Orange County NC Website
DocuSign Envelope ID: DOA4A6EF-052F-43B9-8A6A-0884A66603B2 <br /> CERTIFICATE OF LIABILITY INSURANCE DAT12/21/❑IYY5Y1 <br /> 2�112018 <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 BELOW. THIS <br /> CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br /> PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or he endorsed. If <br /> SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this <br /> certificate doss not confer rights to the certificate holder in lieu of such endorsements. <br /> PRODUCER CONTACT <br /> NA E: CLIENT CONTACT CENTER <br /> FEDERATED MUTUAL INSURANCE COMPANY PONE <br /> HOME OFFICE: P.O.BOX 328 (., ,No. <br /> o E:t):888-333-4949 FAX C Na:507-445A664 <br /> OWATONNA, MN 55060 E-MAIL CLIENTCONTACTCENTER FED1N5 COM <br /> INSURERIS)AFFORDING COVERAGE NAIC all <br /> 1113URER A.-FEDERATED MUTUAL INSURANCE COMPANY 13935 <br /> INSURED 348-705-5 INSURER B.- <br /> TRAQEMASTERS SERVICES INCORPORATED INSURER C.' <br /> 5012 NEAL RQ <br /> DURHAM, NC 27705-2362 INSURER D: <br /> INSURER E: <br /> INSURER F-. <br /> COVERAGES CERTIFICATE NUMBER:34 REVISION NUMBER:0 <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,EXCLUSIONS <br /> AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> L R INSR WVD MMIDDIYYYY MMIDDIYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,DOO <br /> CLAIMS-MADE �OCCUR PREMISES O a occurrence $100,000 <br /> ME EXP(Any one person) EXCLUDED <br /> A Y N 9337203 02/11/2019 02/11/2020 PER SONAL&ADVINJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,0U0 <br /> POLICY ❑PRO <br /> GTkI;R: JECT ❑LOG PRODUCTS-COMPIOP RGG $2,000,000 <br /> x <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> a acciden <br /> X ANY AUTO BODILY INJURY[Per personl <br /> OWNED AUTOS ONLY SCHEDULED <br /> A AUTOS Y N 9337203 02/11/2018 11211112020 BODILY INJURY{Per acciden!] <br /> HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY Per act den <br /> X UMBRELLA LIAB x OCCUR EACH OCCURRENCE $5,000,000 <br /> A EXCESS LIAR CLAIMS-MADE N N 9337204 02/11/2019 02/11/2020 AGGREGATE $5,000,000 <br /> DEp I I RETENTION <br /> WORKERS COMPENSATION X PER STATUTE ER <br /> AND EMPLOYERS'LIABILITY ER <br /> E.L.EACH ACCIDENT <br /> ANY PROMEMBERIEXCLUDRIEXECUTIVE ❑NIA N 9337205 02/11/2019 02/11/2020 $1,000,000 <br /> +� OFFICE Cory In ER EXCLUDED. E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> {Mandatory in NHI <br /> IF yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AC OR 101,Addi lion al Remarks Schedule,may he attached i1 more space is requi re d) <br /> SEE ATTACHED PAGE <br /> CERTIFICATE HOLDER CANCELLATION <br /> 348-705-5 340 <br /> ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> HILLSBOROUGH, NC 27278-8181 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> a 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered inarks of ACORD <br />