Orange County NC Website
DocuSign Envelope ID: B068DOEB-3ECB-42B6-8BC8-CAFOECOE99C9 11/3/2020 2:53:55 PM <br /> A <br /> DATE(MM/DDIYYYY)`oRo° CERTIFICATE OF LIABILITY INSURANCE 11/3/2020 <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 endorsements . <br /> PRODUCER CONTACT <br /> coo <br /> NAME: <br /> i of Tech 1nsu ranee A/CNNo EXt: (800)668-7020 FAX No): 877-826-9067 <br /> an��murean mmr� E-MAIL <br /> lechlnsurance ADDRESS: <br /> 30 N.LaSalle,25th Floor, Chicago, IL 60602 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Twin City Fire Insurance Company 29459 <br /> INSURED INSURER B: <br /> Airdna LLC INSURERC: <br /> 1507 Blake Street, Denver,CO,80202-1321 INSURERD: <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 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 IN SD WVD POLICY NUMBER MM/DD MM/DD <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTE <br /> CLAIMS-MADE � OCCUR PREMISES Ea occur ence $ 1,000,000 <br /> MED EXP(Any one person) $ 10,000 <br /> A Yes Yes 46SBMAA6879 6/15/2020 6/15/2021 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DIED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> 15 Blake,L.L.C.,James McNab III and United Business Bank are included as Additional Insureds as their interest may appear with respect to the General <br /> Liability policy;Waiver of subrogation in favor of 15 Blake,L.L.C.,James McNab III and United Business Bank with regard to the general liability coverage.This <br /> insurance is primary and non-contributory to any other insurance provided as respects general liability coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 15 Blake, L.L.C.,James McNab III and United Business Bank THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 2455 Bennett Valley Road,Suite B-301,Santa Rosa,CA 95404. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE - <br /> rl <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />