Orange County NC Website
Browse       Search
DocuSign Envelope ID: EDA3D663-EOCD-4A89-8551-72F3CF28CEBF <br /> -�•17� OP ID:SF <br /> DATE(MMIDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 02/11/2016 <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 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 /> Lee-Moore Insurance Agency Inc PHONE FAX <br /> P.O.BOX 667 A/C No Ext: 'C'No): <br /> West End,NC 27376 E-MAIL <br /> A <br /> Alex Maiolo DDRESS:PRODUCER MDMHI-1 <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED MDM Historical Consultants,In INSURERA:Hartford Insurance 14397 <br /> Cynthia de Miranda <br /> PO Box 1399 INSURER B: <br /> Durham, INC 27705 INSURER C: <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 /> INSR TYPE OF INSURANCE I DDR W D POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY 22SBMVE4769 09/25/2015 09/25/2016 PREMISES Ea occurrence $ 300,00 <br /> CLAIMS-MADE [::]OCCUR MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> POLICY PRO Loc Emp Ben. $ 5,00 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ 100,00 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE <br /> X HIREDAUTOS 22SBMVE4769 09/25/2015 0912512016 (PER ACCIDENT) $ <br /> X NON-OWNED AUTOS 22SBMVE4769 09/25/2015 09/2512016 $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Dept of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Environment,Agriculture, <br /> Parks,and Recreation <br /> PO Box 8181 AUTHORIZED REPRESENTATIVE <br /> Hillsborough,INC 27278 Alex Maiolo <br /> ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />