Orange County NC Website
DocuSign Envelope ID: D1041CA6-DBD4-42BE-8B32-7C592BF2BA15 <br /> TMASY-1 OP ID:W3 <br /> �►coRC]►° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> �►�--�' 09/19/2014 <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 <br /> PHON: <br /> RICH&CARTMILL,INC <br /> 2738 East 51st#400 (NCNNo,Ext): (NC,No): <br /> Tulsa, OK 74105 E-MAIL <br /> Patrick Mandeville ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Travelers Casualty Ins Co <br /> INSURED TMA Holdings, LLC;dba TMA INSURER B:Travelers Indemnity Co 25658 <br /> Systems, LLC;ACT Systems, LLC INSURER C:Standard Fire Insurance Co 19070 <br /> Risk Partner, LLC; <br /> Maintenance Partner, LLC INSURER D: <br /> 5100 E. Skelly Dr., Suite 900 INSURER E: <br /> Tulsa, OK 74135 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY X 6802C0557001342 09/22/2013 09/22/2014 DAMAGE TO RENTED 300 000 <br /> PREMISES(Ea occurrence) $ <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY PRO- <br /> JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 <br /> (Ea accident) $ s s <br /> A ANY AUTO BA3C08662A13SEL 09/22/2013 09/22/2014 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE <br /> AUTOS (PER ACCIDENT) <br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 <br /> B EXCESS LIAB CLAIMS-MADE CUP2C13380A1342 09/22/2013 09/22/2014 AGGREGATE $ 2,000,000 <br /> DED X RETENTION$ 5000 $ <br /> WORKERS COMPENSATION x WCSTATU- OTH- <br /> ER EMPLOYERS'LIABILITY TORY LIMITS <br /> Y/N <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE ICUB2C15748813 09/22/2013 09/22/2014 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1 000 000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Sample Certificate of Insurance <br /> AUTHORIZED REPRESENTATIVE ��� <br /> / s.eig t.GX/ <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />