2018-769-E AMS - Triangle Office Equipment HR reception door

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DocuSign Envelope ID: BF67E240-318E-4955-A9D4-AC184FC3BA36 CERTIFICATE OF LIABILITY INSURANCE DATE(M 10/30//2018 Y) 018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(lies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Patty Miller NAME: Business Insurers of Carolinas IX AICC c Ext: (919)968-4611 C,No): (919)968-8991 800 Eastowne Drive,Suite 208 E-MAIL pmiller@business-insurers.com ADDRESS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA: Tri-State Ins Co of Minnesota 31003 INSURED INSURER B: Acadia Insurance Company 31325 Triangle Office Equipment,Inc. INSURER C: PO Box 2372 INSURER D: INSURER E: Chapel Hill NC 27515 1INSURER F: COVERAGES CERTIFICATE NUMBER: CL18103023879 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDIL 5U5R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA CLAIMS-MADE IX-1OCCUR PREM SESO(Ea occur ante) $ 300,000 MED EXP(Any one person) $ 10,000 A Y ADV435917042 11/01/2018 11/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT POLICY 1-1 PRO- ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CNA 4359171-42 11/01/2018 11/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) HUnderinsured motorist BI $ 1,000,000 UMBRELLA LIAB ter"`"""` 1,000,000 X OCCUR EACH OCCURRENCE $ B EXCESS LAB CLAIMS-MADE CNA4359171-42 11/01/2018 11/01/2019 AGGREGATE $ 1,000,000 DED I RETENTION $ Follows form GL/AL/WC $ WORKERS COMPENSATION X1 SPERTATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1'000'000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A WCA4359172-42 11/01/2018 11/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If ves,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Hired Auto Physical Damage B CNA4359171-42 11/01/2018 11/01/2019 Limit/ACV $65,000 deductible $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured in reference to the General Liability policy per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE 131 West Margaret Lane Hillsborough NC 27278 ©1988-201115 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD