Orange County NC Website
Browse       Search
DocuSign Envelope ID:5FF56C04-3BB8-4567-932F-25B632A40E72 <br /> AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> ��. 06108/2016 <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(3es) 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 /> Hiscox Inc PHONE IAIC,1No.Ext�888 202-3007 i mac.Not: <br /> .. . . <br /> 520 Madison Avenue E-MAIL ADDRESS: contact @hiscox.COm <br /> 32nd Floor INSURER(S)ArFORDINGCOVERAGE NAIC# <br /> New+York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B <br /> Silvia Lissette Saca INSURER C: <br /> 103 N.Crabtree Knoll <br /> INSURER D <br /> INSURER E: <br /> Chapel Hill NC 27514 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 /> INSR ADDLSUBR <br /> LTR TYPE OF INSURANCE POLICY NUMBER ... MMIUDIYYYY MWDDNM LIMITS ..... <br /> COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE F OCCUR DAMAGE <br /> TO RENTED --- --- <br /> PREMISES(£a occurrence) $ _ <br /> MEP EXP(Any one person) $ <br /> ._. PERSONAL&ADV INJURY <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO [ l LOC PRODUCTS-COMPIOPAGG $ <br /> _... <br /> OTHER: $ ....._ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> Ea aceidanl) <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED --- --- <br /> AUTOS AUTOS BODILY INJURY(Per aoddent) S V <br /> HIRED AUTOS NON-OWNEDPROPERTYdAMAGE _.._. ._._ <br /> AUTOS Per accident)__ $ _ <br /> UMBRELLALIAB OCCUR EACH OCCUR. .._..... !. <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> i D£D RETENTION Is <br /> WORKERS COMPENSATION PER OTH- <br /> iAND EMPLOYERS'LIABILITY YIN -STATUTE ER <br /> ANYPROPRtETORIPARTNERrEXECUTtVE E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBEREXCLUDED? �.NIA -.--- .... _.... ...__ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S <br /> It yes,describe under --.. ....... .._. <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> Professional Liability Each Claim: $250,000 <br /> A UDC-1763911-EO-16 07/01/2016 07101I2017 Elggregate: $250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10f,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 DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />