Orange County NC Website
Browse       Search
DocuSign Envelope ID: 72574FBA-38BB-482F-A711-18C4CFEC2EDF <br /> Previous PolicyNumber Policy Number <br /> Y <br /> S 1940885 S 1940885 <br /> SELECTIVE INSURANCE COMPANY OF SOUTH CAROLINA <br /> 3426 TORINGDON WAY, CHARLOTTE,NC 28277 <br /> DECLARATIONS - COMMERCIAL UMBRELLA LIABILITY COVERAGE <br /> Item One-Name of Insured & Mailing Address Policy Period <br /> From: JUNE 7, 2014 <br /> SEE COMMERCIAL POLICY COMMON DECLARATION: IL-7025 To: JUNE 7, 2015 <br /> 12:01 A.M.,Standard Time At The <br /> Insured's Mailing Address. <br /> Producer: Producer Number: <br /> SEE COMMERCIAL POLICY COMMON DECLARATION: IL-7025 00-07265-00000 <br /> Named Insured is: CORPORATION <br /> Business of the Named Insured: MEDICAL <br /> Limits Of Insurance <br /> Occurrence Limit $1,0 0 0,0 0 0.0 0 Aggregate Limit $1,0 0 0,0 0 0.0 0 <br /> Self Retained Limit: $.0 0 <br /> Schedule of Underlying Insurance and Limits <br /> Standard Employers Liability or Stop-Gap Policy No. WC7227674 <br /> Employers Liability Policy <br /> Company SELECTIVE INS CO OF AMERI <br /> Policy Period Employers Liability Each Accident $10 0,0 0 0 <br /> From: JUNE 7, 2 014 Disease Each Employee $10 0,0 0 0 <br /> To: JUNE 7, 2015 Disease Each Policy $5 0 0,0 0 0 <br /> Commercial General Liability Policy Policy No. <br /> Company <br /> Policy Period General Aggregate <br /> From: Products-Completed Operations <br /> To: Personal and Advertising Injury Limit <br /> Each Occurrence Limit <br /> Automobile Liability Policy Policy No. S 194088504 <br /> Company SELECTIVE INS CO OF SOUTH <br /> Policy Period Bodily Injury and Property <br /> From: JUNE 7, 2014 Damage Combined Each Accident $1,0 0 0,0 0 0 <br /> To: JUNE 7, 2015 <br /> Premium Schedule: <br /> Estimated Exposure Base Rate Rate Per Annual Minimum Premium Estimated Premium Due <br /> In the event of cancellation by the Named Insured we will receive and retain not less than as the Policy Minimum Premium. <br /> Forms and Endorsements: <br /> SEE FORMS AND ENDORSEMENT SCHEDULE: IL-7035 <br /> MAY 13, 2014 SERVICE CENTER <br /> Issue Date Issuing Office Authorized Representative <br /> CX-0003 (01/99) INSURED'S COPY <br />