|
06/13/2023
<br />Business Insurers of Carolinas
<br />501 Eastowne Drive, Suite 250
<br />PO Box 2536
<br />Chapel Hill NC 27515
<br />Crystal Perry
<br />(919) 968-4611 (919) 968-8991
<br />cperry@business-insurers.com
<br />Summit Design and Engineering Services PLLC
<br />320 Executive Court
<br />Hillsborough NC 27278
<br />Travelers Indemnity 25658
<br />Travelers Property Cas Co of America 36161
<br />Bridgefield Casualty 10335
<br />Great American Spirit Ins Co 33723
<br />CL2332338062
<br />A Y 6304K089149 01/01/2023 01/01/2024
<br />1,000,000
<br />300,000
<br />5,000
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />B Y 8100T750703 04/02/2023 04/02/2024
<br />1,000,000
<br />Business Auto
<br />Enhancement
<br />B
<br />0
<br />Y CUP5K458639 01/01/2023 01/01/2024
<br />6,000,000
<br />6,000,000
<br />Follow Form GL/AU/WC
<br />C N Y 019656884 01/01/2023 01/01/2024 1,000,000
<br />1,000,000
<br />1,000,000
<br />D Workers Compensation & Employers
<br />Liability states CO, IL, PA, MI, WV WCE928520 01/01/2023 01/01/2024
<br />Each Accident $1,000,000
<br />Disease- Each Employee $1,000,000
<br />Disease-Policy Limit $1,000,000
<br />Orange County, its officers, official agents and employees are included as an additional insured on the General Liability and Auto Liability policies as
<br />required by written contract. Umbrella/Excess policy follows form. Waiver of subrogation in favor of Orange County with regards to Workers Compensation
<br />policy. 30 day notice of cancellation provided by endorsement.
<br />Designate Orange County Attn: Risk Management
<br />PO Box 8181
<br />Hillsborough NC 27278
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />DocuSign Envelope ID: 42CE1DAC-C809-4104-BD18-FA7A68891DDA
|