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DocuSign Envelope ID:E7E2AC23-E3B6-4B7D-8086-97FOB910D1AE
<br /> ,„..........141, CONSCLE-02 DBUSS
<br /> '`E?R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 10/19/2016
<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:MACT Debbie Buss
<br /> Hub International Northwest LLC PHONE FAx ..
<br /> P.O.Box 1226 (arc No,Ext) {360)748-fl05$ (NC,No):(360)237-0252
<br /> Chehalis,WA 98532 ADDRESS:debbie.buss @hubinternationalcom
<br /> INSURER(S)AFFORDING COVERAGE NAIC X
<br /> INSURER A Berkley Assurance Company
<br /> E INSURED INSURER B:American Fire and Casualty Company •24066
<br /> 1 Console Cleaning Specialists,Inc.dba Communication INSURER C:Starstone Specialty Insurance Company 44776
<br /> I __.. __.. ...............
<br /> Center Specialists INSURER D-
<br /> 115 Crego Hill Road
<br /> Chehalis,WA 98532 INSURER E
<br /> i
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: 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 /> INSD WVD ...... ...
<br /> INSR
<br /> ....POLICYEFF ...POLICY E%P ,.... .. _._.. -_-....
<br /> LTR• TYPE OF INSURANCE POLICY NUMBER (MM/DDIYYYY):(MMIODIYYYY) LIMITS
<br /> A X i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE 0...
<br /> OCCUR _ PREMISES $ 100,000
<br /> X VUMB0063152 06/20/2016.06/20/2017 '
<br /> MED EXP(Any one person) $
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER ' GENERAL AGGREGATE $ 2,000,000
<br /> PRO- ,•
<br /> .. ;POLICY JECT LOC
<br /> PRODUCTS COMP/OP AGG $ 2,000,000
<br /> •
<br /> OTHER: '., $
<br /> AUTOMOBILE LIABILITY ' , . .
<br /> •
<br /> . COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> B
<br /> ANY AUTO X X ',BAA56199907 06/20/2016 06/20/2017. BODILY INJURY(Per person) $
<br /> ALL OWNED i X ±SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ,AUTOS
<br /> NON-OWNED ' "PROPERTY DAMAGE .. ...... ....__.....
<br /> $
<br /> HIRED AUTOS ;AUTOS (Per accident)
<br /> $
<br /> UMBRELLA UAB ; X ',OCCUR EACH OCCURRENCE $ 2,000,000
<br /> C X EXCESS LIAR CLAIMS-MADE 85620,1162ALI 06/20/2016 06)20/2017 AGGREGATE $ 2,000,000
<br /> DED i RETENTION$ $
<br /> PER 0TH-
<br /> -ANe EMPLOYERS'LIABILITY YIN' STATUTE ER
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE VUMB0063152 06/20/2016 06120/2017 E L EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N l A 1 ;
<br /> (Mandatory in NH) : E.L.DISEASE-EA EMPLOYEE' $ 1,000,000
<br /> ;it yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Orange County Emergency Services shall be named additional insured's as required by written contract,see VCAS2011 11112 and CA8810 01/10,attached.
<br /> Waiver of Subrogation Applies,see VCAS9925 06111 and CA8810 01/10,attached.REF:Contract 2015-2016
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> OCounty Emergency 5ervic THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Orange
<br /> a ge County Emergency
<br /> Drive
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTATIVE
<br /> ...,ice gar
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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