Orange County NC Website
Browse       Search
DocuSign Envelope ID: 30A67060-F305-4F21-802E-49D2C241AElB <br /> A°►M" CERTIFICATE OF LIABILITY INSURANCE DATE8M(jh DIYYYY) <br /> 08!0612014 <br /> PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> Marsh Dawson Insurance Agency,LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 5410 NC Highway 55,Sutie At HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> Durham, NC 27713 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 919.806.5109 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED- INSURER A: Nationwide Mutual Insurance Company-__ <br /> Fun2Ref,LLC INSURER B: Riverport Insurance Company <br /> 1105 Infinity Road - <br /> Durham,NC 27712-9795 INSURER C: <br /> INSURER D: <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTR INSR TYPE OF INSURANCE POLICY NUMBER DATE(MMI�DITYYYE PRATE(MM@DlYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 <br /> X A ® COMMERCfAL GENERAL LIABILITY GENERAL AGGREGATE 5 2,000,000 <br /> ACP GLGO 2235150455 0811612014 08/16/2015 <br /> ❑ ❑CLAIMS MADE N OCCUR PRODUCTS.COMPIOP AGO S 2,000 000 <br /> ❑ PERSONAL&ADV INJURY S 1,Q <br /> DAMAGE TO RENTED S 300,000 <br /> EMISES.JE <br /> GEN'L AGGREGATE LIMIT APPLIES PER MED EXP(Anyone person) $ 5,000 <br /> LJ <br /> POLICY I I I ]LOC $ <br /> ® JEGT PRO- Li <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO <br /> (Ea accident) $ <br /> ❑ <br /> ❑ ALL OWNED AUTOS BODILY INJURY <br /> ❑ SCHEOULEDAUTOS (Parperson) $ <br /> ❑ HIRED AUTOS BODILY INJURY <br /> X NON•OWNEDAUTOS (Peraccldent) S <br /> ❑ _, PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY•EAACCIDENT $ <br /> ❑ ANYAUTO OTHERTHAN� EAACC $ <br /> ❑ AUTOONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $ 1,000,000 <br /> ACP CAF 2235'!50455 0811612014 0811612015 <br /> ❑ OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 <br /> S <br /> ® DEDUCTIBLE S <br /> RETENTION $ $OTH <br /> B WORKERS COMPENSATION AND TORY LIMITS �. ER <br /> EMPLOYERS'LIABILITY WC•32-90.018509.03 08/30/2013 08130/2015 E.L.EACH ACCIDENT S 100,000 <br /> ANY PROPR€ETORWARTNERIEXECUTNE <br /> OFFICERIMEMBER EXCLUDE D7 E.L.DISEASE•EA EMPLOYE $ 100,000 <br /> II yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LINK S 500,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Certificate Holder is listed as Additional Insured for Liability. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Ontnge County DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> PO BOX 8181 NOTICE.TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> I-Ellsborough,NC 27278 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> 19-644-3042 REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> TOt1 fC!M DR7USpJt <br /> ACORD 25(2001108) 0 ACORD CORPORATION 1988 <br />