Orange County NC Website
Browse       Search
DocuSign Envelope ID: EAC4D42F-1012-4CD3-BC5A-58FFA19EB1 BA <br /> DATE tMMIUDIYYYY) <br /> A o® CERTIFICATE OF LIABILITY INSURANCE 03/02/2021 <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 INSURERS), 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 /> CONTACT pray Gates <br /> PRODUCER NAME: <br /> PHONE 919-732-1052 FAX <br /> No), 919-732-1574 <br /> StateFarm RICK ASHBY AAIC o.Ext <br /> ASHBY INS AGENCY -MAIL DRAY� <br /> RICKYOURWORLD.COM <br /> AMDDE RESS: <br /> 1000 CORPORATE DRIVE STE 101 INSURERS AFFORDING COVERAGE NAiC# <br /> HILLSBOROUGH,NC 27278 INSURER A: State Farm Fire and Casualty Company 25143 <br /> INSURED INSURER 6: <br /> RYAN N CAREY INSURER C <br /> 310 COUNTY SEAT DR INSURER D: <br /> HILLSBOROUGH, NC 27276 INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THE INSURED NAMED <br /> R THE POLICY <br /> HAVE ENISSUED <br /> BOVE <br /> INDICATED.THIS IS TOCIFY NOTWI TTHSTANDING ANYIREQUIREMENT, TERM OR CONDITION ION OF ANY CO TRACTO OR OTHER DOCUMENT4 O PERIOD <br /> THAT THENTH 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 /> ADDL SUER POLICY EFF POLICY EXP LIMITS <br /> INSR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY <br /> LTR 1,000,000 <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE O RENI r, 300,000 <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ <br /> MED EXP(Any one person) $ 5,000 <br /> A Y 93ERT8434 03/10/2021 03110/2022 PERSONAL&ADV INJURY S <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER: 2,000,000 <br /> POLICY�JEC ❑ LOC PRODUCTS-COMPlOP AGG 8 <br /> OTHER: COMBINED SING LELIMIT $ <br /> AUTOMOBILE LIABILITY Ea accident <br /> BODILY INJURY(Per person) $ <br /> ANY AUTO <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS PROPERTY DAMAGE <br /> HIRED NON-OWNED Per accident $ <br /> AUTOS ONLY AUTOS ONLY <br /> UMBRELLA UAB OCCUR ;FACHURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE TE $DE❑ RETENTION$ OTH- <br /> WORKERS COMPENSATION UTE ER <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? ❑ N!A <br /> EL.DISEASE-EAEMPLOYE $ <br /> fMandatory In NH) <br /> If yes,describe under F_L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> ADDITIONAL INSUREDS:Orange County, NC 300 W.Tryon St.Hillsborough NC 27278 <br /> Hedgehog Holdings 1100 Wake Forest Rd Raleigh,NC 27604 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County,NC 300 W_Tryon St.Hillsborough NC 27278 <br /> ACCOR ITH THE POLICY PROVISIONS. <br /> Hedgehog Holdings 1100 Wake Forest Rd Raleigh,NC 27604 AUTH nDREPRE NTATIVE / <br /> J <br /> ©1988- 15 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks o ACORD <br /> 4 Q61486 132849.12 63-1F 2016 <br />