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OP ID:CE <br /> `,,,°� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br /> 12121/2016 <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 terns 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 /> CONTACT <br /> PRODUCER NAME: <br /> Tyson Insurance Services,Inc. PHONE FAX <br /> 2609 N Duke St Suite 102 o A/C No <br /> P.O.Box 15734 ADDRESS: <br /> Durham,NC 27704- PRODUCER ID :NANTCAF <br /> Carmon C.Ellis <br /> INSURERS AFFORDING COVERAGE NAK:# <br /> INSURED Nantucket Cafe,Inc. INSURERA:The Harford Mutual Ins.Co. <br /> P.0.Box 2655 INSURER B:First Benefits Insurance Co. <br /> Chapel Hill,NC 27515 INSURER C:Progressive Insurance Co. <br /> INSURER D; <br /> 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 LICY EFF P UCV EXP LIMITS <br /> TR TYPE OF INSURANCE POLICY NUMBER MM/DD MMID <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY 8168063 07/04/2016 07104/2017 PREMI ES Ea occurrence $ 500,00 <br /> CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 6,00 <br /> PERSONAL S ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> PRODUCTS-COMP/OP AGG $ 1,000,00 <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 <br /> 11/19/2016 11/19/2017 (Ea accident) <br /> C X ANY AUTO 0276366-1 BODILY INJURY(Per poison) $ <br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS PROPERTY DAMAGE $ <br /> X HIRED AUTOS (PER ACCIDENT) <br /> $ <br /> X NON-OWNEDAUTOS <br /> $ <br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 <br /> EXCESS LIAB X CLAIMS-MADE 7970607 07/04/2016 07/04/2017 AGGREGATE $ <br /> A $ <br /> DEDUCTIBLE <br /> $ <br /> RETENTION $ WC STATU- I X OTH- <br /> WORKERS COMPENSATION TORY LIMITS ER.. <br /> AND EMPLOYERS'.LIABILITY Y/N 1,000,00 <br /> C-5441-2016 06/0112016 06/01/2017 E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBEREXCLUDED? N <br /> B ANY PROPRIETOR/PARTNERIEXECUTIVE IA 1,000,00 <br /> (Mandatory In NH) <br /> E.L.DISEASE-EA EMPLOYEE $ <br /> B yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mom space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANC08 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County Dept.of ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Aging <br /> Attn: Isabel M.Jackson AUTHORIZED REPRESENTA <br /> 2551 Homestead Road Carmon C.Ellis C <br /> Chapel Hill,NC 27516 Yd; <br /> ®1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD <br />