Orange County NC Website
Browse       Search
DocuSign Envelope ID: 37D4F6F1-AC79-498E-8C6C-2FCA1 B5F95B6 <br /> DATE IMM/Dp1YYYY) <br /> 4�Imo® CERTIFICATE OF LIABILITY INSURANCE 6/18/2015 <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 /> 'RODUCER CONTACT Ellen Walker <br /> NAME: <br /> Business Insurers of Carolinas ATONE Ext: (919) 968--4611 AIC No); (919)968-8991 <br /> BOO Eastowne Drive, Suite 208 A DD-MAIL ewalker @business-insurers.com <br /> ---- _..- <br /> PO Box 2536 INSURER(S)AFFORDING COVERAGE . - NAIC#. <br /> Chapel Hill. NC 27515-2536 INSURERA:Union Insurance Company __-.. 2.5644 <br /> _._ _......._.. _._.... .. . ._... _ .. <br /> NSURED INSURBRB:United Wisconsin Insurance Company 129157 <br /> Freedom House Recovery Center, Inc INSURER C; <br /> 104 New Stateside Drive NSURERD: <br /> INSURER E: <br /> Chapel hill NC 27516 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1561813089 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 /> JR TYPE OF INSURANCE ADDL SUBRr POLICY NUMBER MMIDIDIYYYYY MNUDDl1 YYY <br /> LIMITS <br /> X -COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> A CLAIMS-MADE �I'; OCCUR PREMISES(Ea occurrence)_ $ 1,000,000 <br /> X Professional Liability X CBA427860741 7/1/2015 7/1/2016 MED EXP(Any one person) $ 20,000 <br /> X Sexual & Physical Abuse PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> 7 POLICY PRO ❑ LOG PRODUCTS-COMNOPAGO $ 3,000,000 <br /> JECT OTHER: Is <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ J 1000,000 <br /> j (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULEp X CPA427860741 7/1/2015 7/1/2016 BODILY IN (Per accident)'$ <br /> AUTOS NON,OVJNED PROPERTY DAMAGE <br /> Peraccident)._, $ <br /> F X HIRED AUTOS X AUTOS <br /> i <br /> j Medical payments $ 5,000 <br /> J <br /> UMBRELLALIAB EACH OCCURRENCE $ 1,000,000 <br /> OCCUR _ <br /> A X fl, EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 <br /> I_.. ---- -._ ....._. .... ....___.. <br /> DED I RETENTION$ CPA427860741 7/1/2015 7/1/2016 $ <br /> WORKERS COMPENSATION Excluded: Board Members X PER ;OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER _ <br /> iOFFICER/MEMBER EXCLUDED? y NIA 500 000 <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN E,L.EACH ACCIDENT <br /> B (Mandatoryin NH) --- 0400143254 5/16/2015 5/16/2016 E.L.DISEASE-EAEMPLOYEE,$ 500,000 <br /> dyes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 <br /> A Employee Dishonesty ICPA427860741 7/1/2015 7/1/2016 $25,000 <br /> I i <br /> I � j <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> Orange County is also an additional insured with respect to General Liability and Automobile Liability, <br /> required by written contract. Forms attached. <br /> CERTIFICATE HOLDER CANCELLATION <br /> achambers @orangecountync,g <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> Ellen Walker/ELLEN ��� <br /> ©1988-2014 ACORD CORPORATION, All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />