Orange County NC Website
A� Rte® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM /DD/YYYY) <br />2/19/2018 <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 />Marsh & McLennan Agency LLC <br />1400 Eastchester Drive, St 200 <br />High Point NC 27265 <br />CONTACT <br />NAME: Amy Everhart <br />PHONE FAX <br />N • 336 878 7800 AC No): 212 607 6549 <br />ADDRIESS: Amy. Everhart marshmma.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />10/24/2017 <br />INSURERA: Hartford Casualty Ins. Co. <br />29424 <br />$1,000,000 <br />INSURED SOILA -1 <br />INSURER B : Hartford Underwriters Ins Co <br />30104 <br />Soil & Environmental Consultants PA <br />8412 Falls of Neuse Rd Ste 104 <br />INSURER C: Builders Mutual Ins. Co. <br />10844 <br />INSURER D: Evanston Insurance Company <br />35378 <br />Raleigh NC 27615 -3543 <br />INSURER E : <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />PRO- LOC <br />POLICY F <br />OTHER: <br />INSURER F : <br />$ 2,000,000 <br />COVERAGES CERTIFICATE NUMBER: 1118832288 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 />INSD <br />SUER <br />POLICY NUMBER <br />MM /DD1YYYY <br />EXP <br />MM/ DY <br />/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Contractual Liab <br />22SBAUK8993 <br />10/24/2017 <br />10/24/2018 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 300,000 <br />X <br />MED EXP (Any one person) <br />$ 10,000 <br />X <br />No XCU Exclusion <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />PRO- LOC <br />POLICY F <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />22UECNA7889 <br />10/24/2017 <br />10/24/2018 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />22SBAUK8993 <br />10/2412017 <br />10/24/2018 <br />EACH OCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ 3,000,000 <br />DED X RETENTION $ io.000 <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUTIVE YNI <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />WCP102169804 <br />1012412017 <br />10/24/2018 <br />X STATUTE EORH <br />E.L. EACH ACCIDENT <br />$ 500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />D <br />Professional Liability <br />Pollution Liability <br />MKLV2ENV100413 <br />10/24/2017 <br />10/24/2018 <br />Limit <br />Limit <br />5,000,000 <br />5,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County <br />PO Box 8181 <br />Hillsborough NC 27278 <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 />©1988 -2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />