Orange County NC Website
Browse       Search
DocuSign Envelope ID:2E257032-C223-4432-A677-B42BBD11D6BE <br /> I MERRFRA OP ID: NJE <br /> A�4 ° CERTIFICATE OF LIABILITY INSURANCE 0 9/1 712 01 8 <br /> 09/17/2018 <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 Phone: 919-682-4814 NAME: Natalie Engelhart <br /> The Sorgi Insurance Agency Fax: 919-682-4906 PHONE 919-682-4814 FAx <br /> 16 Consultant Place Suite 102 A/C No Ext: wc,No): <br /> Durham,NC 27707 E-MAIL <br /> James E.Sorgi,CIC —ADDRESS: natalie@sorgiinsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Erie Insurance Exchange 26271 <br /> INSURED Merry Franksters, LLC INSURER B: <br /> Kelsey Williams <br /> 101 Hillcrest Ave INSURER C: <br /> Carrboro,NC 27510 INSURER D: <br /> INSURER E <br /> INSURER F <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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> • X COMMERCIAL GENERAL LIABILITY X Q362600305 12/26/2017 12/26/2018 DAMAGE TO RENTED 1 000 00 <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> X POLICY PRO- LOC $ <br /> JECT <br /> AUTOMOBILE LIABILITY COEa M aBINED SINGLE LIMIT ccident $ 1,000,000 <br /> • ANY AUTO Q101130713 10/11/2017 10/11/2019 BODILY INJURY(Per person) $ <br /> ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Additional Insured: Orange County Government <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORC0001 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange Count Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> g Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> P O Box 8181 <br /> Hillsborough, NC 27278 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 />