Orange County NC Website
Browse       Search
DocuSign Envelope ID: FCE3B12B-34AF-485D-9888-6CADC04FD9D6 <br /> CIVIL-2 ❑P ID:SF <br /> DATEIMM+DDNYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE T031O8r2019 <br /> THIS CERTIFICATE 15 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(fes) 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 CONTACT <br /> First Insurance Services,Inc. NAME: Brian M.Jones <br /> i PHO <br /> NE. 919-941-'Q549 .j_FinAlc No:g19-941-B735 <br /> Sox$2409 IA1NE.Err}: <br /> Durham,NC 27717 EMAIL b anea448 nC.rr.Com <br /> Brian M.Jones ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIL N <br /> NSURERA.HSrtford Casuatty insurance Co 29424 <br /> INSURED Civil Consultants,Inc. INSURER8: <br /> 3708 Lyckan Parkway Ste 201 <br /> Durham,NC 27707 INSURERC <br /> INSURERD: <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 /> 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 TYPE OF INSURANCE DDC D n POLICY NUMBER M DDfYYYY MM(C Y ExP — LIMITS <br /> COMMERCIAL GENERAL LIABILrrY EACH OCCURRENCE $ XX <br /> DAMAGE TO RENTEIY-- <br /> CLAIMS-MADE 0 OCCUR PREMISES C Eaoecvrrenoe $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY S <br /> GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S <br /> HPOLICY JECCTT El LOG PRODUCTS-COMPIOPAGG S <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED <br /> EaaoGdenl s1NGLE LIMITS xX <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS I <br /> AUTOSNON OWNED PROPERTY D HIRED AUTOS AUTOS Potawdenl <br /> S <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 XX <br /> EXCESS LIAR CLAIMS•MA13E AGGREGATE 5 <br /> DEC F RETENTION$ i <br /> WORKERS COMPENSATION in �( PER <br /> AND EMPLOYERS'LIABILITY STATUTE EORTH <br /> A ANY PROPRIE7ORIPARTNEfVEXECrUTIVE Y NIA 22WBCCK0275 EXCLUDE TONY 06/24/2018 06/2412019 E.L EACHACCIDENT $ 1,000,00 <br /> OFFICERIMEMSER EXCLUDED? <br /> {Mandatory In NH] ITAHER,MICHAEL PIOCCO& E.L.DISEASE-EA EMPLOYE $ 1r041)r00 <br /> H yyees,describe under <br /> DESGRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 1,00D,00 <br /> KEITH GETTLE <br /> DESCRIPTION OF OPERATIONS;I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be atlached ff more spa co is to qu lrad] <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE4 <br /> Orange County-Department of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Environment,Agr€aulture,Parks& THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Recreation ACCORDANCE WITH THE POLICY PROVISIONS, <br /> Attn:Marabeth Carr <br /> 306A Revere Road AUTHORIZED REPRESENTATIVE <br /> PO Box8181 x6. "O '�� <br /> Hillsborough,NC 27278 <br /> d 198E-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />