Orange County NC Website
Browse       Search
DocuSign Envelope ID: 187C85AD-DC20-46B5-86B8-A54BD110D96D <br /> DATE(MMIDDIYYYY) <br /> A R°� CERTIFICATE OF LIABILITY INSURANCE 3/142016 <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(ios) 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 CONTACT <br /> NAME: Patt y Miller <br /> Business Insurers of Carolinas PnHiONE Ext: (919)968-4611 — tAIG,No):tsls)96e-es91 <br /> $00 Eastawne Drive, Suite 208 ADDRIESS:pom @business-insurers.com <br /> —— — <br /> PO BOX 2536 ENSURER(S)AFFORDING COVERAGE NAIC# <br /> Chapel Hill NC 27515-2536 INSURERAMnion Insurance Company 25844 <br /> INSURED INSURERB:Stonewood. Ins. Co. 11828 <br /> CRA Associates, Inc INSURER a: <br /> ......._._... <br /> 222 Cloister Court INSURER D: <br /> INSURER E: <br /> Chapel Hill NC 27519 1 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL161814323 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 /> tNSR TYPE OF INSURANCE ..._._.____ ADDL SUBR POLICY NUMBER MWDD YYYY MNV DIYY Y LIMITS <br /> LTR <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> ... � DAMAGF TO RENTED --- <br /> A CLAIMS-MADE I � OCCUR PREMISES Eaaccurrence $ 300,000 <br /> — - <br /> X CNA4298062 40 7/9/2015 7/9/2016 MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY H PRO- � l LOG PRODUCTS-COMP/OPAGG S 2,000,000 <br /> JECT u _ <br /> OTHER: Employment Pracilces Liab Ins $ 100,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Fgpcddent <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> X ALL OWNED X SCHEDULED CNA4296862 40 7/9/2015 7/9/2016 BODILY INJURY(Per accident) $ <br /> AUTOS AUTGS ..........._..__....._.-- <br /> - - NON-OWNED PROPERTY DAMAGE <br /> X HIRED AUTOS X AUTOS Peraccident $ <br /> Uninsured motorist B[split limit $ 1,000,000 <br /> A X UMBRELLA LIAB X OCCUR CRA4298062 40 7/9/2015 7/9/2016 FACHOCCURRENCE $ 4,000,000 <br /> t <br /> EXCESS LIAB CLAIMS-MADE Umbrella follows forms AGGREGATE $ 4,000,000 <br /> LIED RETENTION$ GL,Auto & WC --- $ <br /> WORKERS COMPENSATION X PER _0T H_EMPLOYERS'LIABILITY YIN PER ,.._..__€T <br /> ANY PROPRIETORIPARTNERIEXECUTIVE N t A E.L.EACH ACCIDENT $ 500,000 <br /> OFFICER/MEMBER EXCLUDED? -- <br /> B (Mandatory In NH) y WC1000002205 2015A 12/31/2015 12/31/2016 F.L.DISEASE-EA EMPLOYE $ 500,000 <br /> I( es,describe under i <br /> DSCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Orange County is included as additional insured in reference to the General Liability policy per written <br /> contract per attached policy forms CLCG0114, CLCG0472, CLCG2062. If subrogation is waived, subject to <br /> terms and conditions of the policy, certain policies may require an endorsement. A statement of this <br /> certificate does not conquer rights to the cert±fiate holder in lieu of such endorsements. <br /> i <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 /> PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> I <br /> Patty Miller/PATTY <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> INS025 onl4na} <br />