Orange County NC Website
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? <br />INSRADDLSUBRLTRINSDWVD <br />PRODUCER CONTACTNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFFPOLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO-POLICYLOC PRODUCTS - COMP/OP AGGJECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person)$ <br />OWNEDSCHEDULED BODILY INJURY (Per accident)$AUTOS ONLYAUTOS <br />HIREDNON-OWNED PROPERTY DAMAGE $AUTOS ONLYAUTOS ONLY (Per accident) <br />$ <br />OCCUR EACH OCCURRENCE <br />CLAIMS-MADE AGGREGATE$ <br />DEDRETENTION$ <br />PEROTH-STATUTEER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below <br />INSURER(S) AFFORDING COVERAGENAIC # <br />COMMERCIAL GENERAL LIABILITY <br />Y / N <br />N / A <br />(Mandatory in NH) <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 />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 />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 />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDERCANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />$ <br />$ <br />$ <br />$ <br />$ <br />The ACORD name and logo are registered marks of ACORD <br />MBOYD <br />09/07/2018 <br />CAROBRE-01 <br />A <br />ETD0481149 <br />A <br />ETD0481149 <br />B <br />0000575009 <br />A <br />ETD0481149 <br />A ETD0481149 <br />500,000 <br />500,000 <br />500,000 <br />0 <br />2,000,000 <br />2,000,000 <br />2,000,000 <br />2,000,000 <br />1,000,000 <br />2,000,000 <br />Liq Lia-1,000,000 10,000 <br />500,000 <br />1,000,000 <br />1,000,000 <br />X <br />X <br />X <br />X <br />X <br />X <br />X <br />XX <br />X <br />X <br />03/23/201803/23/2019 <br />03/23/201803/23/2019 <br />03/23/201803/23/2019 <br />03/23/201803/23/2019 <br />03/23/201803/23/2019 <br />Certificate holder ia additonal insured as respects to the General Liaiblity a& Liquor Liability <br />Athens Insurance110 W. Washington Avenue <br />Athens, TN 37303 <br />(423) 745-8888(423) 745-3062 <br />Orange County Government <br />P O Box 8181 <br />Hillsborough, NC 27278 <br />CBGP Sub, LLC DBA Carolina Brewery <br />460 West Franklin St <br />Chapel Hill, NC 27516 <br />Cincinnati Insurance Company <br />Eastern Alliance Ins Group <br />10677 <br />X <br />Property <br />DocuSign Envelope ID: C5229EFD-3B29-455F-BAC0-DE18BB7B19C0