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ACORD TM CERTIFICATE OF LIABILITY INSURANCE DATE(MM7YYYY)
<br /> 1DD
<br /> 4/1712014 10:17:58 PM
<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 endomement(s).
<br /> PRODUCER MARSH USA,INC. Contact Name:
<br /> 1166 Avenue of the Americas Phone No: Fax No: 704731-1209
<br /> New York NY 10036
<br /> Producer Email:
<br /> Producer Customer No:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURED TIME WARNER CABLE MEDIA INC. INSURER A: New Hampshire Ins.Co. 23841
<br /> 316 E.MOREHEAD STREET,SUITE 400 INSURER B: Insurance Co,of the State PA 19429
<br /> CHARLOTTE NC 28202 INSURERC: ACE American insurance Company 22667
<br /> INSURER D: Navigators Insurance Company 42307
<br /> INSURER E: National Union Fire Ins Co of Pittsburgh 19445
<br /> INSURER F: Commerce&Industry Insurance Company 19410
<br /> CnVERAQFS CERTIFICATE 97979 102
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br /> PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br /> WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br /> THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDL SUB EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSRD tAIVD POLICY NUMBER (POLICY (MMIDDIYYYY) uMrrS
<br /> GENERAL LIABILITY GL 6819552 1/1/2014 1/1/2015 EACH OCCURRENCE $ 3,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 1,000,000
<br /> F 1 CLAIMS-MADE ❑ OCCUR MED EXP(Any one $ 10,000
<br /> person)
<br /> PERSONAL&ADV INJURY $ 3,000,000
<br /> GENERAL AGGREGATE $ 20,000,000
<br /> r N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000
<br /> POLICY []PROJECT ❑LOC $
<br /> AUTOMOBILE LIABILITY CA 2248202 AOS 1/1/2014 1/1/2015 COMBINED SINGLE LIMIT
<br /> X ANY AUTO ( ) (Ea accident) $ 5,000,000
<br /> CA 2248203(MA)
<br /> ALL OWNED AUTOS CA 2248204(VA) BODILY INJURY
<br /> E SCHEDULED AUTOS (Per pion) $
<br /> HIRED AUTOS BODILY INJURY $
<br /> (Per accident)
<br /> NON-OWNED AUTOS PROPERTY DAMAGE
<br /> (Per accident) $
<br /> X
<br /> UMBRELLA LIAB- X OCCUR XOOG27056696 1/1/2014 1/1/2015 EACH OCCURRENCE $ 25,000,000
<br /> C EXCESS LIAB [:]CLAIMS-MADE
<br /> AGGREGATE $ 25,000,000
<br /> DEDUCTION
<br /> RETENTION $ $
<br /> A WORKERS COMPENSATION 049101760(ADS), 049101784(CA), 1/1/2014 1/1/2015 X vuC SrgTU- H-
<br /> OT
<br /> AND EMPLOYERS'LIABILITY Y/N 049101785(FL),049101786(ME), TORY LIMITS ❑ T
<br /> 049101788(MN), 049101790 ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A (ND,WA,WI,WY),049101781 E.L.EACH ACCIDENT $ 2,000,000
<br /> OFFICER/MEMBER EXCLUDED? (IL,KY,NC,NH,UT),049101782(NJ,PA), E.L.DISEASE-EA
<br /> Mandatory in NH? 049101783(AZ,GA,VA), $ 2,000,000
<br /> 049101789(OR-Ins.B) EMPLOYEE
<br /> B If yes describe under 049101787(MA-Ins.B) E.L.DISEASE-POLICY LIMIT $ 2,000,000
<br /> SPECIAL PROVISIONS below
<br /> OTHER
<br /> E Excess WC OH($1 M Retention) WC 6636265 1/1/2014 1/1/2015 WorkersComp-Statutory $ 1,000,000
<br /> E Excess WC OH($1M Retention) WC 6636265 1/112014 1/112015 Employers Liability $ 1,000,000
<br /> D Excess Auto Only NYI4EXC702201IV 1/1/2014 1/1/2015 Each Occurrence
<br /> $ 2,500,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br /> EVIDENCE OF INSURANCE
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br /> ORANGE COUNTY HEALTH DEPARTMENT BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
<br /> 300 W.TRYON STREET IN ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> HILLSBOROUGH NC 27278 AUTHORIZED REPRESENTATIVE
<br /> Sf1";" a
<br /> ACORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved.
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