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2018-714-E AMS - Herndon Restaurant Equipment Animal Svc freezer
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2018-714-E AMS - Herndon Restaurant Equipment Animal Svc freezer
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Last modified
11/14/2018 10:04:00 AM
Creation date
11/2/2018 4:56:03 PM
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Template:
Contract
Date
10/25/2018
Contract Starting Date
10/29/2018
Contract Ending Date
12/31/2018
Contract Document Type
Contract
Amount
$628.88
Document Relationships
R 2018-714 AMS - Herndon Animal Svc freezer
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2018
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DocuSign Envelope ID:4BA5F256-6AB5-4D7D-8668-A03F8A7CEAA9 <br /> - 0 [GATE(FAMIDWYYYY) <br /> Ac Rte' CERTIFICATE OF LIABILITY INSURANCE <br /> '10119/2018 <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 PCIICy(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 ri hIs to the certificate holder in Iles of such endorsements. <br /> PRODUCER CN2'MWc' <br /> _NAME:. - Don McClintock <br /> McClintock and Associates PHONE 919 484- <br /> ---� FAx 919 t3t}6-8700 <br /> (A!C-.Na„EXD ( ) - 4822 _.. -- <br /> E-MAIL don rrtcclintockinsurancea ene .com <br /> 5850 Fayetteville Read ss:._,,. <br /> tabaE_ � Y — <br /> Suite 203 ___— [NSURER7S)AFFORDING COVERAGE NAIL Ji_T <br /> Durham — �,— NC 27713 IN8URERA: Dartford_Casqail�Insuranrae Com any <br /> INSURED 13 SURER a <br /> Herndon Brothers Refrigeration INSURER C: <br /> Phoenix f=ood Equipment Parts,Inc. INSURER fa _._-- <br /> 4312 Roxboro Rd. _INSURER E_--.._ <br /> Ourham NC 27704 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 /> IL R _ - - Q13L5UE1R, ---- �.�---'• r'OLECYEFF� POLEGYEKrs LIFAITS _ <br /> TYPE OF ILJSURANCE POLICYNUMBER ML1 @D i 1.t1PUDlYYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 <br /> cIAIMS-MADE i X�!OCCUR DIVF1lRGF T(a RE�tTEf?" U40,000 <br /> PREIa115�S{En c�ccu rence � <br /> MED EX ony ono rsan .$ 10,000 <br /> A N N 122SBAV07989 6/112018 61112019 PERSONAL&AOV INJURY s 11000,000 <br /> GEN•L AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE – s 2,00©000 <br /> EC <br /> J <br /> POLICY E ?C� LOG PRODUCTS-COMPIOP AGG s 2,000,000 <br /> - <br /> 5 <br /> OTHER: <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Per parson) $ _ <br /> OWNED SCHEDULED BODILY INJURY;P'eraccident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON•OWNED PRDPERTY DAIrfAGE $ <br /> AUTOS ONLY AUTOS ONLYgLgEder1) _ <br /> s <br /> X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE s 1,000,000 <br /> A EXCESS LIAS CIAiIsIS-MADE N, N i 22SBAVG7989 61112018 61112019 AGGREGATE _ &•1,000,000 <br /> DID RETENTION$ $ <br /> WORKERS COMPENSATION PER ETH- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETORIPARTNEMExE=iVE YIN N r A {� 22WBC I V2112 11112018 1(112019 E.L.EACH ACCIDENT v$ 1 000,000 <br /> A OFPICERIMEMSCREXCLULIED? Y E.I..OISFAIiE-PA EMPLOYEE $ 11,000,000 <br /> (Mandatory in NH) ......_..- <br /> If i describe under <br /> D a RIPTION OF OPERATIONS bobw E.L.DISEASE•POLICY LIMIT S 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD SDI•AddliirmM Remarks Schedule.may be auechea if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THE=REOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ATTM Asset Manager <br /> PO Sox 8181 AUTHORIZEQ REPRESENTATIVE <br /> Hillsborough NC 27278 <br /> Fax: Email: 1988-2015 ACORD CORPORATION, All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />
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