|
DocuSign Envelope ID: 34524780-73C6-4CB6-96BA-FBCD698FCD21
<br /> IC"R®®
<br /> A DATE(MMlDD)YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 3/14/2016
<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(ies)must be endorsed. If SUBROGATION IS WANED,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 Patty Miller
<br /> Business Insurers of Carolinas PHONE Ext: (919)968^4611 LAIC.No):(919)968-0991
<br /> 800 Eastowne Drive, Suite 208 EDORIESS:pom @business–insurers.com
<br /> PO Box 2536 INSURER(s)AFFoRDINGCOVERAGE N_AICN-____
<br /> Chapel Hill NC 27515-2536 INSURERA;Union Insurance Com an 25844
<br /> INSURED INSURERB:Stonewood Iris. Co. 11828
<br /> CRA Associates, Inc INSURER C: `
<br /> 222 Cloister Court INSURE D:
<br /> INSURER E:
<br /> Chapel Hill NC 27514 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 /> INSR TYPE OF INSURANCE ADDL S BR POLICY NUMBER MMl DnYYY MMIDDI EXP LIMITS
<br /> LTR
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DA�iA ETORENTE 300,000
<br /> A __ ,_..,CLAIMS-MADE �OCCUR a occurrence $ _—_ ..
<br /> X CNA4298862 40 7/9/2015 7/9/2016 MEDEXP(Any one person) $ 1-0,000
<br /> --..._....-------.... ..........._-- ---.-.-..._........---
<br /> PERSONAL&ADVINJURY_ S 1,000,000
<br /> GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE H S 2,000,000
<br /> X POLICY u PRO- rl LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> JECT
<br /> OTHER: Employment Practices $ 100,000
<br /> AUTOMOBILE LIABILITY (Ee aeBddEer0i1 SINGLE LIMIT S 1,000,000
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED
<br /> X AUTOS rx AUTOS CNA4298862 40 7/9/2015 7/9/2016 BODILY INJURY(Pereccident) $
<br /> NON•OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident) $
<br /> Uninsured motorist BI spill limit S 1,000,000
<br /> A X UMBRELLA LIAB I X OCCUR CNA4298862 40 7/9/2015 7/9/2016 EACH OCCURRENCE 4,000,000
<br /> EXCESS LIAB CLAIMS-MADE Umbrella follows forms AGGREGATE.,_ _ $ 4,000,000
<br /> DED I I RETENTIONS I IGL,Auto 6 WC $
<br /> WORKERS COMPENSATION X PFR OTH- $
<br /> AND EMPLOYERS'LIABILITY STATUTE, ER 1
<br /> ANY PROPRIETOWPARTNERIEXECUTIVE YIN E.L.EACHACCI.O_ENT_ S 500 000 r
<br /> B OFFICEWMEMBER EXCLUDED? a NIA — '-- 1
<br /> (Mandatory In NH) X "01000002205 2015A 12/3112015 12/3112016 E.L.DISEASE-EA EMPLOYEE $ 500,000
<br /> I(yyB describe under
<br /> 1
<br /> DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> I
<br /> Orange County is included as additional insured in reference to the General Liability policy per written
<br /> contract per attached policy forms CLCGO114, 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 certifiate 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 Country 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 /> Patty Miller/PATTY
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 onidnil l
<br /> i
<br /> I
<br />
|