Orange County NC Website
DocuSign Envelope ID: BF3C5166 -81ED- 4933- 8E10- 6F78F4ED8E20 <br />Page 1 of 1 <br />CERTIFICATE OF LIABILITY INSURANCE <br />FDAT�E'MMIDDNYYY) <br />0/2018 <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 <br />Willis of North Carolina, Inc. <br />c/o 26 Century Blvd <br />P.O. Box 305191 <br />CONTACT <br />NAME: <br />PHONE 1- 877 - 945 -7378 FAX 1 -888- 467 -2378 <br />A/C No Ext : A/C, No <br />ADDRESS: certificates @willis.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />Nashville, TN 372305191 USA <br />INSURERA: Lloyd's <br />B7874 <br />INSURED <br />Reliant Management Group, Inc <br />INSURER B: Federal Insurance Company <br />20281 <br />CLAIMS -MADE � OCCUR <br />116 New Edition Court <br />INSURER C: <br />INSURER D: <br />Cary, NC 27511 <br />INSURER E: <br />$ 100,000 <br />INSURER F: <br />$ 5,000 <br />A <br />COVERAGES CERTIFICATE NUMBER: W5148056 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICYNUMBER <br />POLICY EFF <br />MM /DD <br />POLICY EXP <br />MM /DD <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE � OCCUR <br />DAMAGES(RENTED <br />PREMISES Ea occurrence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />A <br />Y <br />CJ10010817 <br />08/01/2017 <br />08/01/2018 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />POLICY jRa 1:1 LOC <br />PRODUCTS - COMP /OP AGG <br />$ 3,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />B <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />73583759 <br />04/08/2017 <br />04/08/2018 <br />BODILY INJURY Per accident <br />( ) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DIED RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N <br />OFFICER/MEMBEREXCLUDED? NO <br />(Mandatory in NH) <br />N/A <br />71745029 <br />04/08/2017 <br />04/08/2018 <br />x PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 100,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 100,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Orange County CJRD, Orange County, NC are included as additional insured with respect to General Liability. <br />CERTIFICATE HOLDER CANCELLATION <br />©1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SR ID: 15573472 - 581900 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Orange County CJRD <br />Orange County, NC <br />7�1�cryc�`iLv <br />©1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SR ID: 15573472 - 581900 <br />