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2023-607-E-AMS-Blalock's Towing & Recovery-Contract for Twoing Services
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2023-607-E-AMS-Blalock's Towing & Recovery-Contract for Twoing Services
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Last modified
10/25/2023 8:21:52 AM
Creation date
10/25/2023 8:21:48 AM
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Contract
Date
10/17/2023
Contract Starting Date
10/17/2023
Contract Ending Date
10/19/2023
Contract Document Type
Contract
Amount
$5,000.00
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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <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 />CONTACTPRODUCERNAME: <br />FAXPHONE(A/C, No):(A/C, No, Ext): <br />E-MAILADDRESS: <br />PRODUCER <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED INSURER A : <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 TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY) (MM/DD/YYYY)INSR WVD <br />GENERAL LIABILITY EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCOMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence) <br />CLAIMS-MADE OCCUR MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $ <br />PRO-$POLICY LOCJECT <br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident) <br />ANY AUTO BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS PROPERTY DAMAGE $(PER ACCIDENT)HIRED AUTOS <br />$NON-OWNED AUTOS <br />$ <br />UMBRELLA LIAB EACH OCCURRENCE $OCCUR <br />EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br />$DEDUCTIBLE <br />$RETENTION $ <br />WC STATU- OTH-WORKERS COMPENSATION TORY LIMITS ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <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 />AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09) <br />OP ID: JLS <br />10/04/2023 <br />Natalie EngelhartThe Sorgi Insurance Agency <br />16 Consultant Place Suite 102 <br />Durham, NC 27707 <br />James E. Sorgi, CIC <br />919-682-4814 <br />natalie@sorgiinsurance.com <br />BLALTOW <br />Blalock's Towing & Recovery <br />T C Blalock <br />3504 NC Hwy 86 South <br />Hillsborough, NC 27278 <br />Erie Insurance Exchange 26271 <br />American Zurich Insurance Co <br />AX X <br />Q100180961 10/01/2023 10/01/2024 <br />X <br />See Garage <br />1,000,000 <br />AX Q100180961 10/01/2023 10/01/2024 <br />AX Q100180961 10/01/2023 10/01/2024 <br />On-Hook/GKLL 120,000AXQ100180961 10/01/2023 10/01/2024 <br />A Q100180961 10/01/2023 10/01/2024On-Hook/GKLL <br />X 1,000,000 <br />XA Q340171786 10/01/2023 10/01/2024 <br />X <br />B 6ZZUB1K37332723 05/23/2023 05/23/2024 100,000 <br />100,000 <br />500,000 <br />Orange County Asset Management <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />DocuSign Envelope ID: 5A55F802-EF65-457D-91DC-17D0262581B8
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