2018-008-E DEAPR - Laura Phillips Historic properties records book

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DocuSign Envelope ID: F630E90C -F2C1- 4392 -A1 DD- 04B9E50D1AD4 CERTIFICATE OF LIABILITY INSURANCE 8045 9 /119/20 THIS CERTIFICATEIS 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 USAA INSURANCE AGENCY INC /PHS 812846 P: (888) 242 -1430 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: �AIC,No,Ext): (888) 242 -1430 FAX (888) 443 -6112 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: Hartford Casualty Ins Co 29424 INSURED LAURA A. W. PHILLIPS 59 PARK BLVD WINSTON SALEM NC 27127 INSURER B: COMMERCIAL GENERAL LIABILITY INSURER C : INSURER D: INSURER E: EACH OCCURRENCE 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 TYPEOFINSURANCE ADDL SUER POLICYNUMEER POLICDYEFF POLICYEXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) s300,000 _ X y, MED EXP (Any one person) $10,000 A General Liab 65 SBA NN0653 09/10/2017 09/10/2018 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 PRODUCTS - COMP /OP AGG s2,000,000 POLICY F__] PRO � LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1 000,000 $1, BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 65 SBA NNO653 09/10/2017 09/10/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ n ORXERS COMPENSATION ANDEMPLOYERS'LLIEILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN PER OTH- STATUTE I JER E.L. EACH ACCIDENT - $ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) ❑ WA E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT s DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CFRTIFICATE HOLDER CANCELLATION UC 19BB -2015 AGUKD GUKPUKA I IUN. All rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Orange County Dept of Environment, BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4 Agriculture, Parks & Recreation PO BOX 8181�� HILLSBOROUGH, NC 27278 UC 19BB -2015 AGUKD GUKPUKA I IUN. All rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD