Orange County NC Website
Browse       Search
DocuSign Envelope ID:81EB53FE-770C-4A5C-B8E5-E43BBDC488FD <br /> ® DATE(MM/DD/YYYY) <br /> ACORI7 <br /> CERTIFICATE OF LIABILITY INSURANCE 12/21/2020 <br /> THIS CERTIFICATE 15ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT <br /> AFFIRMATNELYOR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT <br /> CON57RYTE A CONTRACT BETWEEN THE ISSUING INSURER(5),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:Ifthe certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WANED, <br /> subject to the terms and conditions ofthe policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certlficate <br /> holder In lieu of such endorsements. <br /> PRODUCER CONTACT <br /> NAME: <br /> NASW RRG Plan Administrator PHONE FAX <br /> 1200 East Glen Avenue Wc,No,Ext): (A/C,No): <br /> Peoria Heights,IL 61616-5348 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA: NASW Risk Retention Group 14366 <br /> Nancy Berson INSURER B: <br /> 105 Millrock Ct INSURERC: <br /> Carrboro, NC27510 INSURERD: <br /> IINSURERE: <br /> INSURER R <br /> CUSTOMER ID:4BE72V4GBC CERTIFICATE NUMBER:P-IND4BM8X9BZAD-00 REVISION NUMBER:001 <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS <br /> SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POUCYEXP LIMITS <br /> LTR INSR WVD (MM/0DAN" (MM/DDAYM <br /> COMMERCIAL GENERALLb181LI1Y EACH OCCURRENCE $ <br /> DAMAGE TO RENTED $ <br /> COMMERCIAL GENERAL LIABILITY PREMISES(Ea Occurrence) <br /> CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ <br /> EPLI-CLAIMS MADE PERSONAL&ADV INIURY $ <br /> GENERAL AGGREGATE $ <br /> EPLI-OCCUR PRODUCTS-COMP/oP AGG $ <br /> P <br /> AGGREGATE LIMIT APPLIES PER: $ <br /> POLICY PROJECT LOC <br /> OTHER <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> H SCHEDULED <br /> AUTOS ONLY BODILY INJURY(Per person) $ <br /> OWNED AUTOS BODILY INIURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> ]ONLY AUTOSONLY (Per accident) <br /> UMBRELLA OCCUR EACH OCCURRENCE __ $ <br /> LUB AGGREGATE $ <br /> EXCESS UAB CLAIMS-MADE $ <br /> DED RETENTION $ <br /> OMRS COMPENSATION PER STATUTE OTHER <br /> D EMPLOYERS'LIABILITY YM E.L.EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNER/ ❑ N/A <br /> EXECUTIVE OFFICER/MEMBER E.L.DISEASE-EACH EMPLOYEE $ <br /> EXCLUDED? Ifyes,describe under E.L.DISEASE-POLICY UMIT $ <br /> (Mandatory In NH)bescription of Operations Belo <br /> Professional Liability Insurance Per Claim Limit $1,000,000.00 <br /> Retroactive Date:11-17-2020 Aggregate Limit $3,000,000.00 <br /> A N N P-IND46M8X98ZAD-00 11/17/2020 11/17/2021 State Licensing Board Limits $3S,000.00 <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 OFTHE ABOVE DESCRIBED POLICIES BE <br /> Orange County Government CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE <br /> PO Box 8181 WILL BE DELIVERED ON ACCORDANCE WITH POLICY PROVISIONS. <br /> Hillsborough,NC 27278 <br /> AUTHORIZED " P U� <br /> REPRESENTATIVE / 1 <br /> © 1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />