2017-479-E Finance - Farmer Foodshare - Outside Agency Performance Agreement

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DocuSign Envelope ID:8A1AB1BF-ACDB-42A1-A3DE-9E9549E569B4 FARME-3 n2n'L0 coRO CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DD/YYYY) 08!10/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 910-673-4771 ACT Alex Maiolo Lee-Moore Insurance Agency Inc PHONE 910-673771 FAX P.O.Box 667 (NC,No,Est): A/C,No): West End,NC 27376 ADDRESS:leemooremsurance @gmail.com Alex Maiolo INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AUTO-OWNERS INS.COMPANY 18988 INSURED Farmer Foodshare INSURER B;AON Association Services I Gini Bell 902 N Mangum St _INSURER C: Durham,NC 27701 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP ... 01.1, LIMITS LTR TYPE OF INSURANCE INS() WVD POLICY NUMBER li IMM/DDIYYYYf �/DD/YYYYI�i A X COMMERCIAL GENERAL LIABILITY $ 2,000,000 EACH OCCURRENCE - CLAIMS-MADE OCCUR X 35269000 06/15/2017 06115/2018 MEMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY �$ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER G ENERAL AGGREGATE $ 2,000,000 PRO-RO- LOC PRODUCTS PRO- $ 2,000,000 OTHER $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) _ $ _.._ X ANY AUTO 5126900000 06/15/2017 06/15/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED P�7OPERTYpAMAGE AUTOS ONLY _.... ..I AUTOS ONLY ( er accdent) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION X STATUTE _ . __ ERH- ANDEMPLOYERS'LIABILITY Y/N 35278607 05/29/2017 05/29/2018 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A --- _-- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500'000 If yes,describe under 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B D&O Liability NFP0128555-00 06/15/2017 06/15/2017 DOLT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Orange County,its officers,official agents,and employees are listed as additional insured on General Liability policy. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN �] ty ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management 200 S Cameron St AUTHORIZED REPRESENTATIVE Hillsborough,NC 27278 rip • AI ACORD 25(2016/03) ©1988-2015 ACORD CORPORATIO . All rights reserved. The ACORD name and logo are registered marks of ACORD •