Orange County NC Website
DocuSign Envelope ID: 585A91DA-A62A-43BF-BEBF-OC18454AB59E <br /> Ac"R" CERTIFICATE OF LIABILITY INSURANCE F DATE(MNUDD/YYYY) <br /> 04/15/2016 <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 an'd 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 Louise Churchill <br /> NAME <br /> Herring&Bickers Insurance Agency (A/C. Ext: (�c,No>: (919)479 1868 <br /> 2344 Operations Drive E-MAIL <br /> SS: <br /> Suite 101 INSURERS AFFORDING COVERAGE NAIC# <br /> Durham NC 27705 INSURER A: HARTFORD CAS INS CO 29424 <br /> INSURED INSURER B: Erie Insurance Exchange 26271 <br /> Signs Now/Occasions Engraving, Stokes Inc dba INSURER C: <br /> 1322 Fordham Blvd INSURER D: HARTFORD UNDERWRITERS INS CO 30104 <br /> INSURER E: <br /> Chapel Hill NC 27514 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE POLICY EFF POLICY <br /> LTR I SD WVD POLICYNUMBER MM/DDYYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br /> CLAIMS-MADE F OCCUR D AGE TO RENTED <br /> PREMISES(Ea occurrence) $ 1000000 <br /> MED EXP(Any one person) $ 10000 <br /> A N N 22SBAUC3584 08/10/2015 08/10/2016 PERSONAL&ADV INJURY $ 1000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 <br /> X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2000000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> B ALL OWNED X SCHEDULED <br /> AUTOS AUTOS N N Q09-0630393 09/06/2015 09/06/2016 BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE <br /> HIREDAUTOS AUTOS Peracddent $ <br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-M <br /> _ AGGREGATE $ <br /> DIED I I RETNTION$ $ <br /> WORKERS COMPENSATION X STATUTE ORH <br /> AND EMPLOYERS'LIABILITY YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 <br /> D OFFICER/MEMBEREXCLUDED? N!A N 22WECRH7577 08/10/2015 08/10/2016 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500000 <br /> Ifyes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100000 <br /> j <br /> i <br /> DESCRIPTION OF OPERATIONS/,LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) I <br /> Re: Operations usual to sign banners mfg/engraving in NC. <br /> Officer's are excluded from Work Comp. <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I <br /> 131 W Margaret Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 "x — T <br /> I <br /> Fax: Email:abames @orangecountync•gov ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />