Orange County NC Website
Browse       Search
DocuSign Envelope ID: B55679E1-82FB-4A06-BBCF-6BC218E4CADA <br /> ACC?R°J CERTIFICATE OF LIABILITY INSURANCE 09/13/2016 <br /> L.,.r <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 Chris Rubish <br /> HIGH & RUBISH INSURANCE AGENCY PHONE FAX <br /> 6015 FARRINGTON ROAD (A/C,No,Ext): 919-913-1144 (A/C No): 919-913-1155 <br /> PO BOX 3040 Mass: chrisr©highandrubish.com <br /> CHAPEL HILL NC 27515 INSURER(S)AFFORDINGCOVERAGE NAIC# <br /> INSURERA: NAUTILUS INSURANCE COMPANY 17370 <br /> INSURED INSURER B: <br /> PIEDMONT WILDLIFE CENTER, INC. <br /> INSURER C: <br /> 364 LEIGH FARM ROAD INSURERD: <br /> INSURER E: <br /> DURHAM NC 27707 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 ADDL <br /> INSR SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> (MM/DD/YYYY) (MM/DD/YYYY) <br /> GENERAL LIABILITY X NN706894 09/01/2016 09/01/2017 EACH OCCURRENCE $1 , 000 , 000 <br /> A X COMMERCIAL GENERAL LIABILITY PR S RENTED <br /> PREMISES((Ea occurrence) $100 , 000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $5, 000 <br /> PERSONAL&ADV INJURY $1 , 000 , 000 <br /> GENERAL AGGREGATE $2, 000 , 000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $INCLUDED <br /> X POLICY PRO- <br /> JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED 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 EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> WILDLIFE PER FORM L805 TS L805 (5/09) . HIREDAAUTOION, 000 , 000/$1 , 000 , 000; NON <br /> OWNED AUTO $1 , 000 , 000/$1 , 000 , 000 . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY GOVERNMENT <br /> AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />