Orange County NC Website
Browse       Search
DocuSign Envelope ID: 19E4A71 B-E91 B-461 B-ABEF-84C2EFCDC386 <br /> OP ID: DS <br /> ,a►corro° CERTIFICATE ®F LIABILITY INSURANCE DATE 109120/6 <br /> � osrosr2a15 <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 poltcy(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 endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> High&Rubish Insurance Agency PHONE FAX <br /> P.O.Box 3040 AIC No Ext: AIC No <br /> 60115 Farrington Rd.Ste 101 E-MAIL <br /> Chapel Hill,NC 27517 PRODUCER <br /> Jeffrey A.Rubish CUSTOMERI,,;TILLE-1 <br /> INSURER{S)AFFORDING COVERAGE NAIC N <br /> INSURa D Greg Tilley's Pressure INSURERA:Erie Insurance Exchange 26274 <br /> Cleansing,Gregory Tilley D1B1A <br /> 3600 Hwy 54 West INSURER II <br /> Chapel Hill,NC 27516 INSURERC: <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 /> rA TYPE OF INSURANCE DD POLICY NUMBER MMlD�YIYYI l POLICY wI) /yYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 <br /> DAMAGE TO-REII X COMMERCIAL GENERAL LIABILITY Q381760672 0211712016 02117/2016 PRFF.AISFS Ea occurrence $ <br /> 1,000,00 <br /> CLAIMS-MADE Fx—]OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL&AOV INJURY S 1,000,00 <br /> GENFRAL AGGREGATE S 2,000,00 <br /> GFN'L AGGREGATE LIMIT APPLIESPFR: PRODUCTS-COMPIOPAGO S 2,000,00 <br /> POLICY PRO- LOG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 <br /> BODILY Q102740041 1012712014 10/27/2015 <br /> A X ANY AUTO BODILY NJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEOULED AUTOS PROPERTY DAMAGE <br /> X HIREDAUTOS (PERACCtDENT) S <br /> X NON-OWN£DAUTOS S <br /> 5 <br /> +XEXCESSI RELLALIAB X OCCUR EACH OCCURRENCE S 1,000,00 <br /> CLAIMS-MADE AGGREGATE $ 1,000,00 A Q261770167 02/17/2016 02117/2016 <br /> CTIBLE NTION S S <br /> WORKERS COMPENSATION X WC STATU- I OTH- <br /> AND EMPLOYERS'LIABILITY Y!N TORY LIMITS ER <br /> A ANY PROPRIETOFUPARTNERfEXECUTIVE- NIA Q861700463 0211712015 0211712016 Ft_EACH ACCIDENT $ 500,00 <br /> OFFiCERR:IEMBER EXCLUDED? <br /> (Mandatory In NH) EL_DISEASE-EA EMPLOYEE 500,00 <br /> If yes,desenbe under <br /> DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT S 500,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is require dl <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANG-3 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P.O. Box 8181 <br /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />