Orange County NC Website
DocuSign Envelope ID:A18808EO-5F70-4494-BCOC-49B95D82162D <br /> DDIYYYY) <br /> DATE(MM/ <br /> CERTIFICATE OF LIABILITY INSURANCE FDATE <br /> 019 <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 endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: Shanua Griffith <br /> Hylant-Columbus PHONE FAX <br /> 565 Metro Place South, Suite 450 A/c No Ext:614-932-1200 A/c No):614-932-1299 <br /> Dublin OH 43017 ADDRESS: shanua.griffith@hylant.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Continental Casualty Company 20443 <br /> INSURED LIFEMOB-01 INSURER B:Valley Forge Insurance Co 20508 <br /> Lifeline Mobile, Inc.2050 McCaw Rd INSURER C:Continental Insurance Company 35289 <br /> Columbus OH 43207 INSURERD: <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:87656217 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 ADDL SUBR POLICY EFF POLICY EXP <br /> D LIMITS <br /> LTR IN WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> B X COMMERCIAL GENERAL LIABILITY Y Y 4032466585 9/2/2018 9/2/2019 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED PREM SES(Ea occurrrence $200,000 <br /> MED EXP(Any one person) $15,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY F7 PRO- <br /> JECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: EBL $1,000,000 <br /> C AUTOMOBILE LIABILITY Y C4032466618 9/2/2018 9/2/2019 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> A X UMBRELLA LIAB X OCCUR CUE4032466599 9/2/2018 9/2/2019 EACH OCCURRENCE $1,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 <br /> DIED X RETENTION$() $ <br /> g WORKERS COMPENSATION 4032466585 9/2/2018 9/2/2019 PER X OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER Ohio Stop Gap <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBEREXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> C Garage Keepers C4032466618 9/2/2018 9/2/2019 Limit $2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional 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 /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />