Orange County NC Website
DocuSign Envelope ID:A1BBE8B5-5DD9-4ED3-AO3E-CODE693C46EF <br /> .14 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 08/27/2020 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br /> POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br /> AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, <br /> subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not <br /> confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> USAA INSURANCE AGENCY INC/PHS NAME: <br /> 65812846 PHONE (888)242-1430 FAX (888)443-6112 <br /> (A/C,No,Ext): (A/C,No): <br /> The Hartford Business Service Center <br /> 3600 Wiseman Blvd E-MAIL <br /> San Antonio,TX 78251 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Twin City Fire Insurance Company 29459 <br /> MRS AUDREY L PINTO INSURER B: <br /> 1005 EAST OAK DR <br /> INSURER C <br /> DURHAM NC 27705-1876 <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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED $1,000,000 <br /> PREMISES Ea occurrence <br /> X General Liability MED EXP(Any one person) $10,000 <br /> A X 65 SBM AB6298 10/01/2020 10/01/2021 PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY❑PRO- I—XI LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> JECT <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS- AGGREGATE <br /> MADE <br /> DED RETENTION$ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY AT <br /> ER <br /> ANY YIN E.L.EACH ACCIDENT <br /> PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE <br /> (Mandatory in NH) <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS below <br /> A EMPLOYMENT PRACTICES 65 SBM AB6298 10/01/2020 10/01/2021 Each Claim Limit $10,000 <br /> LIABILITY Aggregate Limit $10,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the Insured's Operations.Orange County and Hedgehog Holdings are an additional insured per the Business Liability Coverage Form <br /> SS0008,attached to this policy. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> 300 W TRYON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED <br /> HILLSBOROUGH NC 27278-2438 IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> I�F,119_ �a3 CG?oGa-iz�Gr�> <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />