Orange County NC Website
DocuSign Envelope ID: Cl BB2094-A106-46B7-8CA2-D9ADE86E020E <br /> - � <br /> AC r GA DATE(MMIDDIYYYYj <br /> �. CERTIFICATE OF LIABILITY INSURANCE 6/26/2017 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NQT 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 NAME;CONTACT ATny Carl <br /> Jennings Bryan-Chappell Insurance Services P11CNNb.Exq; (336)227-7458 �a,c,Ne):(336)303-1000 <br /> PO BO% 1118 E-MAIL <br /> ADARESS; y am t}Gins.GOm <br /> ...................................... ......C .. <br /> iNSURER(S)AFFORDING OV ERAGE NAIC!r <br /> Burlington NC 27216 INSURERA;Nautilus Insurance Company 17370 <br /> INSURED INSURER B: I <br /> Claws Inc. INSURER C: <br /> 1516 Jo Mao Rd INSURER D: , <br /> INSURER E t i <br /> Chapel Hall NC 27516 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:CL1762603098 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 /> ADDL SUBR POLICY EFF POLICY EXP <br /> INSR TYPE OF INSURANCE LIMITS <br /> LTR ,. pip WV)7 POLICY NUMBER (MMIDDlYYYY) (MM1DDlYYYYI <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 <br /> "DAL A'CEIII RENttb <br /> A )CLAIMS-MADE ( OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> NN728239 1/5/2017 1/5/2018 MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 500,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAI.AGGREGATE $ 1,000,000 I <br /> X POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ Included <br /> OTHER: <br /> AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> -ANY AUTO BODILY INJURY(Por person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per occident) $ <br /> AUTOfi ,.AUTOS <br /> N ED }HdfiFH PY t)AMAL <br /> $ <br /> HIRED AUTOS AUTOS (Par s o,denl) <br /> $ <br /> UMBRELLA LIA6 OCCUR EACH OCCURRENCE $ I <br /> EXCESS LIAB CLAIMS-MACE AGGREGATE $ <br /> DED RETENTION$ $ ... <br /> . ... .. .. <br /> WORKERS COMPENSATION " . i PER. 1 <br /> AND EMPLOYERS'LIABILITY ,,,,,,,,I STATUTE....... I OTIL <br /> ER <br /> ANY PROPRIETOR'PARTNERJEXECUTIVE Y-I.N I E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? C l NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE;$ <br /> II yea,deacrlbe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMP $ <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space 1a required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> (919)918-2393 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Animal Control THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Paula Phillips ACCORDANCE WITH THE POLICY PROVISIONS, <br /> 1601 Eubanks Rd. <br /> Chapel Hill, NC 27516 AUTHORIZED REPRESENTATIVE <br /> Amy Carl/AC --.1 tn0( 1/NQ_ -' <br /> S 1988.2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> 1NS025 roman)) <br />