|
DocuSign Envelope ID: 137AC14B-6250-4081-9084-0BFOB086A047 138398
<br /> 6
<br /> ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> ki......------ 6/8/2016
<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 Shannon Francois
<br /> NAME:
<br /> Commercial Lines-(813)639-3000 PHONE FAX
<br /> (A/C,No,Ext):813.636.5353 (A/C,No):813.639.7192
<br /> Wells Fargo Insurance Services USA, Inc. EMAIL
<br /> ADDRESS: shannon.francois@wellsfargo.com
<br /> o.com
<br /> 2502 N. Rocky Point Drive, Suite 400 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Tampa, FL 33607 INSURER A: Federal Insurance Company 20281
<br /> INSURED INSURER B: North American Elite Insurance Co. 29700
<br /> Legends Hospitality, LLC INSURER C: Pacific Indemnity Company 20346
<br /> 400 Broadacres Drive,2nd Floor INSURER 0: National Union Fire Ins. Co.of Pittsburgh,PA 19445
<br /> INSURER E:
<br /> Bloomfield, NJ 07003 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 10553239 REVISION NUMBER: See below
<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 SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 79573707 03/01/2016 03/01/2017 EACH OCCURRENCE $ 1,000,000 RETED
<br /> CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $ 1,000,000
<br /> X Retention:$0 MED EXP(Any one person) $ Excluded
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> POLICY PRO X
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Aggregate Cap $ 12,000,000
<br /> A AUTOMOBILE LIABILITY 73560655 03/01/2016 03/01/2017 COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> N -OWNED PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS (Per accident) $
<br /> X Hired Car Phy $
<br /> B X UMBRELLA LIAB X OCCUR UMB2000372-01 03/01/2016 03/01/2017 EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION O3/O1/2016 03/01/2017 X STATUTE OETH
<br /> C AND EMPLOYERS'LIABILITY 79573708 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Professional/E&O 01-307-68-48 03/31/2016 03/01/2017 10,000,000 Limit of Liability
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Chapel Hill/Orange County Visitors Bureau is named as additional insured as it relates to general liability in accordance with the terms and conditions of the
<br /> policy.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Chapel Hill/Orange County Visitors Bureau SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 501 W. Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Chapel Hill,NC 27516
<br /> AUTHORIZED REPRESENTATIVE /�
<br /> 1, a+....
<br /> I ✓
<br /> The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01)
<br />
|