2018-105-E Health - Rochette and Associates training

Browse Search

DocuSign Envelope ID: 30809FAD -A9DE- 4881 - 9740 - 361075204924 A� a® CERTIFICATE OF LIABILITY INSURANCE DATE 127 /2 IYYYY) o9/z7/za17 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 StateFarm MARY WILSON STATE FARM • 9660 FALLS OF NEUSE RD SUITE 165 RALEIGH NC 27615 CONTACT Courtney Hartman NAME: P "C "No Ext : 919- 872 -1225 Ea c No . 919-676-2327 E -MAIL : CDurtney@MARYWILSONSMYAGENT.COM INSURER {S) AFFORDING COVERAGE NAIC # wsURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED ROCCHETTI, RICKY & LINDA J 10204 HALLBERG LN RALEIGH NC 27614 -7716 INSURER B: COMMERCIAL GENERAL LIABILITY INSURER C: INSURER D : INSURER E: EACH OCCURRENCE INSURER F: COVERAGES CFRTIFICATE 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 LTR TYPE OF INSURANCE ADDL SUBR - POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ OCCUR PREMISES (Ea occurrence) $ MEP EXP (Any one person) $ PERSONAL 8. ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ POLICY [:] PRO JECT 17� LOG $ OTHER: AUTOMOBILE LIABILITY B COMINED SINGLE LIMIT 'Ea accident $ BODILY INJURY (Per person) $ 100,000 A ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON- O1ANFD AUTOS ONLY AUTOS ONLY 3778201- D21 -33D 09127/2017 04/21/2018 BODILY INJURY (PeTaccident) $ 300,000 PROPERTY DAMAGE Per accident $ 100,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB Ld CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIFXECUTIVE OFFICERIMEMBER EXCLUDED? 0 (Mandatory in NH) NIA EL. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addition[ Remarks Schedule, may be attached if more space is required) rFIPTIGICATE HOLDER CANCELLATION ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16 -2616 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZER RERNLA9ITNE ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16 -2616