Orange County NC Website
DocuSign Envelope ID:299DAE81-C703-494C-B9EC-EB57F8ABA670 <br /> Clisent#:4322 DYANMQUEST <br /> ACORD,., CERTIFICATE OF LIABILITY INSURANCE OA7E SMMIODIYYYY]o11061202n <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 /> IMPORTAIJT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME: T Andy Tribendis <br /> The 5imkiss Agency,Inc. k( N- FA ACNo - 670727.5414 <br /> 1041 Old Cassatt Road EMAIL ADDRESS: tribendisandy@simkiss.com <br /> Berwyn,PA 19312 INSURER(S)AFFORDING COVERAGE NAIC 41 <br /> INSURER A:Travelers Property Casualty Co of Amer 25674 <br /> INSURED INSURER B,Travelers Casualty&Surety Co. 19038 <br /> Dynamic Quest, LLC INSURER C: <br /> 4821 Koger Blvd Main <br /> INSURER O: <br /> Greensboro, NC 27407 <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES ❑F 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 CONTRACTOR 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 ADOLISUBfi POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE POLICY HUNKER MMIDDIYYYY MMIDDIYYYY LIMITS <br /> - - --- ---- LNG YYY4. - --- — { ----]- .-. -- <br /> A x COMMERCIAL GENERAL LIABILITY ZPP16N22010 5/24/2019 05/2412020 EACH OCCURRENCE 51,000 000 <br /> ppgqMgqGE T ��EHTEO <br /> CLAIMS-MADE u OCCUR RR URHTYEa occurrence 000,000 <br /> MED EXP{Any one person s5,000 <br /> PERSONAL&ADV INJURY $1 000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 <br /> POLICY❑JECOT- [ILOC PROP UCTS-COMPIOPAGG 52,000 000 , <br /> OTHER: S <br /> A AUTOMOBILE LIABILITY BA9K699985 5/24/2019 051241202 (Ea ND SINGLE UNIT 1,000,090 <br /> x ANY AUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED I BODILY INJURY(Per accident) S <br /> AUTOS ONLY AUTOS <br /> AUTOS ONLY NON-OWNED PROPERTY DAMAGE S ---- <br /> AUTOS ONLY ,iPer acciden! <br /> $ <br /> A x UMBRELLA LIAB X OCCUR CUP9K727349 5/24/2019 05/24/202 EACH OCCURRENCE $9000000 <br /> EXCESS LIAt3 CLAIMS-MADE AGGREGATE $9 000 000 <br /> DED I X I RETENTION_510000 5 <br /> B WORKERS COMPENSATION UB4PTT55Z5 1/01/2020 01101/2021 X PER OTH- <br /> AHD EMPLOYERS'LIABILITY <br /> OFFYCERIMEMBEH EXCLUDEp7 ECUTIVE� NIA E.L EACH ACCIDENT 51,000,000 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S1 000000 <br /> If yes.R under <br /> DESCRIPTION OF OPERATIONS belaw I EL.DISEASE-POLICY LIMIT $1 000000 <br /> A E&O 1 Cyber ZPI..16N22009 0512412019 05/24/202 $3M per CLM 1$3M Agg <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Add(I Ion at Remarks Schedule,may be attached II more space is required} <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County Information SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Technologies ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 131 W. Margaret Lane <br /> Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE <br /> 13. C_ 1.�, .. <br /> p 198 8-2 015 ACOR❑CORPORATION.Ail rights reserved. <br /> ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S5986111M598592 AD <br />