Orange County NC Website
.ACCORD® CERTIFICATE OF LIABILITY INSURANCE <br />/Y <br />DATE (MWDDYYY) <br />07/10/2018 <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 Hanover Excess & Surplus, Inc. <br />CONTACT <br />NAME: <br />PO Box 12450 <br />PHC No Ext : A� No): <br />E -MAIL <br />ADDRESS: <br />CPS2898875 <br />INSURE NS) AFFORDING COVERAGE <br />NAIC # <br />WILMINGTON, NC 28405 <br />INSURERA : SCOTTSDALE INSURANCE COMPANY <br />41297 <br />DAMAGE TO REN—TE-D- <br />PREMISES Ea occurrence) <br />INSURED ORANGE TENNIS CLUB <br />INSURERB: <br />MED EXP (Any one person) <br />INSURER C : <br />INSURER D: <br />3500 COTTON RUN RD <br />INSURER E : <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO L] LOC <br />JECT <br />OTHER: <br />GENERAL AGGREGATE <br />EFLAND, NC 27243 <br />INSURER F: <br />$ 2,000,000 <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 />SUER <br />POLICY NUMBER <br />MM/DDY/YYYY <br />MM/DD"YY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE E OCCUR <br />CPS2898875 <br />09/14/2017 <br />09/14/2018 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO REN—TE-D- <br />PREMISES Ea occurrence) <br />S 100,000 <br />GEN'L <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO L] LOC <br />JECT <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />S <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />$ <br />- <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETOR/PARTNER/EXECUTIVE " <br />OFFICER/MEMBER EXCLUDED? I I <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />STATUTE ERH <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />Deductible: $ <br />DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County Government <br />P 0 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 (2016103) The ACORD name and logo are registered marks of ACORD <br />