Orange County NC Website
DocuSign Envelope ID:D6209C59-EDDE-4EE9-9585-F8B68F281E19 <br /> "...mii TERRENV-01 JROBINSON <br /> AAcoRLY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> �••-- 9/16/2016 <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 <br /> NAME: <br /> Rogers Insurance Agency PHONE (919)362-8310 FAx 919 362-4101 <br /> 512 W Williams Street <br /> (NC,No,Ext): ) (NC,No): ( ) <br /> Apex,NC 27502 • rADDRE SS: no o ersinc.net <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Evanston Insurance Company 35378 <br /> INSURED INSURER B:Penn National Security Insurance Company 32441 <br /> Terraquest Environmental Consultants PC <br /> INSURER C:Pennsylvania National Mutual Casualty Insurance Company 14990 <br /> 100 East Ruffin St INSURER D: <br /> Mebane,NC 27302 INSURER E: <br /> 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 INSD SUBR POLICY EFF POLICY EXP <br /> VD POLICY NUMBER <br /> W LIMITS <br /> (MM/DD/YYYY) (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR 15PKGSE20338 11/01/2015 11/01/2016 DAMAGES( <br /> PREMISES(Ea RENTED occurrence) $ 100,000 <br /> X Pollution MED EXP(Any one person) $ 25,000 <br /> X Professional PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER. CONTRACTORS POL $ 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> B ANY AUTO AX90723808 09/11/2016 09/11/2017 BODILY INJURY(Per person) $ <br /> X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X AAUTO WNED Pera Edent)DAMAGE $ <br /> $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A EXCESS LIAB CLAIMS-MADE 15EFXSE20195 11/01/2015 11/01/2016 AGGREGATE $ 1,000,000 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> Y/N <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE WC90723808 09/11/2016 09/11/2017 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <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 Housing Human Rights and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Development ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 300 W.Tryon Street <br /> Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE <br /> Cat"Ij c yunco wt <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />