Orange County NC Website
Browse       Search
DocuSign Envelope ID:89584B08-7AD7-4FCB-B089-38730E36FB39 <br /> LAWRE-1 OP ID: MG <br /> AC'C�►Rt�►" CERTIFICATE OF LIABILITY INSURANCE DATE(MMtDD/YYYY) <br /> lk,. /2/0312015 <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(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 endorsoment(s). <br /> PRODUCER NAMTE cT Phillip Alien <br /> Thompson-Allen,Inc. PHONE 336-599 2175 arc No <br /> P.O.Box 100 Arc No 111: 336-599-6932 <br /> Roxboro,NC 27573 E-MAIL <br /> Marcia D.Green ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Cincinnati Insurance Company 10677 <br /> INSURED Tommy Lawrence Electrical INSURER B:Cincinnati Casualty Company 28665 <br /> P.O.Box 641 u'm <br /> Roxboro,NC 27573 INSURER 0: <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 /> ItTR TYPE OF INSURANCE D D O POLICY NUMBER POLICY JNYYY POLICY MJDNYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,00 <br /> CLAIMS-MADE 1XI OCCUR EPP 0096783 0811612015 08116/2016 PREMISES(Eat occurrence) $ 100,00 <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 500,00 <br /> GENE AGGREGATE LIMIT APPLIES PEW GENERAL AGGREGATE $ 1,000,08 <br /> POLICY PRO- El LOC PRODUCTS-COMPK7PAGG $ 1,000,00 <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY EOha.tdEeDISINGLE LIMIT $ 1,000,00 <br /> A X ANY AUTO EBA0096783 08/1612015 08116/2016 BODILY INJURY(Perperson) $ <br /> ALLOYYNEO SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS ANON-OWNED PROPERTY DAMAGE S <br /> HIREDAUTOS AUTOS (Per accident) <br /> X UMBRELLA LfAB X OCCUR EACH OCCURRENCE $ 6,000,00 <br /> A EXCESSLIAB CLAIMS-MADE EPP 0096783 08!1612015 0811612016 AGGREGATE $ 5,000,00 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X PER FORT H- <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETORIPARTNEWEXECUTIVE YIN 08966267-18 01/01/2015 0110112016 E.L.EACH ACCIDENT S _ 100,00 <br /> OFFICERtMEMBER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-FA EMPLOYE S 100,00 <br /> If yyas,describe under <br /> DESCRiPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 600,00 <br /> DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES(ACORO 101,Additional Romarks Schedule,may be attached If More space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGCG <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Parks and Recreation <br /> Lori Taft AUTHORIZEDREPRESENTATIVE <br /> 200 South Cameron Street Marc€a D.Green <br /> Hillsborough,INC 27278 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD <br />