2014-329 Aging - Nantucket Grill, Inc. for Senior Lunch $177,000

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J u 1. 1. 2014 1 :45PM TYSON INS No. $366 P, 1/ICIP ID:CFA CERTIFICATE OF LIABILITY INSURANCE °" 10 If 1 0710'114 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREIR(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the policy(iss) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 919-471-8222 SECT 7 on Insurance services,Inc. — 3314-A North Duke Street PH P.0.Box 15734 E.NUUL Durham,NC 27704- AD M; Carmon C.Ellis CUsTOmeRIDxjNANTCAF _ INSURE S AFFORDING 20NMG& INSURED Nantucket Cafe,Inc. INSURERAIThe Harford Mutual Ins.Co. P.O.Box 2655 INSURER B:First Benefits Insurance Co. Chapel Hill,NC 27515 IN11URBIt C:Travelers Prope!tjtCasualty INSURER D: INSURER E IN9URER F: ----___. COVERAGE$ CERTIFICATE NUMBER: REVISION UMBER: _ THI$IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY -PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE' TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICISS.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE VM POLICY NUMBER Y OD PO C UNITS GENERAL LIABILITY °'- EACHOCCURRENCE a 1,000,0 --_- X COMMERCIAL GENERAI LIABILITY 8143180 07/04/15 07/04H4 PREMISES a eearranre S 500,00 CLAIMS-MAOE �X OCCUR __._.. ._- MED EXP am person) S _ 5,0 A 8151534 07/04/14 07/04115 pERSONALbADVINJURY S 1,000.0 GENERAL AGGREGATE S 2,000,00 GEN'LAC,GREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPACO S 1,000,00 POLICY 0 LOG S -- AUTOMOBILE UABIL17Y COMBINED SINGLE LIMB C X ANYAIJro BA-40670808-13SEL 11/19113 11119/14 (Esaetldent) $ 1,000,00 ALL OWNED AUTOS SODILYLNJURY(Psrpv=iI S ---- SCHEDULED ALrTOS BODILY INJURY(Per daft nl) $ -- PROPERTY DAMAGE S X HIREPAUros (Per4SddhW X NON-OWNED AUTOS $ S --- UMBRELIA LIAR I X OCCUR EACH OCCURRENCE S 1,000,000 ExC!-LIAe X CWMS-MADE AGGREGATE S A 960460&7963640 07104/13 07104/16 ---- DEDUCTIBLE g ETENT N S S ---- WORHERS COMPENSATION WC STATU- p'H- ---- AND EMPLOYERS'LIABILITY X B ANY PROPRIETOR/PARTNEWp(ECUTIVE YIN 0-5441-2014 06/01/14 06/01/15 E.LPACHACCIOENT 3 1,000,00 OFFICERIMEMBER E)(CLUDEO7 0 N/A (MarmLoary In NH) EL DISEASE-EAEMPL7 S 1,000,00 R yea desalbe Vatlar E L DISEASE-POLICY LIM IT s _1,000,00 DESCRIPTION OF OPERATIONS below I LF L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ASach ACORD 101.Add(donal Remutu Schedule.If more space Is required) 2010 GMC MOTUCADX$A1118955&2010 GMC S010TUGADXBA1 122708,$1000 Comp& $1000 Coll.Ded. CERTIFICATE HOLDER CANCELLATION SENICEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BI_CANCELLED BEFORE Senior Center of Oran a County THE EXPIRATION DATE THEREOF, NOTICE WILI. BE DELIVERED IN 9 ty ACCORDANCE WITH THE POLICY PROVISIONS. fax#919-732-2239 Attu:Isabella - -- 103 Meadowlands Dr. Corm IYED C.Ellis Carmon C.Ellis ' Hillsborough,NC 2727$ Q 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD