Orange County NC Website
Browse       Search
DocuSign Envelope ID:55159D6E-AB02-4A21-AE01-F9384E7BFD4D <br /> 711/0812018 <br /> E(MMfDDrYYYY) <br /> � CERTIFICATE OF LIABILITY INSURANCE <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(les) 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 CONTACT <br /> NAME: <br /> PHONE FAX <br /> AIC No): <br /> Andrew F.Jones E-MAIL <br /> AODREss: <br /> 729 W NC HIGHWAY 54 INSURER(S)AFFORDING COVERAGE I NAIC# <br /> DURHAM NC 27713 INSURERA: NATIONWIDE PROPERTY AND CASUALTY INSUF 37877 <br /> INSURED INSURERS: <br /> INSURER C: <br /> CIVIL CONSULTANTS INC INSURERO: <br /> 3708 LYCKAN PKWY STE 201 INSURERE: <br /> DURHAM NC 27707-2586 INSURERF: <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 SEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE AODL SUBR POLICY NUMBER 1 W LICYEFF YE XP <br /> LTR DDDIYYY M D LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO <br /> CLAIMS-MADE f OCCUR PREMISES(EaENTED occurrence) $ <br /> MED EXP(Arty one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> F PO- <br /> POLICY JE C LOG PRODUCTS-COMPTOP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 0 ,'IQ <br /> E ccidenU <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> A ALL OWNED X SCHEDULED ACP BAK 3046634707 04/24/2018 04124/2019 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per aoCldefil <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> DEQ I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILI Y YIN STATUTE ER <br /> ANYPROPRIETORIPARTNEPJEXECUTI.E NIA E.L.EACH ACCIDENT $ <br /> OFFICEWMEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Rcmarks 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 DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Orange County <br /> AUTHORIZED REPRESENTATIVE <br /> PO Box 8181 Diane Burgess <br /> Hillsborough NG 27278 C)DCZA- <br /> D 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks Of ACORD <br />