Orange County NC Website
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />11/02/2022 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATIONIS WAIVED, <br />subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not <br />confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />USAA INSURANCE AGENCY INC/PHS <br />65812846 <br />The Hartford Business Service Center <br />3600 Wiseman Blvd <br />San Antonio, TX 78251 <br />CONTACT <br />NAME: <br />PHONE <br />(A/C, No, Ext): <br />(888) 242-1430 FAX <br />(A/C, No): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />INSURED <br />Kelly Oakes <br />221 BRIDGE ST <br />HILLSBOROUGH NC 27278-9903 <br />INSURER A : Twin City Fire Insurance Company 29459 <br />INSURER B : <br />INSURER C : <br />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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF INSURANCE ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />(MM/DD/Y YYY)LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />X 65 SBM NZ8862 12/01/2022 12/01/2023 <br />EACH OCCURRENCE $1,000,000 <br />CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br />PREMISES (Ea occurrence)$1,000,000 <br />X General Liability MED EXP (Any one person)$10,000 <br />PERSONAL & ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $2,000,000 <br />POLICY PRO- <br />JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000 <br />OTHER: <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />(Ea accident) <br />ANY AUTO BODILY INJURY (Per person) <br />ALL OWNED <br />AUTOS <br />SCHEDULED <br />AUTOS BODILY INJURY (Per accident) <br />HIRED <br />AUTOS <br />NON-OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS- <br />MADE <br />EACH OCCURRENCE <br />AGGREGATE <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY <br />PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/ A <br />PER <br />STATUTE <br />OTH- <br />ER <br />Y/N E.L. EACH ACCIDENT <br />E.L. DISEASE -EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />A EMPLOYMENT PRACTICES <br />LIABILITY <br />65 SBM NZ8862 12/01/2022 12/01/2023 Each Claim Limit <br />Aggregate Limit <br />$10,000 <br />$10,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. Orange County of North Carolina and Hedgehog Holdings are Additional Insureds per the Business Liability <br />Coverage Form SS0008, attached to this policy. <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County of North Carolina <br />300 W TRYON ST <br />HILLSBOROUGH NC 27278-2438 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br />DocuSign Envelope ID: E69EA1B5-0AE6-48B7-B234-FB1873D5BD72