Orange County NC Website
DocuSign Envelope ID: 7A9252AF- OE3A- 47EE- A4F6- 2A3D9DF527FF <br />MARICHE OP ID: NJE <br />A�4 ° CERTIFICATE OF LIABILITY INSURANCE <br />07/24/2018 <br />0 7 /2412 01 8 <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 Phone: 919- 682 -4814 <br />The Sorgi Insurance Agency <br />16 Consultant Place Suite 102 Fax: 919 - 682 -4906 <br />NAME: Natalie Engelhart <br />PHONE FAX <br />A/C No Ext :919- 682 -4814 11, No): 919 - 682 -4906 <br />E- MAIL <br />natalie@sorgiinsurance.com <br />Durham, NC 27707 <br />James E. Sorgi, CIC <br />—ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Erie Insurance Exchange <br />26271 <br />A <br />INSURED Marian Cheek Jackson Center <br />INSURER B: Westchester Fire Insurance Co <br />for Saving and Making History <br />08/15/2018 <br />08/15/2019 <br />512 West Rosemary St <br />INSURER C: <br />INSURER D: <br />Chapel Hill, INC 27510 <br />INSURER E <br />INSURER F <br />$ 5,00 <br />PERSONAL & ADV INJURY <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 />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />Q970503239 <br />08/15/2018 <br />08/15/2019 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1 000 00 <br />CLAIMS -MADE � OCCUR <br />MED EXP (Any one person) <br />$ 5,00 <br />PERSONAL & ADV INJURY <br />$ 1,000,00 <br />Q970503239 <br />08/15/2017 <br />08/15/2018 <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,00 <br />X POLICY PRO- LOC <br />JECT <br />$ <br />AUTOMOBILE LIABILITY <br />COEa M aBINED SINGLE LIMIT ccident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANY AUTO <br />X <br />Q970503239 <br />08/15/2017 <br />08/15/2018 <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />X HIRED AUTOS X NON -OWNED <br />AUTOS <br />UMBRELLA LAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR /PARTNER /EXECUTIVE <br />OFFICER /MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N/A <br />Q921501020 <br />Q921501020 <br />08/15/2018 <br />08/15/2017 <br />08/15/2019 <br />08/15/2018 <br />X WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 500,00 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,00 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,00 <br />B <br />Professional Liab. <br />EONNCF138950892 <br />11105/2017 <br />11/05/2018 <br />Prof Liab 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Orange County is named as additional insured as regards General Liability <br />per written contract. <br />CERTIFICATE HOLDER CANCELLATION <br />ORANGEC <br />Orange County <br />Risk Manager <br />PO 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 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />