Orange County NC Website
Browse       Search
DocuSign Envelope ID:52A89AAF-4F9B-4171-A9AB-856EB935BF90 <br /> ,a►cv CERTIFICATE OF LIABILITY INSURANCE DATE(M M/DDIYYYY) <br /> 03/11/2021 <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 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 NAME: Steven Stacy <br /> Pelnik Insurance PHONE (919)459-8000 FAX (866)714-3576 <br /> AIC Na Ext: WC.No <br /> 100 Ridgeview Drive E-MAIL Steve.Stacy@Pelnik.com <br /> ADDRESS: <br /> Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Cary NC 27511 INSURERA: The Hanover Insurance Group <br /> INSURED INSURER B: Allmerica Financial Benefit 41840 <br /> Intellicom Inc.,DBA:PLC Communications Inc. INSURER C: <br /> 2902 S Miami Blvd Ste C INSURER D <br /> INSURER E <br /> Durham NC 27703 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL2131121107 REVISION NUMBER: <br /> THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED OELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> SR TYPE OF INSURANCE '' POLICY EFF POLICY <br /> LTR INSD WVD POLICYNUMBER MMIDDIV MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY RRENCE s 2,000,000 <br /> EACH OCCU <br /> CLAIMS-MADE 7x OCCUR PREMISES Ea occurrence s 500,000 <br /> MED EXP(Any one person) s 15,000 <br /> A OZ6-D866854-00 04/01/2021 04/01/2022 —PERSONAL BADVINJURY $ 2,000.000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> POLICYFXPRO- <br /> JECT LOC PRODUCTS-COMP/OPAGG S 4,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY C 0 M bSIN LE IMIT $ 1,000,000 <br /> Ea aci lc en4 <br /> ANYAUTO BODI LY INJURY(Per person) s <br /> B OWNED SCHEDULED AVVB-D866847-00 04/01/2021 04/01/2022 BODI LY INJURY(Per accident) S <br /> AUTOS ONLY AUTOS <br /> X W HIRED X NON-ONED PROPERTY DAMAGE 5 <br /> /1 AUTOS ONLY /'� AUTOS ONLY PeraccIden! <br /> $ <br /> X UMBRELLA LAB OCCUR EACH OCCURRENCE S 6,000,000 <br /> A EXCESS LAB CLAIMS-MADE OZ6-D866854-00 04/01/2021 04/01/2022 AGGREGATE $ 6,000,000 <br /> DED I X RETENTION S 0 S <br /> WORKERS COMPENSATION X1 <br /> PER STATUTE EOR <br /> IV H <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTE Y/N EL EACHACCIDENT $ 1,000,000 <br /> B OFFICER/MEMBEREXCLUDEI �N N/A W26-D866842-00 04/01/2021 04/01/2022 <br /> (Mandatory in NH) EL DISEASE-EAEMPLOYEE S 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1.000,000 <br /> Leased/Rented Equipment <br /> A OZ6-D866854-00 04/01/2021 04/01/2022 Limit 100,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <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 /> Outsource LLC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1960 E Grand Avenue <br /> Suite 1180 AUTHORIZED REPRESENTATIVE <br /> El Segundo CA 90245 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />