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DocuSign Envelope ID:AD9C9BE5-9A4D-4394-8476-901F7564FAF4 NEWDE-1 OP ID: C1
<br /> DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 11/14/2019
<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 919-467-6339 CONTACT Ed Moore&Associates,Inc.
<br /> NAME:
<br /> Ed Moore&Associates, Inc. PHONE 919-467-6339 FAX 919-467-6434
<br /> 103-B Kilmayne Drive (A/C,No,Ext): (A/C,No):
<br /> Cary, NC 27511 E-MAIL
<br /> DRESS:cmoore@edmooreinsurance.com
<br /> Ed Moore&Associates, Inc.
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Cincinnati Insurance Company 10677
<br /> INSURED INSURER B:All Risks Ltd-Oak River Ins Co
<br /> New Destinations Inc
<br /> PO Box 1239 INSURER C:
<br /> Fuquay Varina, NC 27526
<br /> 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 MMPOLICY EFF POLICY EXP LIMITS
<br /> LTR DD YYY (MM/DDIYYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR ETD 0388216 05/26/2019 05126/2020 DAMAGE ( RENTED 1,000,000
<br /> X PREMISES Ea occurrence) $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 3,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO ETD 0388216 05/26/2019 05/26/2020 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> X AUTOS ONLY X AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PerOaccidenDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE ETD 0388216 05/26/2019 05/26/2020 AGGREGATE $ 2,000,000
<br /> DIED X RETENTION$
<br /> B WORKERS COMPENSATION XPER OTH
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> NEWC009178 05/26/2019 05/26/2020 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> A Professional Liab ETD0388216-INCL PRIOR ACT 05/26/2019 05/26/2020 Incident 1,000,000
<br /> RETROACTIVE DATE 05/26/09 Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County Government is an additional insured with respects to General
<br /> Liability coverage when required by written agreement.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ORANGCO
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Outside Agencies
<br /> 200 South Cameron Street AUTHORIZED REPRESENTATIVE
<br /> P.O. Box 8181 Ed Moore&Associates, Inc.
<br /> Hillsborough, NC 27278
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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