Orange County NC Website
Browse       Search
ACORD 25 (2009/01)© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />09/24/2018 <br />PRODUCER <br />THE INSURANCE CENTER OF DURHAM <br />1920 Front St Ste 710 <br />Durham,NC27705--2584 <br />919.471.2541 <br />THISCERTIFICATIONISISSUEDASAMATTEROFINFORMATION <br />ONLYANDCONFERSNORIGHTSUPONTHECERTIFICATE <br />HOLDER.THISCERTIFICATEDOESNOTAMMEND,EXTENDOR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGENAIC # <br />INSURED <br />JW Athletics Foundation <br />2621 Brookhollow Rd <br />Efland,NC27216- <br />INSURER A:Philadelphia Indemnity Insurance Company18058 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />COVERAGES <br />THEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED.NOTWITHSTANDING <br />ANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHISCERIFICATIONMAYBEISSUEDOR <br />MAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSIONSANDCONDITIONSOFSUCH <br />POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ADD'L <br />INSRDTYPE OF INSURANCEPOLICY NUMBER <br />POLICY EFFECTIVE <br />DATE (MM/DD/YYYY) <br />POLICY EXPIRATION <br />DATE (MM/DD/YYYY)LIMITS <br />AXGENERAL LIABILITY PHPK1750468- <br />000 <br />12/11/201712/11/2018EACH OCCURENCE$1,000,000 <br />X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />PREMISES (Ea occurrence)$300,000 <br />CLAIMS MADE X OCCUR MED EXP (Any one person)$2,500 <br />XPROFESSIONAL LIABILITY PERSONAL & ADV INJURY$1,000,000 <br />GENERAL AGGREGATE$3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS – COMP/OP AGG$3,000,000 <br />X POLICYPROJECTLOC <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />(EA accident)ANY AUTO <br />ALL OWNED AUTOS BODILY INJURY <br />(Per person)SCHEDULED AUTOS <br />HIRED AUTOS BODILY INJURY <br />(Per accident)NON-OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />GARAGE LIABILITY AUTO ONLY – EA ACCIDENT <br />ANY AUTO OTHER THAN <br />AUTO ONLY: <br />EA ACC <br />AGG <br />EXCESS / UMBRELLA LIABILITY EACH OCCURENCE <br />OCCURCLAIMS MADE AGGREGATE <br />DEDUCTIBLE <br />RETENTION <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITYY/N <br />WC STATU- <br />TORY LIMITS <br />OTH- <br />ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED?E.L. EACH ACCIDENT <br />(Mandatory in NH)E.L. DISEASE – EA AMPLOYEE <br />If yes, describe under <br />SPECIAL PROVISIONS below E.L. DISEASE – POLICY LIMIT <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />Itisunderstoodandagreedthatthefollowingentityisaddedasanadditionalinsuredbutonlywithrespect(s)totheoperationsofthenamedinsuredexceptthatliabilityresultingfromtheadditionalinsured'ssole <br />negligence. <br />CERTIFICATE HOLDERCANCELLATION <br />Orange County <br />PO Box 8181 <br />Hillsborough,NC27278- <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATE <br />THEREOF,THEISSUINGINSURERWILLENDEAVORTOMAIL 10 DAYSWRITTENNOTICETOTHE <br />CERTIFICATEHOLDERNAMEDTOTHELEFT,BUTFAILURETODOSOSHALLIMPOSENOOBLIGATIONOR <br />LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />DocuSign Envelope ID: E569A9F5-CEAA-4900-97A7-43153531A654