Orange County NC Website
Browse       Search
DocuSign Envelope ID: 1 BBBAFD6-1997-43E8-BE3E-9C058BE528AD <br /> DATE(MMIDDIYYYY) <br /> AC"J?L> CERTIFICATE 4F LIABILITY INSURANCE <br /> ��. 05/17/2019 <br /> THIS CERTIFICATE IS ISSUED AS A NIATTER 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: Calla Moore <br /> Colonial Insurance Agency Hillsborough A",C'N (919)732 2191 FA No): (919)732 2192 <br /> 103 Millstone Dr.Suite A EMAIL ADDRESS, colonial-a enc <br /> ADDRESS: .com C� � Y <br /> Po Box 490 INSURER 8 AFFORDING COVERAGE NAIL 1I <br /> Hillsborough NC 27278 INSURERA: Starr Surplus Lines Ins.Co. 13604 <br /> INSURED INSURER B <br /> Summit Design And Engineering Services, PLLC INSURER C <br /> 504 Meadowlands Drive INSURER D <br /> INSURER E: <br /> Hillsborough NC 27278 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 /> NSR ADOLSUBR POLICY E <br /> LTR TYPE OF INSURANCE INSD WVQ POLICY NUMBER MWDDIYYYY) IMM?DDfYYYYI LIMITS <br /> CQMMERCIAL GENE PAL LIABILITY EACHOCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISES a cecurrence $ <br /> MEU EXP(Arty orre person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ <br /> POLICY JECT LOC -PRO DUCTS-COMP+OPAGG $ <br /> OTHER $ <br /> AUTOMOBILE LIABILITY GOM BIN EDSINGLE LIMIT $ <br /> Ea accident <br /> ANYAUTO BODILYINJURY(Per person) $ <br /> OWNED SCHEDULED BO DI LY IN JU RY(Per acc ident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED ROPERTY D AGE $ <br /> AUTOS ONLY AUTOS ONLY PeracU $ <br /> c!deni <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> ?,ED <br /> XCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> II RETENTION$ $ <br /> WORKERS CO MP EN SAMON <br /> AND EMPLOYERS'LIABILJTY Y r N STATUTE I I ERH <br /> ANY PROPRIETORPARTNER'EXECLITIVE E.L.EACH ACCIDENT $ <br /> 0FPICER:MINBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> Iryes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMTT $ <br /> Professional, E&O Contractors Occurence 5,000,000 <br /> A Pollution Liability N N SLSL-PRO-262380-19 04/02/2019 04/02/2020 Aggregate 5,000,000 <br /> ❑ESCRIPTION Of OPERATIONS+LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached it 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 /> Orange County Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 W Margaret Lane <br /> AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 <br /> Fax: F-rnallabarnes@orangecountync.gov Q 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The AC0RD name and logo are registered marks of ACOR❑ <br />