTZ7370 11/01/2013 11/01/2014 PREM O RENTED <br /> PREMISES Ea occurrence $ 1,000,00 <br /> CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 10,00 <br /> X Business Owners PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> X POLICY I PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,00 <br /> Ea accident $ s <br /> A ANY AUTO 83SBMTZ7370 11101/2013 11/01/2014 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS FX NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS PER ACCIDENT <br /> UMBRELLA LIAS OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY TORY LIMITS R <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> YIN 83WECB10590 11101/2013 11/01/2014 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICER/MEMBER EXCLUDED? F_N1 N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 <br /> A Technology E&O 83SBMTZ7370 11/01/2013 11101/2014 E.Glitch 1,000,00 <br /> CLAIMS MADE RETENTION:$5,000 Aggregate 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG01 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Tax THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g tY ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Administration <br /> 228 South Churton Street, Suit AUTHORIZED REPRESENTATIVE <br /> Hillsborough, NC 27278 e/ �/ <br /> %"6 �©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />