Orange County NC Website
Browse       Search
DocuSign Envelope ID: D3ADCOFO-56OB-45AA-A3EA-B65E3A3AO6DE <br /> DATE(MM1DDIYYYY1 <br /> .�► o� CERTIFICATE OF LIABILITY INSURANCE 0 711 212 0 1 7 <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 INSURERS), 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 /> CONTACT PRODUCER NAME. Natasha Shaffner <br /> StatQFarm Johnny Spillman Jr State Farm PHONE 919-636-5848 FAX No 866-246 8819 <br /> �PJC.NO.Extl�- <br /> A 1208 Raleigh Rd E-MAIL natasha@spillmaninsurance.com <br /> A. DRESS: <br /> Chapel Hill,NC 27516 1NSURERl3}AFFC RDING COVERAGE NAIL# <br /> INSURERA: State Farm General Insurance Company 25151 <br /> INSURED INSURER@: - <br /> Table Ministries Inc. MNsuRERc <br /> 209 E.Main St. F.. <br /> uCarrboro,NC 27510 RER FRER€ <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 ADDL SUER POLICY fPP POLICY EXP LIMITS <br /> TYPE OF INSURANCE _ POLICY NUMBER MMN fDDIV'YYY _ <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 <br /> DA.. GE TO RENTED 300,000 <br /> CLAIMS-MADE OCCUR PREMISES Ea o nen� <br /> MED EXP(An ono rwn S 5,000 <br /> 93-bc-a158-3 0210712017 0210712018 PERSONAL&AOV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE S 2,{}QO,QeQ <br /> GEN'L AGGREGATE LIMIT APPLIES PER' - <br /> PRO- PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> POLICY E JECT ❑LOC S <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> Ea accident} <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED BODILY INJURY(per accident) 5 <br /> AUTOS ONLY AUTOS PROPERTY DA7ulAGE S <br /> HIRED NON-OWNED fPer accident) <br /> AUTOS ONLY AUTOS ONLY -- S <br /> EACH OCCURRENCE s <br /> UM@RELLA LIAR 'OCCUR <br /> EXCESS LIAR CLAIMS-h1ArlE AGGREGATE _ $ <br /> $ <br /> DFD RETENTIONS PER OTHI- <br /> 'WO R KE RS CO M PENSATION I STATUTE <br /> !AND EMPLOYERS"LIABILITY <br /> ANY PROPRER� fETORIPARTNERIEXECUTIVE Y E-L-EACH ACCIDENT $ <br /> OFFICIMEMBER EEXCLUDED? NIA E.L.01SEASE-EA EMPLOYE <br /> (Mandatary In INN . <br /> If yeG,desuibe under E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS below <br /> L I <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERE❑ IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County <br /> 200 South Cameron St. AUTHORt VE <br /> Hillsborough,NC 27278 <br /> Q 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORt] <br /> 1007486 732849.12 03.76.21118 <br />