Orange County NC Website
Browse       Search
DocuSign Envelope ID: E332C792-DA82-4863-845F-68COAEOE8E13 <br /> GILFST1 OP ID: Cl <br /> CERTIFICATE, OF LIABILITY INSURANCE DATE(MMIDWYYYY) <br /> __.w..._.__ <br /> .. ............... P08112/20115 <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 -certificate holder is an ADDITIONAL INSURED,the policy(les):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 onclorsamentis). ...... <br /> PRODUCER CONTACT <br /> NAME Philie S.Wolf <br /> : <br /> The Insurance Center of Durham PHONE FAX <br /> 19,20 Front St,,Suite 710 1 Iy919-471-2641 No),;919-471-2132 <br /> E-MAIL L <br /> P.0.Box 15369 ADDRES&Phil@lnsurancecenterofdurhamcom <br /> Durham,NG 27704- ................. <br /> Philip S.Wolf INSURENS)Affopp!Nq C�VER E F�N N-C-0, <br /> 189 <br /> INSURER A:Auto-O'wners I nsuira nce Co, 8988 <br /> ..................... ------- <br /> INSURED StatlerW. GlIfililen& INSURER 8: <br /> Valeirija Gilfillen INSURER C: <br /> 3302 Saint Marys,Rd, <br /> Hillsborough, NC 27278-9726 INSURER 0: <br /> INSURER E:: <br /> INSURER F.: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> FIRS)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 0-1-HER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERT-AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON Is SUBJECT TO ALL. THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS S14OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR' ............... —AffbUSUAR POLICYFFr- POLACYFXP <br /> LTR-L_ TYPE OF INSURANCE (MMIDUIYYYYJc LIMITS <br /> A X l COMMERCIAL GENERAL LIABILITY EACH OCCURR04CE $ 1,000,000 <br /> CLANS-MAOE I LX I OCCUR X -DWA6F10 t1C=FLY II 35447799 0811112015 0811112016 FR j,,311,5(Fa pswron-). 60,00( <br /> MFn EXP(Any me patson) 5,00( <br /> ------------- <br /> PER,"AL AOV INJURY $ Excludec <br /> GUNERAL AGGREGATE $k,N'I.Ar�C.,RFGATFI,lMfrAPPLIE�4P(iR: 2,000,00( <br /> POLICY <br /> P LOC <br /> HO. PRODUCTS-COMPAOP AGG 2,000,00C <br /> O I F R <br /> AUTOMOBILE UABJLITY COMIONEU SINGUi LIMIT <br /> (Ea <br /> ANY AUTO 0000�Y INJURY JPor peraonl <br /> ALL 01 IANIED SCIIEDOLE0 <br /> UTO 'D HOMLY INJURY(Per accident) $ <br /> A AUTOS <br /> NON-OVMEU P ofltffl-rf <br /> U <br /> ""�4 <br /> :.,AL <br /> 14 AUTdS Arno S <br /> IF <br /> LIMUR LLALI 8 CUR FA��H OCC,URR,E!4CE_ <br /> OC <br /> EXCESS LIAR —CLAIMS-MADE AG REGA'a," <br /> 4ETIENTION <br /> ............. ........... ........... <br /> I WORKERS COMPENSATION PER 1 OTH- I <br /> AND EMPLOYERS'LIABILITY STATUTE I_J_Eft_ <br /> ANY PROPRIETOR1PARrNERA-:XFCU7IVE <br /> I)(7FK,0tWEMtr3ER EXCLUDED? NJA� <br /> (Mandatory In NHI <br /> II rs de 0 d <br /> ' <br /> T-;ibe unGN OF OPERATIONS below .................................. $ <br /> OESCRIPTK)N OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Rornarlu;Schedule„may be attached 11 more space ts required) <br /> Management Consultant,Architect <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANO,16 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P 0 Box 8181 <br /> Hillsboirough,NC 27278 AUTHORIZE-0 REPRESENTA <br /> Philip S.Wolf <br /> .......................... <br /> @ 1988-2014 ACORD COR RATION. All!rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />