Orange County NC Website
DocuSign Envelope ID: 1CCA18DC-6CC1-428C-A15D-5173EE24B471 <br /> ACORN® DATE(MM/DD/YYYY) <br /> � CERTIFICATE OF LIABILITY INSURANCE 11/13/2015 <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 CONTACT Producer HOUSE <br /> NAME: <br /> Hays Companies PHONE (617)723-7775 A/C No: <br /> 133 Federal Street, 2nd Floor ADDRIESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Boston MA 02110 INSURER AAtlantic Specialty Insurance 27154 <br /> INSURED INSURERB:Trumbull Insurance Company 27120 <br /> Tyler Technologies, Inc. INSURERC:Certain Underwriters at Lloyds <br /> 5101 Tennyson Parkway INSURER D: <br /> INSURER E: <br /> Plano TX 75024 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:11.1.15-3.1.16 GL, Auto, 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 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED 1 000 000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r r <br /> A CLAIMS-MADE FxI OCCUR 711013784-0002 3/1/2015 3/1/2016 MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> X POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ 1,000,000 <br /> A X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED 711013784-0002 3/1/2015 3/1/2016 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS Per accident <br /> X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 15,000,000 <br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 <br /> DED I I RETENTION$ 711013784-0002 3/1/2015 3/1/2016 $ <br /> B AND EMPLOYERS'LIABILITY WORKERS COMPENSATION WC STATU- ER <br /> Y/N X TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) OBWBCS5886 3/1/2015 3/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> C Professional Liability B0901LI1414036000 11/17/2015 11/17/2016 Occurence Limit: $20,000,000 <br /> C Professional Liability B0901LI1414036000 11/17/2015 11/17/2016 Aggregate Limit: $20,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <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 /> Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> James Hays/SKING --- <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025 rgmnnr�ni Th. arrio 1 n.mn­1 11-ern rnnic*n 11 m.rl,.of arrio 1 <br />