Orange County NC Website
Browse       Search
DocuSign�lope ID: D4CDBB73-83EB-4869-8BDB-F30AC167CBDB CREAT-5 <br /> OP ID, AUWI <br /> ' ft a CERTIFICATE OF LIABILITY INSURANCE D 12/03/2019 Y) <br /> �� 12/03/2019 <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 rights to the certificate holder in lieu of such endorsements. <br /> PRODUCER 919-878-9412 CONrncr Marsh&McLennan Agency,LLC <br /> Marsh& McLennan Agency LLC PHONE 919-878-9412 FAX 919-256-1969 <br /> 2301 Sugar Bush Road Suite 520 A/c,No,Exc: A/C,No): <br /> Raleigh, NC 27612 E-MAIL <br /> Matthew Horney <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Selective Ins.Co of America 12572 <br /> INSURED INSURER B:Hartford ACC&Indemnity Co 22357 <br /> Creative Business Interiors <br /> Inc. INSURER C: <br /> 8720 Fleet Service Drive <br /> Raleigh,NC 27617 INSURER D <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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � OCCUR S 2338296 11/27/2019 11/27/2020 DAMAGE TO RENTED 500,000 <br /> PREMISES Ea occurrence $ <br /> MED EXP(Anyoneperson) $ 15,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 3,000,000 <br /> 17 OTHER: <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accident $ <br /> X ANY AUTO S 2338296 11/27/2019 11/27/2020 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED P.OPcc_%t) AGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 <br /> EXCESS LIAB CLAIMS-MADE S 2338296 11/27/2019 11/27/2020 AGGREGATE $ 3,000,000 <br /> DED RETENTION$ <br /> B WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> 22WBCEM0470 11/27/2019 11/27/2020 500,000 <br /> OFFICER/MEMBERANY EXC UDED�CUTIVE � N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 <br /> If yes,describe under 500,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGEC <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ORANGE COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC.27278 AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />