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DocuSign Envelope ID:54B16D7E-C063-4FF1-B6ED-4F40C221096B
<br /> ACORG7® DATE(MM/DD/YYYY)
<br /> �. CERTIFICATE OF LIABILITY INSURANCE 10/30/2017
<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 have ADDITIONAL INSURED provisions or be endorsed.If
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this w
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c
<br /> PRODUCER CONTACT a
<br /> NAME:
<br /> Aon Risk services, Inc. of Washington, D.C. PHONE FAx s.-Aon Risk services Central, Inc. (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 a
<br /> Chicago IL office E-MAIL p
<br /> 200 East Randolph ADDRESS: _
<br /> Chicago IL 60601 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: Zurich American Ins Co 16535
<br /> MAXIMUS Consulting Services, Inc. INSURER B: XL Specialty Insurance CO 37885
<br /> 808 Moorefield Park Drive, Suite 205
<br /> Richmond VA 23236 USA INSURER C: The Continental Insurance Company 35289
<br /> INSURER D: American Zurich Ins Co 40142
<br /> INSURER E: National Union Fire Ins Co of Pittsburgh 19445
<br /> INSURER F: QBE Specialty Insurance Company 11515
<br /> COVERAGES CERTIFICATE NUMBER: 570069075732 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVO (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 0L05096218 02 05/01/2017 05/01/2018 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000 M
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 m
<br /> o
<br /> OTHER: o
<br /> N-
<br /> A AUTOMOBILE LIABILITY BAP 5096219 02 05/01/2017 05/01/2018 COMBINED SINGLE LIMIT $1,000,000 to
<br /> (Ea accident) ..
<br /> X ANY AUTO BODILY INJURY(Per person) o
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) N
<br /> AUTOS ONLY AUTOS
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE A
<br /> ONLY AUTOS ONLY
<br /> (Per accident) w
<br /> E
<br /> a)
<br /> B X UMBRELLA LIAB X OCCUR US00075267L217A 05/01/2017 05/01/2018 EACH OCCURRENCE $2,000,000 0
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED X RETENTION$10,000
<br /> D WORKERS COMPENSATION AND WC509621602 05/01/2017 05/01/2018 X IPER TUTE IOTH-
<br /> EMPLOYERS'LIABILITY STA ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> A WC5 OFFICER/MEMBER EXCLUDED? N N WC509621702 05/01/2017 05/01/201$
<br /> (Mandatory in NH) WI 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 /> E E&O-PL-Primary 017202809 08/01/2017 08/01/2018 Agg/Per Claim $2,000,000
<br /> Claims Made SIR $10,000,000
<br /> SIR applies per policy terms & conditions ey
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: CAP EMS 17-19
<br /> ...-r
<br /> ._-_,
<br /> .._
<br /> _.
<br /> ..
<br /> ._,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE KA
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br /> orange County AUTHORIZED REPRESENTATIVE
<br /> 200 South Cameron Street
<br /> Hillsborough NC 27278 USA 9" m Cr
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<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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