Orange County NC Website
The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE HOLDER <br />© 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) <br />AUTHORIZED REPRESENTATIVE <br />CANCELLATION <br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />LOCJECTPRO-POLICY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OCCURCLAIMS-MADE <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence) <br />$DAMAGE TO RENTED <br />EACH OCCURRENCE $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$RETENTIONDED <br />CLAIMS-MADE <br />OCCUR <br />$ <br />AGGREGATE $ <br />EACH OCCURRENCE $ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS <br />PERSTATUTE OTH-ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />$ <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />(Mandatory in NH) <br />OFFICER/MEMBER EXCLUDED? <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />HIRED AUTOS NON-OWNEDAUTOS AUTOS <br />AUTOS <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE $ <br />$ <br />$ <br />$ <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 />INSD <br />ADDL <br />WVD <br />SUBR <br />N / A <br />$ <br />$ <br />(Ea accident) <br />(Per accident) <br />OTHER: <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 endorsement(s). <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />INSURED <br />PHONE(A/C, No, Ext): <br />PRODUCER <br />ADDRESS:E-MAIL <br />FAX(A/C, No): <br />CONTACTNAME: <br />NAIC # <br />INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />INSURER(S) AFFORDING COVERAGE <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 />INS025 (201401) <br />1/30/2019 <br />Craft Insurance Center <br />823 North Elm Street <br />PO Box 14946 <br />Greensboro NC 27415 <br />Phyllis Carter, CIC, CISR <br />(336)375-0600 (336)375-7004 <br />pcarter@craftinsurance.com <br />ESG Holdings, Inc. <br />See Named Insured Attachment <br />7 Maple Leaf Drive, Suite 104 <br />Greensboro NC 27410 <br />Colony Insurance Company 39993 <br />Selective Ins. Co. Of America 12572 <br />Accident Fund National Insurance 12305 <br />A <br />X <br />X <br />X <br />PACEP3066172 1/31/2019 1/31/2020 <br />1,000,000 <br />50,000 <br />5,000 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />B X <br />S2194934 1/31/2019 1/31/2020 <br />1,000,000 <br />A <br />XX <br />X 10,000 EXC3045002 1/31/2019 1/31/2020 <br />1,000,000 <br />1,000,000 <br />C Y WCV6122801 03 1/31/2019 1/31/2020 <br />X <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />A Professional E&O PACEP3066172 1/31/2019 1/31/2020 Occurrence/Aggregate $1M/$2M <br />A Pollution PACEP3066172 1/31/2019 1/31/2020 Occurrence/Aggregate $1M/$2M <br />P Carter, CIC, CISR/P <br />Orange County <br />PO Box 8181 <br />306-F Revere road <br />Hillsborough, NC 27278 <br />abarnes@orangecountync.gov <br />DocuSign Envelope ID: B22AEABC-F59F-4703-A6B8-6E5D870D4DB9