Orange County NC Website
DocuSign Envelope ID:7B7A5575-2129-453F-BB2E-B460680AF7FE <br /> A4C�® DAE(M TM1DDNYYYI <br /> CERTIFICATE OF LIABILITY INSURANCE F031C912020 <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 INSURERS), 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 NAME: DAWN STEWART <br /> StateFar° RICK ASHBY a1cME; Ext• 919-732-1052 pAx No: 919-732-1574 <br /> ASHBY INS AGENCY ADDRESS: DAWN@ RICKYOURWORLD.COM <br /> 1000 CORPORATE DRIVE STE 109 <br /> INSURE S AFFORDING COVERAGE NAIC# <br /> HILLSBOROUGH,NC 27278 INSURER A: State Farm Fire and Casualty Company 25143 <br /> INSURED INSURER B: <br /> RYANN CAREY INSURER C: <br /> 310 COUNTY SEAT DR INSURER D <br /> HILLSBOROUGH,NC 27278 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. NOTWTHSTANDING 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 EFF POLIGY EXP LIMITS <br /> LTR POLICY NUMBER MMIDDIYYYY MOL1 D1YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 <br /> CLAIMS-MADE IL__V OCCUR DAMAGE RENTED 300,000 <br /> PREMISES Ea occurrence _S <br /> MED EXP{Any one person) S 5,000 <br /> A Y 93ERT8434 03M012020403/1012021 PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 <br /> POLICY E DCJCT PRODUCTS-GDMPfOP AGG 52,000,000 <br /> OTHER: <br /> S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident' <br /> ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY;NJURY(Per eccSdent) S <br /> HIRED NON-OWNED PROPERTY DAMAGE S <br /> AUTOS ONLY AUTOS ONLY I Per accident <br /> i $ <br /> UMBRELLA LiAB OCCUR EACH OCCURRENCE 5 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION S $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANY PROPRIETORIPARTNERaXECUTIVE <br /> OFHOER(MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE:1$ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ <br /> { <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IACORO 101,Additional Remarks Schedule,may be attached if more space is required) <br /> ADDITIONAL INSUREDS:Orange County,NC 300 W.Tryon St.Hillsborough NC 27278 <br /> Hedgehog Holdings 1100 Wake Forest Rd Raleigh,NC 27604 <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,NC 300 W.Tryon St Hillsborough NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Hedgehog Holdings 1100 Wake Forest Rd Raleigh,NC 27604 <br /> A ORIZED REPRESENTATIVE <br /> @ 1988-2016 ACORD COIRPORATION. All rights reserved. <br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <br /> 1001486 132849.12 03-16-2016 <br />