|
DocuSign Envelope ID:77803446-26E8-4424-B3DD-15F947931AE8 BRADS-1 OP ID: CH
<br />ACORO" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE[MMlDDrIYYY]
<br />1112812016
<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 NAME:
<br />CT Philip R. Merry,Jr.
<br />Hutson-Etherredge Companies PHONE g03 FAX649-5141129ParkAvenue, S.W. A/C,No,Ext): A1C,No): 803-648-3179
<br />P. O. Box 419 E-MAIL
<br />Aiken, SC 2 98 02-041 9
<br />ADDRESS:
<br />Philip R.Merry,Jr.INSURER(S)AFFORDING COVERAGE NAIC p
<br />INSURER A:State Auto Insurance Co. 25135
<br />INSURED Bradshaw Consulting Services INSURER B:Auto-Owners Insurance 18988
<br />Tony Bradshaw INSURER C:Ace American Insurance Company2170WoodsideExecutiveCt.
<br />Aiken, SC 29803 INSURER D:
<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
<br />TYPE OF INSURANCE INSD
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />LIMITSMMlDDlYYYY) (MMlDDlYYYY)
<br />A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000
<br />CLAIMS-MADE OCCUR BOP9552989 10/13/2016 1011312017 DAMAGETO RENTED 300,000PREMISES{Ea occurrence} $
<br />X Business Owners MED EXP(Any one person) $ 5,000
<br />PERSONALS ADS INJURY $ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,000
<br />POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br />OTHER
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000Eaaccident)
<br />B X ANY AUTO 4214578800 12/20/2015 12/20/2016 BODILY INJURY(Per person) $
<br />ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br />AUTOS AUTOS
<br />NON-OWNED PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS Per accident)
<br />X UMBRELLA LIAB OCCUR EACH OCCURRENCE 1,000,000
<br />A EXCESS LIAB CLAIMS-MADE CXS2088563 10/13/2016 10/13/2017 AGGREGATE
<br />DED RETENTION$
<br />WORKERS COMPENSATION X PER OTH-
<br />AND EMPLOYERS'LIABILITY STATUTE ER
<br />Y!NAANYPROPRIETOR/PARTNER/EXECUTIVE
<br />NIA
<br />WCP9552991 10/16/2016 10/16/2017 EL.EACH ACCIDENT 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br />If yes,describe under
<br />DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br />C Professional Liab. G4208849-006 05/29/2016 05/29/2017 Ea.Claim 1,000,000
<br />Ded.$5,000 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ORANGEC
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 8181
<br />Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
<br />eUT/
<br />i4,04 ReII /story-•
<br />I
<br />1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25(2014/01)The ACORD name and logo are registered marks of ACORD
<br />DocuSign Envelope ID: 3A3B749D-89FA-4DD4-AB4B-396224600A6A
|