Orange County NC Website
Browse       Search
DocuSign Envelope ID: CB3ADD77- FF09 -4AA8- 9021- DFB1280A0396 <br />DATE (MMIDDFYYYY} <br />c CERTIFICATE OF LIABILITY INSURANCE 3/30/2017 <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 INSUREFt(5), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) 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 />PRODUCER I CGNTACT Steven Stacy <br />NAME: <br />Pelnik Insurance PHONE (919) 459 -8000 j FAx (866 )714 -3576 <br />(AIQ, No, Exq:. fA1C, Nal. _ <br />100 Ftidgevie a Drive ADDRESS: . A Steve. Stacy @ Pelnik . com <br />Suite 100 INSURERS AFFORDING COVERAGE NAIL #! <br />Cary NC 27511 INSLRERA:Selective Ins Co of America 12572 <br />-- <br />INSURED INSURER B Builders Mutual Insurance Co 10844 <br />INTELLICOM INC AND PLC COMMUNICATIONS, INC INSURER C: <br />2902 S MIAMI BLVD STE C nniocvn <br />I DURHAM NC 27703 -9042 I INSURERF : I I <br />r.r)VF=PAr.FS C PRTIPICATI° NIIIL+'IFtF:R•C11733014550 RFVI_%t0N NilMFIPR• <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' ADOL SUER POLICY EFF POLICY EXP <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYY MMfDDM= LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EA0I OCCURRENCE <br />4 1,000,000 <br />A <br />CL41MS -MADE OCCUR <br />$ -..- 500,000 <br />DAMAGE TO RENTED <br />PR EM 9 men ca <br />MEL) UP (Any one pers on) <br />$ 15,000 <br />S 2162397 <br />4/1/2017 <br />4/112018 <br />PERSONAL& ADV INURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER : <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />PRO- <br />POLICY ACT LOC <br />PRODUCTS- COMPh?PAGG <br />$ 3,000,000 <br />$ <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE L IMIT <br />Ea accident <br />$ 1,0OO,OQO <br />BODILY INJJRY (Perparson) <br />$ <br />A <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />9 2162397 <br />411/2017 <br />4!1/207.8 <br />BODILY INURY {FerecciderRl <br />$ <br />- <br />PROPERTYL)AMAGE <br />P racad n <br />NON- O)ANED <br />HIREDAUTOS MJTOS <br />$ <br />F LAo Elite Pac <br />$ <br />X <br />�... <br />UMBRELLA LIZ <br />X i.a.cup <br />EACIIOCCURRENCC <br />$ ...__.6,000_,000 <br />Id EGA II= <br />A <br />EXCESSLIAB <br />(:LAIMS4,1AOE <br />$ 6,000,000 <br />DED I X IRETENTION 0 <br />$ <br />S 2162397 <br />4/1/2017 <br />4/1/2018 <br />WORKERSCOMPENSATION <br />AND EMFLOYERS' LIABILITY YIN <br />X P OTIi- <br />oTATU'fE ER <br />El. E.d. -H ACCIDENT <br />$ 1,000, 000 <br />ANY PROPRIETOPIPARTNERIEXECUTIVE <br />B <br />OFFICER)MEINBER EXCLUDED? ❑NIA <br />(Mandatory In NH) <br />PVC1010300 <br />4/1/2017 <br />4/112018 <br />E.LDISEASE- EAEMPLOYE <br />$ 1,000000 <br />If ve5, desCnbe under <br />DESCR. PT'ION OF 0PERA7 I0 NS below <br />$ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />A <br />Leased (tented Equipment <br />S 2162397 <br />4/1/2017 <br />4/1/2018 <br />LImIt 100,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AC ORD 101, Additional Remarks Schedule, may be attat hed it more space Is requiredl <br />Utk I II-ILA It: MUL <br />(919)644 -3324 <br />Orange County <br />PO Box 8181 <br />Hillsborough, KC 27278 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />0 1 988 -201 4 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2414101) The ACORD name and logo are registered marks of ACORD <br />INSn75 " c:1an1 i <br />