Orange County NC Website
t <br />DocuSign Envelope ID: C525D914- C9F9- 41C7- BOB4- 962FB2B66847 <br />lei' �, �• <br />,ac - <br />CERTIFICATE OF <br />1' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY A <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A <br />OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSUR E <br />If SUBROGATION IS WAIVED, subject to the terms and conditi <br />AROUND THE CORNER INS <br />1431 BROAD ST <br />NC 27705 <br />767HB <br />N7 UKCU <br />GONZALEZ PA =NTERS AND <br />CONTRACTORS TNC <br />4301 SEENNETT MEMORIAL RD <br />DURHAM NC 27705 <br />LIABILITY INS UMNCE DATE(MMIDDIYYYY) <br />06/26/2016 <br />ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />D, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />ons of the policy, certain policies may require an endorsement. A statement <br />ier in lieu of such endorsement(s). <br />CONTACT <br />NAME <br />PHONE FAX <br />AIC, No, Ext : AIC. No <br />E -MAIL <br />ADDRESS: <br />INSURERISI AFFORDING COVERAGE NAIC # <br />INSURERA:TRAVELERS ?ROPERTY CASUALTY COMPANY OF AMERICA <br />INSURER B: <br />INSURER C: <br />INSURER D' <br />INSURER E, <br />INSURER F <br />- -- - i � irurnpen. KEVISIUN NUMBER: <br />THIS IS TO CERTIFY THAT THE PCLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 1NSURED NAMED ABOVE FOR THE <br />POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT <br />WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES <br />DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE <br />BEEN REDUCED BY PAID CLAIMS, <br />IN ADDL SUBR POLICY EFF POLICY EXP <br />L11 TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMInn1Y4VY1 rmminrir v <br />L:61,1 ERGIAL GENERAL iLIABILI7Y <br />CLAIMS -MADE ❑OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />POLCYO PROJECT ❑ LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />DWNEOAUTOS SCHEDULED <br />ONLY AUTOS <br />HIREDAUTOS NON -OWNEE <br />ONLY AUTOS ONLY <br />UMBRELLA LIAB OCCUR <br />—iEXCESS LIAR HCLAIMS-MAI <br />)EDl IRETENTION S <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED> Y <br />(Mandatory In NHl r <br />7 yes• describe under L <br />CERTIFICATE HOLDER <br />ORANGE COUNTY <br />PO BOX 8181 <br />HILLSBOROUGH <br />ACORD 25 (2016103) <br />WA I N <br />(6JUB- 9F56581 -2 -18) <br />03- 18- 18103 -18 -19 <br />may be attached if more space <br />E <br />one <br />RAL AGGREGATE <br />UCTS - COM Plop) <br />'NED SINGLE LIMIT <br />CIDENT is 1, 000, 000 <br />-EA EMPLOYEE S 1, 00 O, 0 00 <br />- POLICY LIMITS 1.000.000 <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />NC 27219 �/_ <br />f Q1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />- -- - i � irurnpen. KEVISIUN NUMBER: <br />THIS IS TO CERTIFY THAT THE PCLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 1NSURED NAMED ABOVE FOR THE <br />POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT <br />WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES <br />DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE <br />BEEN REDUCED BY PAID CLAIMS, <br />IN ADDL SUBR POLICY EFF POLICY EXP <br />L11 TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMInn1Y4VY1 rmminrir v <br />L:61,1 ERGIAL GENERAL iLIABILI7Y <br />CLAIMS -MADE ❑OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />POLCYO PROJECT ❑ LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />DWNEOAUTOS SCHEDULED <br />ONLY AUTOS <br />HIREDAUTOS NON -OWNEE <br />ONLY AUTOS ONLY <br />UMBRELLA LIAB OCCUR <br />—iEXCESS LIAR HCLAIMS-MAI <br />)EDl IRETENTION S <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED> Y <br />(Mandatory In NHl r <br />7 yes• describe under L <br />CERTIFICATE HOLDER <br />ORANGE COUNTY <br />PO BOX 8181 <br />HILLSBOROUGH <br />ACORD 25 (2016103) <br />WA I N <br />(6JUB- 9F56581 -2 -18) <br />03- 18- 18103 -18 -19 <br />may be attached if more space <br />E <br />one <br />RAL AGGREGATE <br />UCTS - COM Plop) <br />'NED SINGLE LIMIT <br />CIDENT is 1, 000, 000 <br />-EA EMPLOYEE S 1, 00 O, 0 00 <br />- POLICY LIMITS 1.000.000 <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />NC 27219 �/_ <br />f Q1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />