Orange County NC Website
Browse       Search
DocuSign Envelope ID: B9586FD4-5663-4F3F-8147-A6259742B4B5 OP ID: KR <br /> CERTIFICATE OF°LIABILITY INSURANCE ` DATE(MM1 011 3112 2131YY) <br /> 01 4 <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 NAMECT Kimberly Rhodes <br /> CITIZENS INSURANCE AGENCY PHONI: 252-492-4061 FAX 2 <br /> P O BOX 109 Arc No: 52-492-6256 <br /> HENDERSON, NC 27536 E-MAIL kim nca ent.com <br /> House Account[Joel T.Cheatham ADOD SS: <br /> ,R000CER -ELFUT-1 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED El Futuro,Inc. INSURERA:Scottsdale Insurance Company <br /> 136 E Chapel Hill Street INSURER B:LIBERTY MUTUAL INSURANCE <br /> Durham,NC 27701 <br /> INSURER C <br /> INSURER D: <br /> INSURER E; <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS 1S 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 /> 1�7R TYPEOFINSURANCE ADDLSUBR POLICYNUMBER POLICY EFF POLICYEXP LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0() <br /> • X COMMERCIAL GENERAL LIABILITY X OPS0065006 10!0512014 10!0512015 PREMISES Ea occurrence $ 300,00 <br /> CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL S ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 3,000,00 <br /> GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00 <br /> X POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,00 <br /> (Ea accident) <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> • X HIRED AUTOS OPS0065006 1010512014 10105!2015 (PER ACCIDENT) $ <br /> • X NON-OWNED AUTOS OPS0065006 10!0512014 10105/2015 $ <br /> $ <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WCSTATU- OTH- <br /> AND EMPLOYERS'LIABILITY TRY LIMn ER <br /> ANY PROPRIETORIPARTNER1EXECUTIVE YIN WC2-641-438700-013 1111212013 11112/2014 E,L.EACHACCIDENT $ 500,00 <br /> OFFICERIMEMBER EXCLUDED? F—] NIA <br /> (Mandatary in NH) E.L.DISEASE-EA EMPLOYE $ 5()0,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> A Professional Liab. OPS0065006 10!05!2014 1()1()512015 Ea Claim 1,000,00 <br /> Claims Made RETRO 10105105 Aggregate 3,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Certificate holder is additional insured under the General Liability, but <br /> only with respects to operations of the Named Insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 9 y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn: Finance Dept <br /> 200 S Cameron Street AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 House Account/Joel T.Cheatham <br /> Hillsboro,NC 27278 <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />