Orange County NC Website
DocuSign Envelope ID: BF20BCEC-F4B5-49CD-AE54-381505248C08 <br /> OP ID: DR <br /> DATE(MMIDDIYYYY) <br /> CERTIFICATE of LIABILITY INSURANCE 04118/2016 <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(Sy, AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyl;ies) 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 endorsements. <br /> PRODUCER Phone:919-682-4814 CONTACT Christine Barnett <br /> NAME. <br /> The SorgiInsurance Agency PHONE FAX <br /> 16 Consultant Place Suite 102 Fax:919-6824906 Cie E:tk 9'19-682-4814 ,�No)::919-6824906 <br /> Durham,NC 27707 E-ih R Chris SOr iinsurance.com <br /> .lames E.Sorgi,CIC a ODDUCER — - - --- <br /> CUSTOMER ID N:TRIALAN -_-__-- <br /> iNSURER(SI AFFORDING COVERAGE NAIC N <br /> INSURED Triangle Landscaping Inc. INSURER A:Erie Insurance Exchange 26271 <br /> Brad Lewis dba INSURER 8- <br /> 3682 Fletchers Way <br /> Stem,NC 27589 INsuRERc: <br /> _INSURER ID; <br /> 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTINCATS 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 TYPE OF INSURANCE ADDL SUB Icy E <br /> POLICY NUMBER POLICY EFF' POLkP LIMITS <br /> — ---------- <br /> LTRWyD <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,U0 <br /> _ COMMERCIAL GENERAL LIABILITY 027726204479 03/2612016 03126/2017 DAMAGE TO RENTED <br /> - - ------ -. - <br /> PREMISES Ea occurrenoe $ <br /> CLAIMS-MADE I X I OCCUR MED EXP(Any one person)._._ $__--— _.- ._. <br /> PERSONAL&AOV INJURY $ 11000,40 <br /> GENERAL AGGREGATE $ 2,000,00 j <br /> GEN'LAGGREGATE LIMIT APPLIES PER: P1111CTS-COMPI0PAGG $ 2,00,00 <br /> POLICY PRO- LOG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 750,t]O <br /> A ANY AUTO Q03263t1379 0312612016 0312 (Ea acdclait).6l2017 BODILY INJURY(Per person) S <br /> ALLOVVNEDAUTOS ..- _..._.._...___ <br /> BODILY INJURY(Per aoddent) $ <br /> X_ SCHEDULED AUTOS <br /> PROPERTY DAMAGE S <br /> HIRED AUTOS (Per accident) <br /> NON•OWNEDAUTOS $ <br /> 5 <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESSLIAB CLAIMS-MADE AGGREGATE 5 <br /> DEDUCTIBLE $ <br /> RETENTION S $ <br /> WORKERS COMPENSATION X I WC STATU- I JOTH- <br /> AND EMPLOYERS'LIABILITY <br /> LIMITS I ER <br /> X ANY PROPRIETORIPARTNER/EXECUTIVE Y!N Q872600669 0312612016 0312612017 E.L.EACH ACCIDENT $ 100,00 <br /> OFFICERIMEMBER EXCLUDED? N I A <br /> (Mandatory in NH) IPLOYEE $ 100,00 <br /> II yyes,desalt>e under <br /> DE SCRIPTIONOF OPERATIONS balmv E.L.DISEASE-PpLICYLIMl7 S 5Q!),QO <br /> A Contractors equip Q272620479 03126/2016 03/2612017 JEquipment 122,87 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addlllonal Remarks Schaduta,iT mnra space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> i <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 Box8181 <br /> Hillsborough,NC 27278 AUTHORIZED REPRESErNT;ATIVE <br /> D 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />