Orange County NC Website
Disclaimers <br />Page 2 of 2 <br />SCHEDULE OF FORMS <br />DATE (MM/DD/YY) <br />08/26/2025 <br /> APA-CERT-FORMLIST 0914  Certificate Number: 1198109 <br /> Insured:Venus Film, LLC <br />This Schedule of Forms is attached to and made part of certificate number 1198109, as of 08/26/2025 at 09:02 AM PT, and lists the forms included in the <br />policy(s) and subsequent endorsement (s) at the time this certificate was issued. <br />    Form # Ed. Name <br />IL0269 0908 NC Changes - Cancellation and Nonrenewal <br />IL0021 0908 Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br />UABL105ACW 0117 Commercial General Liability Changes <br />U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism <br />Automobile <br />U-CA-531-B 0208 Notice Regarding Terrorism Premium (for Commercial Automobile Ins) <br />UCAD600DCW 1021 Business Auto Declarations <br />UGU619ACW 1002 Schedule of Forms and Endorsements <br />UABA100ACW 0117 Extended coverage For Scheduled Events, Presentations and Productions <br />CA0001 1120 Business Auto Coverage Form <br />UABA120ACW 0117 Additional Insured - Owners Or Lessees Scheduled Person Or Organization <br />UABA106ACW 0117 Unscheduled Production, Presentation Or Event Exclusion <br />UABA125ACW 0117 Production Stunt Or Pyrotechnic Exclusion <br />IL0021 0908 Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br />CA0126 0125 North Carolina Changes <br />CA2048 1013 Designated Insured <br />UABA104ACW 0117 Business Auto Changes <br />Workers' Compensation Policy Policy form assignment to be handled by insurance carrier. <br />This Certificate of Liability Insurance includes the Type of Insurance, Limits, and Schedule of Forms in effect as of  08/26/2025 at 09:02 AM PT. It does not affirmatively or <br />negatively amend, extend, or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder. You may be required to request an updated <br />certificate in the event of subsequent policy modifications. <br />The information included in this certificate that has been provided by Abacus Insurance Brokers, LLC is for your information only, and does not create a contract or agency <br />relationship between the certificate holder or any insured and Abacus Insurance Brokers, LLC. By accepting this certificate the certificate holder acknowledges that Abacus <br />Insurance Brokers, LLC is not the agent of the certificate holder or any insured, but is solely the agent of the listed carrier(s). Abacus Insurance Brokers, LLC makes no <br />representation whether the coverages listed herein are appropriate for the certificate holder or any insured. Please review the listed coverages carefully and direct any <br />questions to your broker. For a complete listing of coverages, terms, conditions and exclusions, please view the referenced Policy(s). <br />Docusign Envelope ID: 257F6E47-2DFB-40BE-98E9-D7FFC13E6CF0