Orange County NC Website
INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />NAME:CONTACT <br />INSURER C : <br />INSURER B : <br />(A/C, No):FAX <br />E-MAILADDRESS: <br />CUSTOMER ID: <br />PRODUCER <br />PRODUCER <br />(A/C, No, Ext):PHONE <br />INSURED INSURER A : <br />The ACORD name and logo are registered marks of ACORD <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 />LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />REVISION NUMBER:CERTIFICATE 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 />COVERAGES <br />$$ <br />$BOILER & MACHINERY / <br />EQUIPMENT BREAKDOWN <br />$ <br />$ <br />$ <br />TYPE OF POLICY <br />CRIME <br />POLICY NUMBER <br />$ <br />$ <br />$ <br />$ <br />NAMED PERILS <br />CAUSES OF LOSS <br />TYPE OF POLICYINLAND MARINE <br />$ <br />RENTAL VALUE <br />CONTENTS <br />BUILDING <br />DEDUCTIBLES <br />WIND <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />BLANKET BLDG & PP <br />BLANKET PERS PROP <br />BLANKET BUILDING <br />EXTRA EXPENSE <br />BUSINESS INCOME <br />PERSONAL PROPERTY <br />BUILDING <br />FLOOD <br />EARTHQUAKE <br />SPECIAL <br />BROAD <br />BASIC <br />CAUSES OF LOSS <br />PROPERTY <br />POLICY EXPIRATION <br />DATE (MM/DD/YYYY) <br />POLICY EFFECTIVE <br />DATE (MM/DD/YYYY) <br />INSR <br />LTR LIMITSCOVERED PROPERTYPOLICY NUMBERTYPE OF INSURANCE <br />$$ <br />$ <br />SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />© 1995-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 24 (2016/03) <br />AUTHORIZED REPRESENTATIVE <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 />CANCELLATION <br />CERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) <br />CERTIFICATE HOLDER <br /> <br /> <br />    <br />  <br /> <br /> ! " # <br /> $$%&<br />' <br />  (') *   <br />+,-$* $$$.+,//( <br />0 012$ <br />1 .( #0 3 <br />0 012$ <br />1 .( #0 3 <br />4 <br />45 <br />67("  8 "9:;"8  < 8< 8 <br /> < 8< <br />  <br /> < < 8 <br />Orange County Health Department <br />300 W. Tryon Street <br />Hillsborough NC 27278 <br />DocuSign Envelope ID: F65E0D95-4748-430B-B7D4-57947C3D102E