Orange County NC Website
Browse       Search
DocuSign Envelope ID:894792A6-7781-44EE-8915-lBC88F8277CE <br /> Client#: 39383 38EXCELLANCE1 <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 01/04/2019 <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 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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NONTACT <br /> AME: <br /> J Smith Lanier&Co-Huntsville PHONE 256 890-9000 1 FAC No,: 256 890-9070 <br /> AIC No,Ext <br /> Marsh&McLennan Agency, LLC -6RE <br /> D REss: <br /> P.O.BOX 6087 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Huntsville,AL 35813-0087 <br /> _ INSURER A:Alabama self Insured We Fund <br /> INSURED INSURER B:Midwest Employers Casualty <br /> Excellance, Inc. <br /> INSURER C <br /> 453 Lanier Road <br /> INSURER D: _ <br /> Madison,AL 36758 <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 /> INSK ADD POLIt:Y EFh ppppIL,I�EY Ep�pp <br /> LTR TYPE OF INSURANCE N .p POLICY NUMBER MMIDD/YYYY MN11Rp!'I'YY1' LIMITS <br /> R ..�f..._,-...— <br /> COMMERCIAL GENERAL LIABILITY EACH <br /> �OCCURRENCE $ <br /> AMAI� E <br /> CLAIMS-MADE OCCUR EaENTED <br /> mPnre $ <br /> MREEDMEXXPPC(An oneperson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- <br /> POLICY JECT LOC PRODUCTS-COMP/OPAGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Ile owwaril) <br /> ril) LE LIMIT <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS PROPERTY $ <br /> HIRED NON-OWNED <br /> AUTOS ONLY AUTOS ONLY dBf>k <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> nEn [ RETENTION.$. _` $ . <br /> A WORKERS COMPENSATION WC10000998002019A 1/01/201901/01/202 X PTA LOTH- <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN PPAL129001 1/0112019 01/01/202 E.L.EACH ACCIDENT $1 000 000 <br /> � N I A <br /> OFFICERIMEMBER EXCLUDED? <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 OOO OOO <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> For Proof of Insurance Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTH}ORIZED REPRESENTATIVE <br /> Y <br /> 019 8- fl15 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S4185168/M4185167 PZR <br />