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2018-804-E AMS - Triangle Office Equipment Replacement BOE Chairs
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2018-804-E AMS - Triangle Office Equipment Replacement BOE Chairs
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Last modified
12/28/2018 10:31:45 AM
Creation date
12/12/2018 4:10:02 PM
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Contract
Date
12/6/2018
Contract Starting Date
12/6/2018
Contract Ending Date
12/31/2018
Contract Document Type
Contract
Amount
$1,256.08
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R 2018-804 AMS - Triangle Office Equipment Replacement Chairs
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2018
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DocuSign Envelope ID:6A7D1334-CFB3-4OE9-83EA-3324C57A6DOC <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(M <br /> 10/30//2018 Y) <br /> 018 <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(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 /> PRODUCER CONTACT Patty Miller <br /> NAME: <br /> Business Insurers of Carolinas AICONN. Ext: (919)968-4611 cX No): (919)968-8991 <br /> 800 Eastowne Drive,Suite 208 E-MAIL pmiller@business-insurers.com <br /> ADDRESS: <br /> PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Chapel Hill NC 27515-2536 INSURERA: Tri-State Ins Co of Minnesota 31003 <br /> INSURED INSURER B: Acadia Insurance Company 31325 <br /> Triangle Office Equipment,Inc. INSURER C: <br /> PO Box 2372 INSURER D: <br /> INSURER E: <br /> Chapel Hill NC 27515 1INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL18103023879 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 ADUL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE_7CLAIMS-MADE IX-1 OCCURPREM SESO(Ea occurrence)TE ence) $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A Y ADV435917042 11/01/2018 11/01/2019 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY 1-1 PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> JECT <br /> OTHER: Employee Benefits $ 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED CNA4359171-42 11/01/2018 11/01/2019 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> HUnderinsured motorist BI $ 1,000,000 <br /> UMBRELLA LIAB _r"`"""` 1,000,000 <br /> X OCCUR EACH OCCURRENCE $ <br /> B EXCESS LIAB CLAIMS-MADE CNA4359171-42 11/01/2018 11/01/2019 AGGREGATE $ 1,000,000 <br /> DED I RETENTION $ Follows form GL/AL/WC $ <br /> WORKERS COMPENSATION X1 SPERTATUTE EORH <br /> AND EMPLOYERS'LIABILITY YIN 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ACH ACCIDENT $ <br /> B OFFICER/MEMBEREXCLUDED? N N/A WCA4359172-42 11/01/2018 11/01/2019 E.L.. <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If ves,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Hired Auto Physical Damage <br /> B CNA4359171-42 11/01/2018 11/01/2019 Limit/ACV $65,000 <br /> deductible $1,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Certificate holder is included as additional insured in reference to the General Liability policy per written contract. <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 /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> AUTHORIZED REPRESENTATIVE <br /> 131 West Margaret Lane <br /> Hillsborough NC 27278 PY4- <br /> ©1988-201115 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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