Orange County NC Website
DocuSign Envelope ID:6ADCODA4-8OF1-42F5-A151-C7F99A87D2A7 XCHMENT B DYANMQUEST <br /> DATE(MMIDD/YYYY) <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 3/21/2019 <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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME: Andy Tribendis <br /> The Simkiss Agency, Inc. PHONEo, 610 727-5300 FAX, <br /> 610-727-5414 <br /> A/C A/C,N Ext: No <br /> P. O. Box 1787 E-MAIL ADDRESS: tribendisandy@simkiss.com <br /> 2 Paoli Office Park INSURER(S)AFFORDING COVERAGE NAIC# <br /> Paoli, PA 19301-0826 INSURER A:Travelers Property Casualty Co of Amer 25674 <br /> INSURED INSURER B:Travelers Indemnity Company <br /> Dynamic Quest, LLC Travelers Casualty Insurance Co of Amer <br /> INSURER C: Y <br /> 4821 Koger Blvd Main <br /> INSURER D <br /> Greensboro, NC 27407 <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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY 6806F981132 05/15/2018 05/15/2019 EACH OCCURRENCE $1 OOO 000 <br /> CLAIMS-MADE OCCUR PREMISES Ea occur°nce $300,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> x POLICY JECTPRO- LOC PRODUCTS-COMP/OPAGG $2,000,000 <br /> OTHER: $ <br /> C AUTOMOBILE LIABILITY BA7F332989 5/15/2018 05/15/201 COEaMBINED ccident SINGLE LIMIT $1, ,OOO OOO <br /> a <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> X AUTOS ONLY X AUTOS ONLY Per accident $ <br /> B UMBRELLA LIAB OCCUR CUP7F333280 5/15/2018 05/15/2019 EACH OCCURRENCE $9 000 000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $9 000 000 <br /> DED X RETENTION$5000 $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Cyber/E&O 6806F981132 05/15/2018 05/15/201 $2M Claim/$2M Agg. <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(,CORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Re: Evidence of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange Count SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 131 W. Margaret Lane ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S534059/M385728 AD <br />