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<br /> DocuSign Envelo p e ID:5490AC8B-128E-434F-AOA3-7F2750DE4393 IABILITY INSURANCE 11/27/2017
<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(les) 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 /> courACt .. .. ._ .
<br /> PRODUCER NAME ANDREW OGHINAN
<br /> BENDELL INSURANCE GROUP INC PHONE: EA (305)249-5055 '�/c
<br /> A/c No,:(305)249-5457
<br /> PO .ox 164235 ADDRESS'BI GGROUP@ BELLSOUTH.NET
<br /> Miami FL 33116-4235 1 INSURER(5) AFFORDING COVERAGE ! NAICr
<br /> ,
<br /> INSURER A LLOYDS OF LONDON
<br /> INSUREO NYMIA GROUP,INC INSURER B•LLOYDS OF LONDON
<br /> 160 NE 86TH STREET INSURER C
<br /> MIAMI, FL 33138 . INSURER D
<br /> INSURER E
<br /> INSURER F
<br /> ill,
<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 /> NSH TYPE.OF INSURANCE �tlb. 8UE'. ,. �.�.... LIMEYS.
<br /> TR NSD wvo POLICY NUMBER (MM/DD/YYYY) )MM/DD/YYYY)
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 ,000,_000
<br /> �I DAMAGE IL)HEN IEU ......_.„,._ _..._..._._.
<br /> CLAIMS-MADE l "JI OCCUR ' PREMISES (Ea occurrence) $ 100 1 000
<br /> IMERCFLO12217' 11/27/17 11/17/18 ,MEDEXPIAnyoneperaon) $ 5 000
<br /> A PERSONAL.&ADV INJURY $ 1 ,0'00 ,0©0'
<br /> GF.,N'L AGGREGATE LIMIT APPLIES PER. i GENERAL AGGREGATE $ 2,000 ,000'
<br /> X POLICY 7 lEC'I PRO 7 I OC PRODUCTS-COMP/OP AGG $ INCLUDED
<br /> OTHER $
<br /> AUTOMOBILE LIABILITY I ' (FOMaBINE DY3INGLL LIMIT $
<br /> ANYAUTO BODILY INJURY(Per person) I S
<br /> -- ALL OWNED '. SCHEDULED , BODILY INJURY(Par accident) $
<br /> AUTOS N NA PFOPERTY DAMAGE
<br /> NON-OWNED $
<br /> HIRED AUTOS AUTOS , (Per accident)
<br /> $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS I..IAB CLAIMS-MADE. AGGREGATE $ _.
<br /> NA
<br /> DED WORKERS COMP'RETENTION e
<br /> ENTION$ $
<br /> PEH U fH
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> YIN
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE " NJA Et.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED, NA
<br /> (Mandatory en NH) E.L. DISEASE-EA EMPLOYEI'$
<br /> IIeSC RePrIiUbe uOnU a FRATIONS below � E.L DISEASE-POLICY LIMIT $
<br /> ,
<br /> 1
<br /> B PROFESSIONAL LIABILITY MTP20150008 11/27/17 '11/27/18 $1 ,000 ,000/2 ,000,000
<br /> RETRO DATE11/27/17
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addiliional Remarks Schedule,may be attached if more space is required)
<br /> CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY PER WRITTEN CONTRACT .
<br /> I
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGE COUNTY NC C/O HOUSING, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> HUMAN RIGHTS & COMMUNITY DEVELOPMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISISNS,
<br /> DEPARTMENT
<br /> 300 WEST TRYON STREET AUTHORIZED REPRESENTATM"HILLSBOROUGH, NC 27278 ( A, , k,,,k-"A--)' ".)
<br /> ©1988-2014A ORD` ORPORATION, All rights reserved.
<br /> ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD ,r'
<br />
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