Orange County NC Website
�-•4 OP ID:KR <br /> CERTIFICATE OF LIABILITY INSURANCE DAT 08116D/YYYY) <br /> Q8/15114 <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 pollcy(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 /> CITIZENS INSURANCE AGENCY 252-492-4061 NAME: Kimberly Rhodes FA <br /> P O BOX 109 PHONE 25�-4g2-4Q61 AiC No:252-492-62516 <br /> HENDERSON, NC 27536 E'M IL .kim nca ent,com <br /> House Account/Joel T.Cheatham PRODUCER ELFUT-1 <br /> INSURERS AFFORDING COVERAGE NAIC N <br /> INSURED El Futuro,Inc. INSURER A:SCOttsdale Insurance Company <br /> 136 E Chapel Hill Street INSURER s:LIBERTY MUTUAL INSURANCE <br /> Durham,NC 27701 <br /> INSURER C: <br /> INSURER D: <br /> INSURER E: <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 TYPEOFINSURANCE ADDLSUB P U R POLICY EFF POLICYEXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> • X COMMERCIAL GENERAL LIABILITY X OPS0063149 10/05/13 10/05114 PREMISES(Ea occurrence) $ 300,00 <br /> CLAIMS-MADE OCCUR MED EXP(Anyone person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 3,000,00 <br /> GEN'LAGGREGATELIMITAPPLIESPER- PRODUCTS-COMPIOPAGG $ 3,000,00 <br /> X POLICY PRO. LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1+000,00 <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per peraon) $ <br /> ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> • X HIRED AUTOS OPS0063149 10105/13 10/05/14 (Peraccident) $ <br /> • X NON-OWNED AUTOS OPS0063149 10105113 10105114 $ <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIS LE $ <br /> RETENTION S $ <br /> WORKERS COMPENSATION WCSTATU- OTH- <br /> AND EMPLOYERS'LIABILITY <br /> $ ANY PROPRIETOR/PARTNERIEXECUTIVE YIN WC2-641-438700-013 11112113 11/12114 E.L.EACH ACCIDENT $ 500,00 <br /> OFFICERIMEMBER EXCLUDED7 NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 <br /> tt yes,describe under <br /> DE IPTION F OPE N below E.L.DISEASE-POLICY LIMIT 1$ 500,00 <br /> A Professional Llab. OPS0063149 10105113 10105114 Ea Claim 1,000,00 <br /> Claims Made IRETRO 10105/05 1 1 Aggregate 3,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORO 101,Additional Remarks Schedule,if morespace is required) <br /> Certificate holder is additional insured under the General Liability, but <br /> only with respects to operations of the Named Insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn:Finance Dept <br /> 200 S Cameron Street AUTHORIZED EP ESENTATIVE <br /> PO Box 8181 House Ac untlJo [T.C eatham <br /> Hillsboro,NC 27278 <br /> 0 198 09 Aq0ftDTbTZP0RAJLPN. All rights reserved. <br /> ACORD 26(2009/08) The ACORD name and logo are registered marks of ACORD <br />