Orange County NC Website
Browse       Search
DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C <br />OP ID: LP <br />,d►��R° CERTIFICATE OF LIABILITY INSURANCE <br />DATE 05//02/2018 02/2018 <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 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 />High & Rubish Insurance Agency <br />P.O. Box 3040 <br />NAME: Jeff Rubish <br />PHONE FAX <br />A/C No, : 919- 913 -1144 Alc No): 919- 913 -1155 <br />E -MAIL natalie ^hi handrubish.com <br />v g <br />6015 Farrington Rd. Ste 101 <br />Chapel Hill, NC 27517 <br />Jeffrey A. Rubish <br />PRODUCER <br />CUSTOMER ID #:OCIM - -1 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />$ 2,000,000 <br />INSURED Orange Congregations In <br />INSURER A: Cincinnati Insurance Company <br />10677 <br />Missions, Inc. <br />300 Millstone Drive <br />INSURER B: Hartford Underwriters Ins. <br />30104 <br />Hillsborough, INC 27278 <br />INSURER C, <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />JECT <br />PRODUCTS - COMP /OP AGG <br />$ 4,000,000 <br />INSURER D <br />A <br />INSURER E <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />INSURER F: <br />EBA0349072 <br />10/15/2015 <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 />DDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD /YYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE L OCCUR <br />X <br />Hillsborough, INC 27278 <br />ECP0349072 <br />10/15/2015 <br />10115/2018 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 2 000 000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 2,000,000 <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />JECT <br />PRODUCTS - COMP /OP AGG <br />$ 4,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />EBA0349072 <br />10/15/2015 <br />10/15/2018 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 2,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(PERACCIDENT) <br />$ <br />X <br />X <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR /PARTNER /EXECUTIVE <br />OFFICER /MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />22WECBV6360 <br />08/18/2017 <br />08/18/2018 <br />X WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 100,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 100,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />A <br />Sexual Misconduct <br />ECP0349072 <br />05/02/2018 <br />10115/2018 <br />Occurence 1,000,000 <br />Aggregate 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Additional Insured Status Applies to Holder <br />CERTIFICATE HOLDER CANCELLATION <br />ORANG -1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />ORANGE COUNTY <br />COUNTY <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />WITH THE POLICY PROVISIONS. <br />P O Box <br />302 W. Tryon St. <br />Hillsborough, INC 27278 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2009/09) <br />©1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />