Orange County NC Website
DocuSign Envelope ID: 1FD1A8E7-CF79-434F-8F7C-386DAAC01881 <br /> A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 01/30//2020 Y) <br /> 020 <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 endorsement(s). <br /> PRODUCER CONTACT Phyllis Carter,CIC,CISR <br /> NAME: <br /> Craft Insurance Center aCONN. Ext: (336)375-0600 ac,No): (336)375-7004 <br /> 823 North Elm Street E-MAIL phy @ p llis.carter assured artners.com <br /> ADDRESS: <br /> PO Box 14946 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Greensboro NC 27415 INSURERA: Colony Insurance Company 39993 <br /> INSURED INSURERB: Selective Ins.Co.OfAmenca 12572 <br /> ESG Holdings,Inc.,dba INSURER C: Accident Fund National Insurance Company 12305 <br /> See Named Insured Attachment INSURER D: <br /> 7 Maple Leaf Drive,Suite 104 INSURER E <br /> Greensboro NC 27410 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 /> TR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE To_7CLAIMS-MADE � OCCUR PREM SES Ea occurrence)l <br /> $ 50,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A PACEP306617 01/31/2020 01/31/2021 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED S2194934 01/31/2020 01/31/2021 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED HNON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> Uninsured motorist $ <br /> X UMBRELLA LIB X OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A EXCESS LIAB CLAIMS-MADE EXC3045002 01/31/2020 01/31/2021 AGGREGATE $ 1,000,000 <br /> DED I X RETENTION $ 10,000 $ <br /> WORKERS COMPENSATION PERX STATUTE EORH <br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> C OFFICER/MEMBEREXCLUDED? NIA WCV6122801 01/31/2020 01/31/2021 <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 /> Professional Liability Occurrence/Aggregate $1M/$2M <br /> A Pollution Liability PACEP306617 01/30/2020 01/31/2021 Occurrence/Aggregate $1M/$2M <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> AUTHORIZED REPRESENTATIVE <br /> 306-F Revere road <br /> Hillsborough NC 27278L/� <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />