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/ 7 ® DATE(MMIDD/YYYY) <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE <br /> ��. 06/28/2017 <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 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 <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): <br /> PRODUCER CONTACT Lori Hiatt,CIC,CSRM,Account Manager <br /> NAME: <br /> SUrry Insurance PHONE 336 386-8228 FAX (336)386-4661 <br /> A/C No Ext: ( ) A/C,No <br /> P.0.Box 128 E-MAIL lod.hiatt@surryinsurance.com <br /> ADDRESS: <br /> INSURERS)AFFORDING COVERAGE NAIC# <br /> Dobson NC 27017-0128 INSURER A: The Charter Oak Fire Insurance Company 25615 <br /> INSURED INSURER B: <br /> Town of Chapel Hill INSURER C: <br /> 405 Martin Luther King Jr.Blvd INSURER D: <br /> INSURER E: <br /> Chapel Hill NC 27514-5705 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> �p CLAIMS-MADE OCCUR 'REM,MS Ea occurrence $ 1,000,000 <br /> MED EXP(Any one person) $ <br /> A 1 11 ZLP-41M7991A 07/01/2017 07/01/2018 PERSONAL SADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY �PRO �LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> JC i I <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED 810-5J243370 07/01/2017 07/01/2018 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000 <br /> A EXCESS LIAB HCILAIMS-MADE ZUP-41M79921 07/01/2017 07/01/2018 AGGREGATE $ 10,000,000 <br /> DED 11 X11 RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ERH <br /> ANY PROPRIETORIPARTNER/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 I 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 /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Orange County Animal Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1601 Eubanks Rd. <br /> AUTHORIZED REPRESENTATIVE <br /> Chapel Hill NC 27516 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />