Orange County NC Website
Browse       Search
DocuSign Envelope ID:9AA5E326-97D5-4361-B4DA-516EAE150E42 <br /> DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 11/22/2016 <br /> THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> JOHNSON INSURANCE SERVICES INC/PHS (A/C,No, (A/C,No): (888) 443-6112 <br /> 272542 P: F: (888) 443-6112 E-MAIL <br /> ADDRESS: <br /> PO BOX 29611 INSURER(S)AFFORDING COVERAGE NAIC# <br /> CHARLOTTE NC 28229 INSURER A: Sentinel Ins Co LTD 11000 <br /> INSURED <br /> INSURER B <br /> INSURER C: <br /> CAROLINA SOFTWARE TECHNOLIGIES INC INSURERD: <br /> 1325 CENTRAL RD INSURERE: <br /> CLEMMONS NC 27012 INSURERF: <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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICYEFF POLICYEXP LIMITS <br /> LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1 000, 000 <br /> PREMISES(Ea occurrence) " <br /> A X General Liab 22 SBM ZG5326 06/25/2016 06/25/2017 MEDEXP(Any one person) $10, 000 <br /> PERSONAL&ADV INJURY $1, 000, 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2, 000, 000 <br /> POLICY PRO- X LOC PRODUCTS-COMP/OP AGG $2, 000, 000 <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 <br /> (Ea accident) r r <br /> ANY AUTO BODILY INJURY(Per person) <br /> A OWNED SCHEDULED 22 SBM ZG5326 06/25/2016 06/25/2017 BODILYINJURY(Peraccident) <br /> AUTOS ONLY AUTOS <br /> X HIRED x NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1, 000, 000 <br /> A EXCESS LIAB CLAIMS-MADE 22 SBM ZG5326 06/25/2016 06/25/2017 AGGREGATE $1, 000, 000 <br /> DED X RETENTION$10,000 <br /> $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <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 $ <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the Insured' s Operations . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />