|
DocuSign Envelope ID: 112713E4-A11 E-4CO3-B5A6-92020A894CD7
<br /> ACCORD DATE(MMIDD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 7/15/2016
<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 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 Tammy Brown
<br /> NAME _._......
<br /> Jennings Bryan—Chappell Insurance Services d of (336)227.7458 FAX
<br /> fpc,Not (336)343-1000
<br /> PO Box 1118 EMAIL tamm b @'bcins com
<br /> ADORE s, y._
<br /> INSURERS AFFORDING COVERAGE NAIC A
<br /> ...._ .. INSURER P y
<br /> Burlington NC 27216
<br /> uRER A:Philadelphia Indemini
<br /> OE Enterprises, Inc. NSURER B United Heartland t Ins Co 18058
<br /> INSURED
<br /> rp , nc. INSURER _.. ..
<br /> I C,
<br /> 348 Elizabeth Brady Road INSURER D
<br /> INSURER E:
<br /> Hillsborough NC 27278 INSURER F:
<br /> ...........
<br /> COVERAGES CERTIFICATE NUMBER:CL167702198 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 /> 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br /> ITR . FOOL SUM" POLICEF POLICY
<br /> L TYPE OF INSURANCE INSO WVO POLICY NUMBER IM A IMDD/YYY Y). ...,.n................,., ........
<br /> LIMITS
<br /> X :COMMERCIAL GENERAL LIABILITY 1,000,000
<br /> A I' j CLAIMS-MADE ..X I OCCUR ( PREM 5ES(PV o m) .... $ 100,000
<br /> PHPK1515803 6/30/2016 6/30/2017 MED EXP(Any one person) $ 5,000
<br /> PERSONAL $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES
<br /> PI PER GENERAL
<br /> PRO
<br /> JECT LOC AGGREGATE $ 2,000,000
<br /> : PRODUCTS COMP/OPAGG $ 2,000,000
<br /> POLICY
<br /> OTI1i/R: $
<br /> °
<br /> U
<br /> TOMOBILE LIABILITY �............... COMEINNE C(�GIHGLE ti ' $ 1,000 000 I
<br /> A
<br /> X ANY AUTO I BODILY INJURY(Per person) $
<br /> ALL OWNED i SCHEDULED 1
<br /> _ AUTOS ,,, AUTOS .EHPR1515803 6/30/2016 6/30/2017 l BODILY INJURY(Per acci cident)I $
<br /> HIRED AUTOS i AUTOS PROPERTY de ,p
<br /> NON-OWNED DAMAGE I ---_
<br /> PAT accfdenl
<br /> X X I �I
<br /> Medical.a menu $ 5,000
<br /> X UMBRELLA LIAR
<br /> OCCUR I EACH OCCURRENCE $
<br /> 4,000,000
<br /> EXCESS LIAR
<br /> A DED X RETENTION$ CLAIMS-MADE 10 000 AGGREGATE $ 4,000,000
<br /> PHUB54610 1 6/30/2016 6/30/2017 $
<br /> WORKERS COMPENSATION OFFICER/MEMBER PRE EXCLUDED?D� Y/N N/A ■ EL. SST EACH ACCIDENT $ ..... 500,000,,,
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE
<br /> B DESCRIPTION OF OPERATIONS below 2000014173 7/1/2016 7/1/2017 EASEL O ECP�O SEE $ 500,000
<br /> If yes,describe under
<br /> A Professional Liability I 'PHSD1145531 6/30/2016 ' 6/30/2017 1,000,000 2,000,000
<br /> A Sexual Abuse / Molestation PHSD1055405 6/30/2016 6/30/2017 1,000,000 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Building Inspections Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> P.O. Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough, NC 27278 1
<br /> AUTHORIZED REPRESENTATIVE
<br /> r/mnyr By wn/"LF
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025/7n1401/
<br />
|