Orange County NC Website
AC®R ®® INSURANCE <br /> U RA 1 � C E DATE (MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY9 / 29 / 2022 <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 Silvia Prieto <br /> NAME: <br /> Leavitt Central Coast Insurance Services , Inc . PHONE ( 831 ) 424 - 6404 FAX Iasi > 4z4 -oi4o <br /> A/C No Ext : A/C, No <br /> License # OG39781 EwMAILs : silvia-prieto@leavitt . com <br /> 950 East Blanco Rd , Suite 103 INSURERS AFFORDING COVERAGE NAIL # <br /> Salinas CA 93901 INSURERA : Sentinel Insurance Company 11000 <br /> INSURED INSURERB : United Financial Casualty Company 11770 <br /> BLUE STRIKE ENVIRONMENTAL INC , DBA : EcoShift Consulting INSURER C : Kinsale Insurance Company 38920 <br /> 126 Bonifacio Pl , Suite G INSURER D : Com West Insurance Company 12177 <br /> INSURER E : Scottsdale Insurance Company a41297 <br /> Monterey CA 93940 INSURERF : Gemini Insurance Company 10833 <br /> COVERAGES CERTIFICATE NUMBER* 2021 - 2022 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDNYYY MM/DDNYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2 , 000 , 000 <br /> DAMAGE TO RENTED 11000 , 000 <br /> A CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 1 , 000 , 000 <br /> 57SBABL3123 11 / 16/2021 11 / 16/2022 MED EXP (Any one person) $ 10 , 000 <br /> PERSONAL & ADV INJURY $ 21 000 , 000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 4 , 000 , 000 <br /> POLICY PRO LOC PRODUCTS - COMP/OPAGG $ 41000 , 000 <br /> X JECT <br /> OTHER: <br /> AUTOMOBILE LIABILITY Ea accidentCMINED SINGLE LIMIT $ 11000 , 000 <br /> ANYAUTO BODILY INJURY (Per person) $ <br /> B ALL OWNED SCHEDULED <br /> AUTOS X AUTOS 03741399 -2 6 / 1 /2022 12 / 1 /2022 BODILY INJURY (Per accident) $ <br /> X X NON-OWNED PerOaccidenRPERTYDAMAGE $ <br /> HIREDAUTOS AUTOS <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 21000 , 000 <br /> C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2 , 000 , 000 <br /> DED RETENTION $ 0100136188 - 1 11 / 16 /2021 11 / 16/2022 $ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS' LIABILITY STATUTE ER <br /> Y / N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ElNIA E.L. EACH ACCIDENT $ 11 000 , 000 <br /> OFFICER/MEMBER EXCLUDED? <br /> D ( Mandatory in NH) WCV5502121 3 / 1 /2022 3 / 1 /2023 E. L. DISEASE - EA EMPLOYEE $ 11 000 , 000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 1 000 000 <br /> E DIRECTORS AND OFFICERS EKS3412885 12 /29 / 2021 12 /29 /2022 PEROCC/AGG $ 1 , 0001000 <br /> F PROFESSIONAL LIABILITY VNPL008495 1 / 18 /2022 1 / 18 /2023 PEROCC/AGG $ 1 , 000 , 000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required) <br /> Those usual to insured operations . Certificate Holder is listed as additional insured per attached SS 00 <br /> 08 04 05 form . <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Asset Management Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS . <br /> 300 West Tyron <br /> Hillsborough , NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> Silvia Prieto / SIPRIE <br /> © 1988 -2014 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 ( 2014101 ) The ACORD name and logo are registered marks of ACORD <br /> INS025 (201401 ) <br />