Orange County NC Website
Browse       Search
DocuSign Envelope ID:9E3E28ED-9044-400E-BF32-00517C3197F3 <br /> (a DATE(MMIDD/YYYY) <br /> ACCRO CERTIFICATE OF LIABILITY INSURANCE 05/01!2017 <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 NAME: <br /> BAUCOM INSURANCE AND FINANCIAL,LLC WC.No.Ext); I FAX No): <br /> P 0130X 964 ADDRESS: <br /> BAUCOM INSURANCE INSURER(S)AFFORDING COVERAGE NAIC# <br /> MONROE NC 28111 INSURERA: NATIONWIDE MUTUAL FIRE INSURANCE COMP/ 23779 <br /> INSURED INSURERS: <br /> INSURER C: <br /> MYRON YANDLE INSURERD: <br /> 203 CHURCH ST INSURERE: <br /> I MORRISVILLE NC 27560-9168 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 ADUL SUER POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS <br /> X .COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> X PDDedClm 250 MED EXP(Any one person) $ 5,000 <br /> A ACP GLGO 2273320867 04/14/2017 04/14/2018 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> X POLICY JECT I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: S <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 NON-OWNED • PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTIONS $ <br /> WORKERS COMPENSATION I PEATUTE I 1 0H <br /> ER <br /> AND EMPLOYERS'LIABILITY <br /> Y/N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more apace is required) <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 Risk Manager AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 Lori Mullis <br /> Hillsbourough NC 27278 <br /> I <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD <br />