Orange County NC Website
Browse       Search
DocuSign Envelope ID: B8F1B8CC-996A-4A3C-9F85-D3D0499CC2D7 <br /> '`�CaRO® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDOIYYYYI <br /> 1 07111/2019 <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 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 endarsement(s). <br /> PRODUCER CON-TACT <br /> NAME: <br /> Hiscox Inc, PHVNE (ggB)202-3007 F,v Na: <br /> 520 Madison Avenue E'}uIDR EA <br /> 32nd Floor A DIL SS; COntact@hiscox.com <br /> New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC p <br /> INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER D: <br /> Lucia Centeno <br /> 8002 Mackenzie Ct INSURER C: <br /> Durham NC 27713 INSURER D: <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 SUB POLICY EFF I POLIO EXP <br /> LTR TYPE OF INSURANCE INSn WVn POLICY NUMBER MMIDDIYYYY MMIDD(YYYY) LIMITS <br /> COMMERCIALGENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE FOCCUR DAMAGE T <br /> O RENTMY-- <br /> PREMISES Ea occurrence) S <br /> MEU EXP(Anyoneparson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY JEC7PRO- <br /> F LOC PRODUCTS-COMWOP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED sENGLE LIMIT $ <br /> Ea scolds t <br /> ANY AUTO BODILY INJURY(Per peraon) S <br /> ALL OWNED SCHEDULED BODILY INJURY[Per accldenl $ <br /> AUTOS AUTOS 1 <br /> NON-OWNED PROPERTY DAMAGE <br /> HIREDAUTOS AUTOS Per accident $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DEC I j RETENTION$ S <br /> WORKERS COMPENSATION PER TH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRiETOR1PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICEPJMEMBEREXCLUDED7 NIA <br /> (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ <br /> It yyes,daacrlbe under <br /> ❑CSCRIPTION OF OPERATIONS tisl w E,L,DISEASE-POLICY LIMIT $ <br /> A Professional Liability 7 UDC4213689-EO-19 07/11/2019 07/11/2020 Each Claim:$250,000 <br /> Aggregate:$250.000 <br /> 0ESCRiPTION OF OP ERATiON$I LOCATI DNS I VEHICLES (ACORD 101,Addltlonal 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 /> 01988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />