Orange County NC Website
Browse       Search
DocuSign Envelope ID:90AE28E6-5DE8-4E61-B536-OOE33816BOE3 ID E <br /> DATE(MMIDD/YYYY) <br /> lli,� CERTIFICATE OF LIABILITY INSURANCE 07/09/2016 <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 /> HI 8h&Rubish Insurance Agency PNHAMEE: Jeff Rtl ish FAx <br /> ONE <br /> P. Box 3040 A/c No,a :919®913®11 (A/C,No): 919®913-1155 <br /> 6015 Farrington Rd.Ste 101 E-MAIL s:leff ighandrubis .corn <br /> Chapel Hill,NC 27517 <br /> Jeffrey .RUbish PRODUCER OCI --1 <br /> y CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED Orange Congregations In INSURER A:Cincinnati Insurance Company 10677 '.. <br /> Missions, Inc, INSURER B:Hartford Underwriters Ins. 30104 <br /> 300 Millstone Drive <br /> Hillsborough, NC 27279 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 /> ILTR TYPE OF INSURANCE I S kDD-L- U D POLICY NUMBER PAM/DDIYEYYY MMIDD/YEYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> TO <br /> A X COMMERCIAL GENERAL LIABILITY EBP0069499 10115/2014 10/15/2015 PREMISES Ea occurrence $ 2,000,000 <br /> CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 10,00 <br /> PERSONAL&ADV INJURY $ 2,000,00 <br /> GENERAL AGGREGATE $ 4,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 4,000,00 <br /> POLICY PRO LOG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) $ 1,000,00 <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> A X HIRED AUTOS EBP0069499 10115/2014 10/1512015 (PERACCIDENT) $ <br /> X NON-OWNED AUTOS $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $ <br /> DEDUCTIBLE <br /> $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU OTH- <br /> AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE 22 ECBV6360 08/1812015 08/18/2016 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICER/MEMBER EXCLUDED? [:1 <br /> NIA <br /> (Mandatory in NH) 22WECBV6360 08/18/2014 08/1812015 E.L.DISEASE-EA EMPLOYEE $ 100,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 500,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> evidence of coverage in force/re: grant <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG-11 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ORANGE COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 300 Millstone Dr ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br />