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DocuSign Envelope ID: E33E7B80-33D2-4987-8883-03OCC6D2B5AF <br /> r <br /> j <br /> I <br /> H <br /> ��1 ® DATE(MM/DD/YYYY) r <br /> ACORO <br /> CERTIFICATE OF LIABILITY INSURANCE 10/08/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4 <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 endorsement(s). <br /> PRODUCER <br /> CONTACT 'p s <br /> NAM <br /> Aon Risk Services Southwest, Inc. PHONE (866) 283-7122 FAX 800-363-0105 m <br /> Houston Tx office (AIC.No.Ext): (AIC.No.): a <br /> 5555 San Felipe <br /> Suite 1500 ADDRESS: _ <br /> Houston TX 77056 USA INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA: Travelers Property Cas CO of America 25674 <br /> Deli Management, Inc. DBA Jason's Deli INSURER B: St Paul Fire & Marine Insurance Co. 24767 <br /> 2400 Broadway INSURER C: The Travelers Indemnity Co. 25658 <br /> Beaumont TX 77702-1904 USA _ <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:570059787777 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. Limits shown are as requested <br /> S TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS <br /> LTR INSD WVD MMIDD)YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY TC2JGLSAI5 D S 1TIL15 EACH OCCURRENCE $5,000,000 <br /> CLAIMS-MADE X❑OCCUR SIR applies per policy terns & conditions D GE TO RE TED $5,000,000 <br /> PREMISES Ea occurrence <br /> MED EXP(Anyone person) $10,000 <br /> PERSONAL&ADV INJURY $5,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 <br /> X POLICY ❑PRO- LOC PRODUCTS-COMP/OP AGG $5,000,000 <br /> o <br /> OTHER: r <br /> A AUTOMOBILE LIABILITY TC27-CAP-152D6524-TIL-15 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT $5,000,000 10 Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) 0 <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIREDAUTOS AUTOS Per accident) w:. <br /> B X .UMBRELLA LIAR X OCCUR ZUP51M2160415NF 01/01/2015 01/01/2016 EACH OCCURRENCE $5,000,000 U <br /> EXCESS LIAR CLAIMS-MADE <br /> SIR applies per policy terns & conditions AGGREGATE $5,000,000 <br /> DED I X RETENTION <br /> C WORKERS COMPENSATION AND TC2KU6152D655A15 01/01/2015 01/01/2016 X STATUTE EORH <br /> EMPLOYERS'LIABILITY YIN workers Comp AOS <br /> ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT $5,000,000 <br /> I, <br /> • OFFICER/MEMBEREXCLUDED? NIA TRKUB152D654815 01/01/2015 01/01/2016 <br /> (Mandatory in NH) workers Comp AZ E.L.DISEASE-EA EMPLOYEE $5,000,000 <br /> Ifyes,describe under ii <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $5,000,000 k` <br /> A BUS Auto Damage T3BAP-152D6536-15 01/01/2015 01/01/2016 Comprehensive Ded. $2,500 <br /> Collision Ded. $2,500 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) } C <br /> SJ (y"g <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE J <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE �� F <br /> POLICY PROVISIONS. <br /> orange County Government AUTHORIZED REPRESENTATIVE F <br /> Attn: Diane shepherd and Gwen capers �f p Q <br /> 200 S. Cameron Street AL <br /> Hillsborough elna <br /> Hillsborough NC 27278 USA <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />