Orange County NC Website
Browse       Search
DocuSign Envelope ID:94F04810-ED21-4E95-8CDC-D01821E590AE <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MIiii YYyy] <br /> 111071,2018 <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(les)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 endorsements). <br /> PRODUCER �ADD orACr Jaml McMillion_ <br /> : <br /> Sfate�°rwui GARY ELLIOTT E 919-842-5057 FAX <br /> 1805 E.FRANI(LIN ST,STE 210 I I{AFC919'B$t4 1948 <br /> cc: >, Ess: #ami rhapelhilisf.com <br /> CHAPEL HILL.,NC 27514 <br /> INSUREMS1 AFFORDING COVERAGE NAiC P <br /> INSURao <br /> INSURes A: State Farm Fire and Casualty Company 25143 <br /> INSURER D <br /> ICEENAN WILLIAMS - <br /> 730 EAGLE POINT Rd INSURER C,. -- <br /> PITTSBfiiR[3,NC 27312-6176 INSURER 0 176 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, NOTIMTHSTANDING ANY REQUIREMENT,TERNS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIPICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> IHSR .. A'D87L SUER PO ICY EFF POLIO EJIP <br /> LTR TYPE OF INSURANCE POLICYRUMBER MIA D Mir) LIMITS <br /> COMMERCIAL GE#ERAL LIABILITY <br /> EACH OCCURRENCE g 50f},0D0 <br /> CLAIMS-MADE �OCCUR TED <br /> PREMISES Ea Renee $ _ <br /> MED EXP(An dno person $ <br /> 93-GV-P089-5 0911112018 69111/2019 PERSONAL 6 ADV INJURY <br /> GEE EGATE LIMIT APPLIES PER: pENERALAGGREQATE $ ,606,606 <br /> I� Ea FI LOC ._- <br /> PRODUCTS.COhSPlOPAGG $ <br /> 5 <br /> AUTOMOBILE LIABELn'Y OMBIN�D SINGLE UM IT <br /> TO <br /> BODILY INJURY(Per person) 5 <br /> SCHEDULED <br /> HIRED ONLY EA,UOTOS BODILY INJURY iPeraceldent) $ <br /> ONLY AUTOS ONLY PROPERTY DAMAG£ $ <br /> ParaccidE t <br /> s <br /> LA LIAR OCCUR EACH OCCURRENCE <br /> UAe CLAIMS-I,pRPE AGGREGATE - <br /> S <br /> D£D RETENTION S <br /> .WORKERS COMPENSATION - $ <br /> AND EMPLOYERS,LIABILITY YIN STATUTE ER <br /> ANY PROPRIErQR/PArSI'NEWEXBCUTIVE E.L.EACHACCiOENT S <br /> OFFICEkrI,tEMDBR EXCLUDED? TNIA <br /> {Manda3ory irl <br /> NH)II yyes,desulba uH) E.L.DISEASE-FA EMPLOYEE $ <br /> r7E5CRIPTION 4F OPERATIONSaa E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACDRD let,Addiri Remarks Schedule,may pe Aeaehad it mare space Is requimd) <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLEO BEFORE <br /> THE EXPIRATION DATE THEREOF, NO'"C6 WILL BE DELIVERED IN <br /> ORANGE COUNTY ACCORDANCE MT"THE POLICY PROVISIONS, <br /> PO Box 8181 <br /> HILLSBOROUGH,NG 27278 AUTHORIZED PRESENTATIVE <br /> Qy1 t 1►r <br /> 1988-2015 ACDRD CORPORATION. All rights reserved, <br /> ACDRD 25(2016103) The ACDRD name and logo are registered marks of ACDRD <br /> 1WI486 :32849.12 03-16-2016 <br /> i <br />