Orange County NC Website
DocuSign Envelope ID: E2A3FD22-97F6-4032-AE98-8051BF17AD9A <br /> DATE(MM/DD/YYYY) <br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE <br /> 11/30/2015 <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 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 NAME: Direct All Inquiries to Email <br /> Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX <br /> 300 S. Riverside Plaza, Suite 1900 'C'No): <br /> E-MAIL Chi—Certificates@ajg.com <br /> Chicago IL 60606 ADDRESS:Chi L% <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Arch Insurance Company 11150 <br /> INSURED ARTHJGA113 INSURER B: <br /> Gallagher Benefit Services, Inc. INSURERC: <br /> P O Box 32985 <br /> Phoenix,AZ 85064-2985 INSURER D <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 309469696 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. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> • X COMMERCIAL GENERAL LIABILITY 41GPP4938408 10/1/2015 10/1/2016 EACH OCCURRENCE $1,000,000 <br /> IX OCCUR DAMAGES( RENTED <br /> CLAIMS-MADE <br /> PREMISES Ea occurrence) $1,000,000 <br /> X SEE DOO MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 <br /> POLICY❑ PRO [X] LOC PRODUCTS-COMP/OP AGG $3,000,000 <br /> JECT <br /> OTHER: $ <br /> • AUTOMOBILE LIABILITY 41 CAS4939008 MA 10/1/2015 10/1/2016 COMBINED SINGLE LIMIT $ <br /> A ( ) 10/1/2015 10/1/2016 Ea accident 3,000,000 <br /> X ANY AUTO 41 CAS4938308(AOS) BODILY INJURY(Per person) $ <br /> AUT OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION 41WCI4938108(AOS) 10/1/2015 10/1/2016 x PER OTH- <br /> A AND EMPLOYERS'LIABILITY y/N 41 WCI4938108(WI) 10/1/2015 10/1/2016 STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? F�] N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> General Liability: <br /> General Aggregate Per Location Subject to$10 Mil Policy aggregate. <br /> Certholder is shown as an Additional Insured on the General Liability policy per form 00 GL0596 00 04 10 attached as required by written <br /> contract pursuant to and subject to the policy's terms, definitions,conditions and exclusions. Waiver of Subrogation applies. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County, NC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn : Gwen Capers <br /> Contracts& Purchasing, 200 South Cameron Street AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 USA P-41 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />