Orange County NC Website
DocuSign�elope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F MARICHE OP ID: NJE <br /> A���o CERTIFICATE OF LIABILITY INSURANCEFDATE0111 IDDIYYYY) <br /> 01/12/2021 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Natalie Engelhart <br /> The Sorg!Insurance Agency PHONE FAX <br /> 16 Consultant Place Suite 102 AIC No Ext:919-682-4814 AIc,No): 919-682-4906 <br /> Durham, NC 27707 —ADDRESS:James E.Sorgi,CIC natalie@SOrgiinSUranCe.COm <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Erie Insurance Exchange 26271 <br /> INSURED Marian Cheek Jackson Center <br /> INSURER B:Westchester Fire Insurance Co <br /> for Saving and Making History <br /> 512 West Rosemary St INSURER C: <br /> Chapel Hill,NC 27510 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 D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY Q970503239 08/15/2020 08/15/2021 DAMAGE TO RENTED 1,000,00 <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GENERAL AGGREGATE $ 2,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> X POLICY JEC T PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 <br /> Ea accident $ <br /> A ANY AUTO Q970503239 08/15/2020 08/15/2021 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS PER ACCIDENT <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Q921501020 08/15/2020 08/15/2021 E.L.EACH ACCIDENT $ 500,00 <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 <br /> B Professional Liab. EONNCF138950892004 11/05/2020 11/05/2021 Prof Liab 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> INFORM1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Insured's Information CO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Copy ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />