Orange County NC Website
Browse       Search
DocuSign Envelope ID: 3BA3A4EC-ODD2-41 B2-A35A-6D989822C204 <br /> A`UK° CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD016 IYYYY) <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 Martha Dickerson <br /> NAME: <br /> Lester Ins. Group, Inc. T/A The Harper Agency IN No.EMI; (336)227-4271 FAX No):(336)222-9467 <br /> 1037 S. Main St. ADDREss:m artha.dickerson @harperinsurance.com <br /> PO Box 1867 INSURER(S)AFFORDING COVERAGE NAIC <br /> Burlington NC 27216 INSURERA:Erie Insurance Exchange 26271 <br /> INSURED <br /> INSURER 8: <br /> Nice S Green Flooring Solutions LLC INSURER C: <br /> 1183 University Drive INSURER D: <br /> 4f105-113 INSURER E: <br /> Burlington NC 27215 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1642906949 REVISION NUMBER: <br /> THIS 15.10 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 ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE JNSD WVD POLICY NUMBER IMM!DDIYYYY) (MM!DD/YYYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000 <br /> PREMISES(Ea occurrence) $ <br /> 039-0750764 3/7/2016 3/7/2017 MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JECr i LOC i PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident)!S <br /> AUTOS AUTOS <br /> NON-OWNED ( PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) S <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> WORKERS COMPENSATION ( PER 0TH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> YJN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? NIA • E.L. S <br /> (Mandatory In NH) , E.L.DISEASE-EA EMPLOYEE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS betOw _ Et_DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <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 /> P 0 Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE ---;--,� <br /> Martha Dickerson/MHD rid4'� �� ` ���'� S6`" <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(201401) <br />