Orange County NC Website
Browse       Search
PIEDM17 OP ID: KB <br /> CERTIFICATE OF LIABILITY INSURANCE DA1 0/1 412 0 1 4Y) <br /> 10/14/2014 <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 /> Senn Dunn-High Point NAME: Dick Dickens,CIC <br /> 1400 Point,Eastchester 2 7265 PHONE FAX <br /> High Point, Drive,St 200 A/C No Ext:336-899-2406 A/c No): <br /> IiESS:ddickens@senndunn.com <br /> M.Bryan Beasley,CIC ADO <br /> INSURER(S)AFFORDING COVERAGE NAIC p <br /> INSURER A:Selective Insurance CO of Amer 12572 <br /> INSURED Piedmont Health Services Inc. INSURER B:Selective Insurance Companies 12572 <br /> 299 Lloyd St. <br /> Carrboro, NC 27510 INSURER C: <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 L SUBIR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE iNqR vrvn POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 19000,00 <br /> B X COMMERCIAL GENERAL LIABILITY S1971482 02/01/2014 02/01/2015 PREMISES RENTED occurrence $ 100,00 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,00 <br /> B X BusinessOwners S1971481 02/01/2014 02/01/2015 PERSONAL$ADVINJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 3,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,00 <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY Oa accident)t ED SINGLE LIMIT <br /> E $ 1,000,00 <br /> B X ANY AUTO 51971482 02/01/2014 02/01/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS PER ACCIDENT $ <br /> �( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 <br /> B EXCESS LIAB CLAIMS-MADE S1971482 02/01/2014 02/01/2015 AGGREGATE $ 3,000,00 <br /> DED X RETENTION$ -0- $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN RY LIMIT ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 7977892 02/0112014 02/01/2015 E L EACH ACCIDENT $ 500,00 <br /> OFFICER/MEMBER EXCLUDED? ❑ NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 <br /> If yes,describe under <br /> D ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGOV <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 200 S Cameron Street <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> V a <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />