Orange County NC Website
A�.�® DATE(MMIDDIYYYY) <br /> ` C? CERTIFICATE OF LIABILITY INSURANCE 04/22/2014 <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 ALTERTHE 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(les)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 /> PRODUCER NAME: <br /> MARSH USA INC. <br /> 20 CHURCH STREET PHONE _ FAX No): <br /> HARTFORD,CT 06103 -MAIL <br /> ADDRESS: <br /> INSURER[$)AFFORDING COVERAGE NAIC 8 <br /> INSURER A:Hartford Fire Insurance Company 19682 <br /> INSURED <br /> CARRIER CORPORATION INSURER B:Natlonel Union Fire Insurance Company of Pittsburgh,PA 19445 <br /> ONE CARRIER PLACE INSURER C:New Hampshire Insurance company 23841 <br /> FARMINGTON,CT 060344015 <br /> INSURER D: I <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:DH5WM583 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. j <br /> INSR ADDL BR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS <br /> A GENERAL LIABILITY 02CSET10004 04101/2014 04/01/2015 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY $2,000,000 general DAMAGE RENTED 300,000 <br /> a re ate per location/protect PREMISES Ea occurrence $ <br /> CLAIMS-MADE I OCCUR $10,000,000 policy MED EXP(Any one person) $ 10,000 <br /> general aggregate 1,000,000 <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE It 2,000,000 f <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2.000,000 <br /> POLICY PRO- LOC $ <br /> A AUTOMOBILE LIABILITY 020SET10000 O) 04/01/2014 04/0112015 COMBINED SING LIMI <br /> 02GSET10019 f HI) (Ea accident) 1,000,000 <br /> X ANY AUTO Hartford Underwriters Ins BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS AUTOS ( ) <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ I $ <br /> B WORKERS COMPENSATION CT WC(SIR2.5MM OEX COV 6636273 04/01/2014 04/01/2015 X WC STATU- OTH- <br /> C AND EMPLOYERS'LIABILITY Y/N CA-0198901481 FIL 901482 Llh <br /> ANY PROPRIETORIPARTNER/EXECUTIVE NJ-019901483 MULTI-019901484 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICERIMEMBER EXCLUDED? F NIA MULTI-019901485 MA-019901486 <br /> (Mandatory in NH) MN-019901487 MULTI-019901488 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ' <br /> If es,describe under PA-019901489 MULTI-019901490 1,000,000 I <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> a <br /> $ <br /> $ <br /> $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) I <br /> I <br /> I <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS, <br /> Orange County AUTHORIZED REPRESENTATIVE <br /> Hilllsbooro gh8 NC 27278 <br /> Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />