Orange County NC Website
DocuSign Envelope ID:A4C366A3-F5D9-473B-9218-AF49BCCA02E0 <br /> Ac" Page 1 of 1 09E(1Mi YYYY) <br /> CERTIFICATE LIABILITY I /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 ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERI AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es)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 endorsemerit(s}. <br /> PRODUCER '...CONTACT <br /> Willis Group PHONE FAX <br /> one world Financial Ctr. - 877-94,5-7378 888-467-2378 <br /> 2.00 Liberty St. E-MAIL Certificate6@wRlliswC4II1 <br /> New York, NY 102,81 <br /> INSURER(S)AFFORDiNGCOWERAGE NAIC# <br /> INSU'RERA.Naticnal Union Fire Insurance Co. of Pitt 19445-601 <br /> INSURED Willis orth America Inc. GHSURERB�: Illinois National Insurance Co. 23817-002 <br /> ' <br /> One world. Financial Ctr. INSURERC:New' Hampshire Insurance. Company 23841-001 <br /> 200 Liberty Street <br /> New York, NY 10281 INSURER D:AIG Europe (UK) Ltd FOOS9-000 <br /> INSURER E: <br /> INSIJRERF: <br /> COVERAGES CERTIFICATE N UMBER:2204081.6 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 CR 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 /> INSR DD' SUB POLICY POLICYEXIP <br /> TYPE OF INSURANCE POLICY NUMBER LIMITS <br /> A -GENERAL LIABILITY GL1,929656 7/1/2014 7/1/2015 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY' DAMAGETOf�ENTED <br /> PREMISES Eaoccurence $ 1. 000 000 <br /> CLAIMS-MADEXOCCUR M ED EXP(Anyone person) $ 10 000 <br /> X. Contractual Liability PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERALAGGREGATE $ 5,000,000 <br /> GEN'LAGGREGATELI MIT APPLIES PER: PRODUCTS-COMPIOPAGG S 1 000 1 000 <br /> POLICY PRO- LOC $ <br /> A AUTOMOBILE LIABILITY CA0939749 7/1/2014 7/1/2015 COMBINED SIN GLELIMIT 1.,000,000 <br /> (Ea accident) $ <br /> ANYAUTO BODILY Ii URY(Per person) $ <br /> ALLOWNED SCHEDULED BODILYINJURY(Peraccident) $ <br /> AUTOS AUTOS - <br /> X HI'REDAUTOS X NON-OWNED PROPERTY kDAMAGE. $ <br /> AUTOS <br /> $ <br /> UMBRELLA.LIAR H OCCUR EACH CCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION I $1 <br /> S WORKERS COMPENSATION WC015684665 (FL) 7/1/2014 7/1/2015 X I wcsTATU- DTH- <br /> AND EMPLOYERS'LIABILITY <br /> • ANY PROPRIETORIPARTNERIEXECUTIVEYrN WCOISG84666 (CA) 7/1/2014 '7/1/2015 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICERIMEMBFREXCLUDED? N1A. <br /> • MandatorylnNIA) WC015684667 7/1/2014 7/3/2015 E.L.DISEASE-EA EMPLOYEE $ 1,0010,000 Vyes,describe under <br /> • I DESCRIPTION OF OPERATIONS below WC'015684668 (AOS) 7/1/2014 7/1/2015 E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> O 11757P13 7/31/2014 7/31/2015 <br /> CRIME COT7ERACE $1,000,000 Limit <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach Acord 1.01,Additional Remarks Schedule,if more space is required) <br /> Additional Insured status will be automatically provided upon awarding of the business to the <br /> Willis entity and in accordance with the terms and conditions of the appropriate insurance policies <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OFTHE ABOVE DFSCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDAN E V4iIThl THE POLICY PROVISIONS. <br /> AUTHORIZ D REFRIES..:ldT TIVE <br /> Evidence of Tnsurance <br /> Cca11:4516780 Tpl:1829595 Cent: 8816 Q1 88-2010ACORD CORPORATION.All rights reserved. <br /> ACORN 25(2010105) The ACC RID name and logo are registered marks o ACORD <br />