Orange County NC Website
DocuSign Envelope ID:43A172E7-E29E-49DA-966A-C47C5091A3DD <br /> CREAT-5 OP ID, MAT <br /> A�QRo CERTIFICATE OF LIABILITY INSURANCE DATE 0211 812 01 9Y] <br /> a211 s1zo1� <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 endorsements . <br /> PRODUCER 919-878-9412 C MTACT Highsmith Insurance <br /> Highsmith Insurance PHONE 91 g_87g.g412 FAX 91 g-256-1969 <br /> a Nlarsh&McLennan Agency LLC (A/C,No,Ext; FAX <br /> Np <br /> 3700 Glenwood Ave.,Suite 430 E-al .matt@highsmithinsurance.com <br /> Raleigh,NC 27612 <br /> Matthew HOrney INSURERS ArFoRDimo COVERAGE NAIC# <br /> INSURER A:Selective Ins,Co of America 12572 <br /> INSURED INSURERS;Hartford ACC&Indemnity Co 22357 <br /> Creative Business Interiors In <br /> 8720 Fleet Service Drive INSURER C: <br /> Raleigh,NC 27617 <br /> INSURER D: <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMB 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 LTR TYPE OF INSURANCE ADOL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE 1,000,000 <br /> MsE <br /> CLAIMS-MACE OCCUR S 2338296 111271201$ 1712712079 DAMAGERE r RENTED 5100,000 <br /> MED EXP(Any one erson 15,000 <br /> PERSONAL&ADV INJURY 1,000,000 <br /> E L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 <br /> x POLICY jPQ� LOC PRODUCTS-COMPIOP AGG S 3,000,000 <br /> R: <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,000 <br /> X ANY AUTO S 2338296 1112712018 11/2712019 BODILYINJURY Per son <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS <br /> yVry p BODILY INJURY Per accident <br /> X AL7Tt]S ONLY X AR OJ OM&Y Pe�aoEcR�naAMAGE <br /> A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3,000,000 <br /> EXCESS LIAS CLAIMS-MADE S 2338296 11/27/2018 11/2712019 AGGREGATE s 3,000,000 <br /> ❑EC I I RETENTION$ <br /> S WORKERS EMPLOYERS'COMPENSATION <br /> LABILITY X PER OTH- <br /> ANY PROPRIETORIPARTNERIEXECUIIVE YIN 22WBCEM0470 11127/2018 1112712019 E L.EACH ACCIDENT <br /> �N ER 500,000 <br /> OFFICERIMEMBER EXCLUDED? NIA - <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 600,000 <br /> II yes,describe Under 500,OQ0 <br /> ❑E I ON F OPERATIONS below E.L.DISEASE-P LI Y I <br /> A Employment Prac S 2338296-01 11/27/2018 F 112712019 Empl Prac 100,Q06 <br /> A Crime S 2338296-01 111271201811112712019 Crime 25,000 <br /> I <br /> DESC Ril PT ON❑F OPERATIONS f LOCATION$1 VEHICLES (ACORD 101,Add lfionaI Roma rks Schedule,may be attached If more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ❑RANGEC <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 /> Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE <br /> ACORD 26(2016103) Q 1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />