Orange County NC Website
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 />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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />$ <br />CERTIFICATE HOLDER <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) <br />AUTHORIZED REPRESENTATIVE <br />CANCELLATION <br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />OTHER: <br />LOCJECT <br />PRO-POLICY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OCCURCLAIMS-MADE <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence)$ <br />DAMAGE TO RENTED <br />EACH OCCURRENCE $ <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$RETENTIONDED <br />CLAIMS-MADE <br />OCCUR <br />AGGREGATE $ <br />EACH OCCURRENCE $UMBRELLA LIAB <br />EXCESS LIAB <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />INSR <br />LTR TYPE OF INSURANCE POLICY NUMBER <br />POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/YYYY)LIMITS <br />PER <br />STATUTE <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />$ <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />(Mandatory in NH) <br />OFFICER/MEMBER EXCLUDED? <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />HIRED NON-OWNED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE $ <br />$ <br />$ <br />$ <br />$ <br />INSD <br />ADDL <br />WVD <br />SUBR <br />N / A <br />$ <br />(Ea accident) <br />(Per accident) <br />The ACORD name and logo are registered marks of ACORD <br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />INSURED <br />PHONE <br />(A/C, No, Ext): <br />PRODUCER <br />ADDRESS: <br />E-MAIL <br />FAX <br />(A/C, No): <br />CONTACT <br />NAME: <br />NAIC # <br />INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />INSURER(S) AFFORDING COVERAGE <br />$ <br />$ <br />$ <br />$ <br />$ <br />YJ8ZEKY8 <br />Orange County <br />200 South Cameron Street <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />1,000,000039826330 <br />Per Loss <br />713-877-8975 713-877-8974 <br />Cyber Liability <br />Cyber Liabilty <br />Professional Liability 1,000,000 <br />AIG Specialty Insurance Company <br />Per Loss <br />26883 <br />2,000,000 <br />12/31/2020 <br />Aggregate <br />MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. <br />10100 Katy Freeway, #400 <br />Houston, TX 77043 <br />Delerrok, Inc. <br />Jessica Brown <br />221 Main Street, Suite 200 <br />Vista, CA 92084 <br />06/26/2020 <br />Re: OCPT <br />In the event of cancellation by the insurance company the policy has been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate <br />holder shown below. <br />A 12/31/2019 <br />Page 1 of 1 <br />DocuSign Envelope ID: 000FC59A-58C3-40A5-B7DA-3677E8179B51