Orange County NC Website
DocuSign Envelope ID: 744F8ADB-CD3C-429C-BA9E-C4FEEC3lA417 <br /> AGENCY CUSTOMER ID: 410000000170 <br /> LOG#: <br /> ADDITIONAL REMARKS SCHEDULE <br /> Page _ of _ <br /> AGENCY MA.MEDINSURED <br /> Aon Risk Services, Inc. of Washington, D.C. MAXIMUS Consulting services, Inc. <br /> POLICY NOM8ER <br /> see Certificate Number: 570056714505 <br /> CARRIER PoAFC CODE <br /> see Certificate Number: 570056714545 EFFECTIVEVATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS ASCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certificate of liability insurance <br /> WORK COMP - AOS underwriting Companies <br /> WORKERS COMPENSATION - ALL OTHER STATES POLICY NO: 42WNMG3740 UNDERWRITING COMPANIES <br /> HARTFORD ACCIDENT AND INDEMNITY COMPANY, 06-0383030, 10448 <br /> Alaska, Alabama, Arkansas, Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, <br /> Florida, Georgia <br /> HARTFORD CASUALTY INSURANCE COMPANY, 06-0294398, 14397 <br /> Hawaii <br /> HARTFORD FIRE INSURANCE COMPANY, 06-0383750, 13269 <br /> Iona, Idaho, Illinois <br /> HARTFORD INSURANCE COMPANY OF THE MIDWEST, 06-1008026, 20605 <br /> Indiana, Kansas, Kentucky, Louisiana <br /> HARTFORD INSURANCE COMPANY OF THE S/E, 06-1013048, 20621 <br /> Massachusetts <br /> HARTFORD UNDERWRITERS INSURANCE COMPANY, 06-1222527, 10456 <br /> Maryland, Maine <br /> PROPERTY/CASUALTY INSURANCE COMPANY OF HFTD., 06-1276326, 30147 <br /> Michigan, Minnesota, Missouri , <br /> SENTINEL INSURANCE COMPANY, LIMITFO, 15-52103, 13161 <br /> Mississippi <br /> ACORD 101(2000101) ©2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />