Orange County NC Website
Browse       Search
DocuSign Envelope ID: D6A14A1A-A8F5-44FD-933C-F5F03807D67F SSY DATE(MM/DD/YYYY <br /> CERTIFICATE OF LIABILITY INSURANCE 8045 9/17/2015 <br /> THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED,subject to the <br /> 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 /> NAME: <br /> COMMERCIAL INSURANCE.NET LLC/PHS �NCO,NN,Ext): (866) 467-8730 (NC,No): (888) 443-6112 <br /> 383397 P: (866) 467-8730 F: (888) 443-6112 ADDRIESS: <br /> PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# <br /> SAN ANTONIO TX 78265 INSURERA: Sentinel Ins Co LTD <br /> INSURED <br /> INSURER B <br /> INSURER C <br /> CALEB CHILDERS DBA MALACHI FILMS INSURERD: <br /> 1323 DAVIS RD INSURERE: <br /> HILLSBOROUGH NC 27278 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 <br /> TERMS,EXCLUS IONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OFINSURANCE ADDL SUER POLICYNUMBER POLICYEFF POLICYEXP LIMITS <br /> LTR INSR WVD MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000, 0 0 0 <br /> CLAIMS-MADE �OCCUR DAMAGE TO RENTED /$1 000, O O O <br /> PREMISES(Ea occurrence) <br /> A X General Liab 38 SBM BW2261 04/01/2015 04/01/2016 MED EXP(Any one person) $10, 000 <br /> PERSONAL&ADV INJURY s2, 000, 0 0 0 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s4, 000, 0 0 0 <br /> PRO- <br /> JECT POLICY PRO ❑X LOC PRODUCTS-COMP/OP AGG s4, 000, 0 0 0 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s2, 000, 000 <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> AUTO S S AUTOS <br /> A A O SCHEDULED 38 SBM BW2261 04/01/2015 04/01/2016 BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) $ <br /> $ <br /> UMBRELLA LIAB d OCCUR EACH OCCURRENCE $ <br /> EXCESS LAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPE.NSATIOry' PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under $ <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the Insured' s Operations . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY GOVERNMENT AUTHORIZED REPRESENTATIVE <br /> 200 S CAMERON STS <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />