Orange County NC Website
DocuSign Envelope ID:70C47CA2-D32F-4B70-861 B-0407CO2653ED <br /> DATE(MM/DD/YYYY) <br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE <br /> �� 1 oi22i2o2o <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 <br /> NAME: Randy HIDSOn <br /> Flowers Insurance Agency LLC PHONE FAX <br /> P.O. Box 368 AIC No Ext: 334-794-8646 AIC No):334-794-5965 <br /> Dothan AL 36302 ADDRESS: randy@flowersinsurance.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Travelers Property&Casualty 27998 <br /> INSURED IVSAN-1 INSURERB: Federal Insurance Company 20281 <br /> IVS dba Angeltrax <br /> 119 S Woodburn Drive INSURERC: <br /> Dothan AL 36305 INSURER D <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1790776850 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y Y ZLP-71M7281A 1/25/2020 1/25/2021 EACH OCCURRENCE $1,000,000 <br /> Fv� DAMAGE CLAIMS-MADE OCCUR PREM SES�IENTE a o_cur ence $300,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY❑ PRO- <br /> JECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> X <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY Y Y BA-31­171548 1/25/2020 1/25/2021 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> L $ <br /> A X UMBRELLA LIAB OCCUR Y Y CUP-81­683531 1/25/2020 1/25/2021 EACH OCCURRENCE $10,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED X RETENTION$In nnn $ <br /> A WORKERS COMPENSATION Y UB-OK152011 2/23/2020 2/23/2021 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Cyber/Prof Liab ZPL 15T25780 1/25/2020 1/25/2021 Per Occ Limit $5,000,000 <br /> A Crime/ERISA 107037139 1/25/2019 1/25/2022 Limit $350,000 <br /> B EPLI 8255-7850 1/25/2020 1/25/202, Limit $2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Certificate holder is additional insured as required per a written contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Orange County Public THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Transportation Services ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ATTN:Allyson Coltrane, <br /> Transportation Services Manager AUTHORIZED REPRESENTATIVE <br /> 600 NC Highway 86 N <br /> Hillsborough NC 27278 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />