Orange County NC Website
DocuSign Envelope ID: 1COFA69C- 6757 -43BD- 8570- E9C8F4DE644E <br />f�1 <br />DRAPADE -01 KCOLLINS <br />A4c"m0' <br />�� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYYY) <br />8/17/2016 <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 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 <br />CONTACT <br />NAME: <br />Ames & Gough <br />8300 Greensboro Drive <br />Suite 980 <br />PHONE FAX <br />AIC No Ext : (703) 827 -2277 (A/C Na : (703) 827 -2279 <br />E-MAIL <br />ou admin h.com <br />ADDRESS: � 9 9 <br />McLean, VA 22102 <br />—ADDRESS, <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Continental Casualty Company (CNA) A, XV <br />20443 <br />INSURED <br />INSURER B, <br />INSURER C : <br />Draper Aden Associates, Inc. <br />INSURER D, <br />2206 South Main Street <br />Blacksburg, VA 24060 <br />INSURER E: <br />INSURER F: <br />CLAIMS -MADE 1:1 OCCUR <br />COVERAGES CERTIFICATE NUMBER: 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 />POLICY NUMBER <br />POLICY EFF <br />MM /DD /YYYY <br />POLICY EXP <br />MM /DD /YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />DAMAGE To <br />CLAIMS -MADE 1:1 OCCUR <br />PREMISES (' E occurrence ) <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY ❑ PRO- <br />JECT ❑ LOC <br />PRODUCTS - COMP /OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />APer accident <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />UMBRELLA LAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR /PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER /MEMBER EXCLUDED? ❑ <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />• <br />Professional Liab. <br />AEH288351149 <br />05/14/2016 <br />05/14/2017 <br />Per Claim Limit 5,000,000 <br />• <br />Professional Liab. <br />AEH288351149 <br />05/14/2016 <br />05/14/2017 <br />Annual Aggregate 10,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />©1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />FOR PROPOSAL PURPOSES ONLY <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />