Orange County NC Website
Browse       Search
000uSign Envelope ID: oE1o8FF0-ooA1-4F5A~^o39-o3ono4764os6 <br /> AC"RV CERTIFICATE OF LIABILITY INSURANCE 10/30/2014 <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($), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the 1policy(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 ondorsement(s). <br /> PRODUCER CONTACT Beverly Pike, AAI <br /> Jake A Parrott Insurance Agency Inc PH�NE..,,D, (252)523-1041 FAX <br /> C N 252)523 <br /> ADDRESS:bpike@parrot tins.com <br /> KINSTON NC, 28502 ±!SqRER8-EMPLOYERS MUTUAL CASUA.LTY CO 21415 <br /> INSURED INSURER BEMASCO INSURANCE COMPANY 21407 <br /> TILE RESTORATION INC' IN�U�E5 SL <br /> PO BOX 160 IN SURER E; <br /> ,HO,OKERTON NC 28538-0160 INSURER r,:, <br /> COVERAGES CERTIFICATE NUMBER:CL14102908345 REVISION NUMBER: <br /> THIS IS TO CER!TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PEMOD <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 PERTAN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR SUER LIMITS <br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER wwootyyyyl (Mw65IYYYYI <br /> GE ERAIL LIABIUTY EACH OCCURRENCE $ 1,000,000 <br /> 1/7/2014 11/7/2015 MEDEXP n <br /> A CLAWS-MADE OCCUR 5D20546 1 0 00 <br /> POLICY PRO 11.(Yr, S <br /> AUTOMOBILE LIABILITY COMMNED SINGLE UMIT <br /> A ANY AUTO <br /> AUTOS AUTOS <br /> HIRED AUTOS NONOW41ED PROPERTY DAMAGE S <br /> AUTOS <br /> Medical Eaymenis 2,000 <br /> X UMBRELLALIAB HCCCUR S 2,000,000 <br /> LED 1-1-111 ON S �5J20546 11/7/2014 11/7/2015 S <br /> WORKERS COMPENSATION X J_T11 <br /> DESCRIPIION OF OPERATIONS�LOCATIONS I VEHICLES (Aftach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED AS PERTAINS TO GENERAL LIABILITY, ON A PRIMARY <br /> BASIS INCLUDING PRODUCTS & COMPLETED OPERATIONS, VIA A WRITTEN CONTRACT IN PLACE WITH THIS REQUIRE�SNT <br /> INCLUDED. CERTIFICATE HOLDER IS LISTED AS, AN ADDITIONAL INSURED AS PERTAINS TO AUTO LIABILITY, VIA A <br /> WRITTEN CONTRACT IN PLACE WITH THIS REQUIREMENT INCLUDED. WAIVER OF SUBROCATION IN FAVOR OF ADDITIONAL <br /> INSUPYED APPLIES TO GENERAL AND AUTO LIABILITY AND WOPJ�ER-S COMPENSATION, VIA A WRITTEN CONTRACT IN PLACE <br /> WITH THIS REQUIRE1,1ENT INCLUDED. <br /> EXCLUDED OFFICERS IN WORKER'S COMPENSATION COVERAGE: DAVID ALBRITTON & CHARLES ALBRITTON III. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 AUTHORIZED REPIRESENTATIVE <br /> Allen Parrott/7-PANNE <br /> ACORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved, <br />