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DocuSign Envelope ID:3CB53A1D-CO4F-4851-913A-A5ED432F87BC
<br /> DATE(2 M)DDIYYYY)
<br /> C"R " CERTIFICATE OF LIABILITY INSURANCE 014
<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 ppolicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the poolicy,certain policies may require an endorsement. A statement on this certificate dines not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> HARSH USA,INC. NAM4F
<br /> 445 SOUTH STREET (AIGNo.Extp: AC Nap:
<br /> MORRISTOWN,NJ 07960-6454 E-MAIL
<br /> AIDDRESS; .
<br /> INSURER51 aEOR.CIING.C�7!v1RA�GE.. .... __ NaIC MM
<br /> - -
<br /> 100129-6-7BA-SBT1-14115 228 . ...._
<br /> INSURER B y
<br /> INSURED The Travelers Indemnity Company 25656
<br /> SIEMENS INDUSTRY.INC;,INCLUDING ....... _........, _._..
<br /> BUILDING TECHNOLOGIES DIVISION'' INSURER c:The Charter Oak Fire Insurance Company 25615
<br /> 1000 DEERFIELD PARKWAY wNSURUR.P Travelers Property Casualty Co of Ame�Ica 25674
<br /> BUFFALO GROVE,IL 60099-4513 -- -
<br /> IN"aURER E,
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: NYC;'-1106752385-02 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 NOTWTHSTANDING 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 T"HE. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
<br /> EXCLUSIONS AND CONDITIONS OF SUCH PCOLICIIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br /> A .
<br /> i iSR ___�._ b_L SUBR POLICY EEE POLICY E%P LIMITS
<br /> L:TR TYPE OF INSURANCE POLICY NUMBER IMM/DDIYYYY MMIDDIYYYY
<br /> A GENERAL LIABILITY GLD1110ID6 /010142014 1010112015 EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE T'C7 RLN 1 E C] 14100,000
<br /> COMMERCIAL GENERA_L,LIABILITY PREMISE;5 Eza occur[tLngq .
<br /> CtAIMS-MADE OCCUR MED EXP(Any one pefson9 $ 100�0�1
<br /> ._....0
<br /> PERSONAL.&ADVINJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 10,000,000
<br /> GEN'L.AGGREGATE:.LIMIT APPLIES PER PH0DLICT6-COMP'IOP A.GG $. I INC L.
<br /> X POLICY PRp- LOG $
<br /> O AUTOMOBILE LIABILITY TC2JCAP7440L34A14 1010192014 1010112015 COMBINED SINGLE LIMIT 2 000 0r
<br /> 1E4 ag�,de�,pl) ....
<br /> X ANY AUTO, 'BOMLY INJURY(Par person)_......$ ., .......,._ NA
<br /> AEI.O'a'A+dEG SCI-IEGIk1L,ED ...... .............- ........._....,._......,......- .._,..._.._,._.,.....__,.,_.
<br /> X BODILY INJURY(Per GCad a tll $ NIA
<br /> AUTOS ALJT`OS
<br /> X NON•OVf WED i'R(,1PER'rY'DATMAO&'. $, NI'A
<br /> HIRED AUTO edarJ. ____...._.. .._.....
<br /> $
<br /> UMBRELLA UAB OCCUR EACI•IOCC'URRE:NCE $
<br /> ..... EXCESS LIAR CLAIMS-MADE AGGREGATE S
<br /> '... DED RE TENT ION$ '$
<br /> C WORKERS COMPENSATION TC20UB744OL27I14(ADS) om1920141 10101192015 X f Y✓C STAT u- oTrn
<br /> AND B �A�a^ PRO RIEETORIPARTNERRI X ECUTlv'E YIN N rA TRICUB744OL28314(AZ,MA,OR 8 WI) 101011'2014 1010'1/2015 E L EACH ACCIDENT LB i 1,000,000 1
<br /> D pMandatory In NHp TWX1UB7440L33814(OH$WA) 1040192014 1010112015 E L DI E',ASE-E.A Ew�IPLOr EE S 10'00,0
<br /> It y ,describe under
<br /> $5t10K LIMIT 1$500K SIR""' 1,000,000
<br /> DESCRIPTUGN..OF OPERATIONS 17elow E L DISEASE POLVCw LTMrn $
<br /> (DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 141,Additional Remarks Schedule,If more space W required)
<br /> RE,JOB NO,,NA
<br /> SEE Al I"AC I IED,
<br /> CERTIFICATE HOLDER CANCELLATION'
<br /> COUNTY OF ORANGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> ASSET MANAGEMENT SERVICES THE EXPIRATION DATE THIEREOF, NOTICE, WALL BE DELIVERED IN
<br /> 600 NC HIGHWAY 86 N ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> HILLSBOROUGH,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA Inc.
<br /> Manashi MLukher}ec mow► ; ..
<br /> c@ 1988-2010 ACCORD CORPORATION. All rights reserved.
<br /> ACCORD 25(2010/05) The ACCORD name and logo are registered)marks of ACtOR'D
<br />
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