CERTIFICATE OF LIABILITY INSURANCE
Review draft in certificate field order. The certificate is issued from your AMS after approval.
Date (MM/DD/YYYY)10/30/2026
ProducerTriangle Demo Agency
Durham, NC
(919) 555-0142
Insurers affording coverage
INSURER ACincinnati Insurance
Insured
Oakwood Cafe LLC
214 W Main St
Durham, NC 27701
Certificate numberDRAFT-1932Revision number0
COVERAGES
| INSR LTR | TYPE OF INSURANCE | ADDL INSD | SUBR WVD | POLICY NUMBER | POLICY EFF | POLICY EXP | LIMITS |
|---|---|---|---|---|---|---|---|
| A | GENERAL LIABILITY | Y | N | GL-4355205 | 12/14/2025 | 12/14/2026 | Each occurrence$1,000,000 Damage to rented premises$100,000 Med exp (any one person)$5,000 Personal and adv injury$1,000,000 |
Description of operations / locations / vehicles
Certificate holder is included as Additional Insured where required by written contract, subject to policy terms, conditions and exclusions.
General liability GL-4355205: Additional insured (CG 20 11).
Certificate holder
Brightleaf Property Management LLC
305 E Chapel Hill St
Durham, NC 27701
CancellationShould any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions.Authorized representativeSigned on approval