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DocuSign Envelope ID : 75DE7265 - DAF3 -A484 - 573S 4DD95EEOBD26
<br /> A COR OP� ( h1hUDDNyVJ
<br /> 04120/2018 L T E . } E HC� tl a � � � � is
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY At ) C1 CONFERS fro R 6GHTS UPON THE CERTIFICATTE 14OLUER4 T L HS �
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR 14ECATIVELY AMEND , EkP TE10D OR ALTER THE COVERAGE AFFE� RVED zY TIDE POL.ICiES
<br /> BELOW4 THIS CERTIFICATE OF INSURANCE GOES NOT CONS+TITU d E A CON - RACT sSETV EEW THE ISSUING INSURER (S ) , ALFi fva'0P1f ED
<br /> P EPRESENTATIVE OR PRODUCER , ANDTHE CERTIFICATE HOLDER ,
<br /> IMPORTANT * Vt the cerE (`r1cato Holder Is an ADDITIONAL INSURED, tiro poHcy ( los) must have ADDITIONAL IN ' SUF> FD pdovislons or be rndorsed.
<br /> If SUBROGATION IS Vt'Ao lVEUj subject to the terms and conditions cat' the pcl ( cy, certain policies may raqulire an endorsement . A statement can
<br /> this certllic4MO does not coElfol' rights to the certiftate Golder In Ifou of such endorsomerd s .
<br /> PRODUCER _--�--s--�—.--- CONTACT
<br /> —
<br /> MARSH USA INC.
<br /> NAME :
<br /> 20 CHURCH STREET PHONE t�rC N �
<br /> HARTFORED, CT OS103 E4A1L
<br /> onraEss :
<br /> INSURER 5 AFF0RI3 (W l COVVP.AGE NAIL 0
<br /> IN5t) RER A Nertford Rre Imurance Company ' 9802
<br /> INSURED INSURER S :Nallonal Unlan Fire Insurance Company of Pllisbu Ir PA 1944b
<br /> OTIS ELEVATOR COMPANY
<br /> ONE FARM SPRINGS ROAD INSURER C :American Homa Assurance Company 19380
<br /> FARMINGTON , CT 06032 INSURER D :Nsw Hampshire Insurance Company 23841
<br /> INSURER E :
<br /> _ INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: BTGCEZHT 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 CONTRACTOR OTHER -DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS ,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES , LIMITS SHOWN! MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> OLICY EXP
<br /> LTRR ADDL TYPE OF INSURANCE b POLICY NUMBER rULI ��r[fC EFF hpwzl LIMITS
<br /> A X COMMERWAL GelEAAL LIAnILIT"Y 2GSETI0004 04l01I201E3 040V2019 1 ,QOQ,O00
<br /> EACH OCCURRENCE S
<br /> CLAIMS-ME X OCCUR $24000 , 000 eneral aggregate per 300,000
<br /> � ,p �t PREMISES Ea oxcnwcs S
<br /> �w 10 ,000,00 pDdicy general aggragale MED f corm parson $ 10 ,000
<br /> PERSONAL 8 ADd INJURY $ 1 ,0001000
<br /> NOTHEk-
<br /> I AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 ,000,000
<br /> POLICY � j� LOC. PRODUCTS - COMPIOPAGC S 2t000,Q00
<br /> I $
<br /> A AUTOMOBILE LIABILITY 02CSE110000 ( NO ) 04101I2018 04I01I2019 a eat 1 ,OD01000
<br /> 2CSET10019 HI )
<br /> X ANY AUTO Hartford Underwriters Ins BODILY INJURY JPorperson) s
<br /> BINNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per sccWant) $
<br /> HIRED NON�OWNIIPMPERTY D
<br /> AUTOS ONLY AUTOS ONLY Per accfent� G $
<br /> $
<br /> A X UMBRELLA LIAB HXOCCUR 2HUTIIXI 1 04/0112018 041O1t2D1EI EACH OCCURRENCE S 10,OQ0 ,00Q
<br /> EXCESS LJAS CLAIMS-MADE AGGREGATE 5 101000 ,04fl
<br /> DED I I RETENTIONS
<br /> B WDRKERS COMPENSA71ON CT WC (SIR 7 . 5MM) EX COV- 04/0112018 0410112010 X PER OTH-
<br /> C AND EMPLOYERS` LIABILITY 656304
<br /> D ANY PROPRIETOR/PARTNEWEXECUTIVE YIN CA-015519205 E.L. EACH ACCIDENT $ 1 ,0001000
<br /> OFFICSRIMEMSEREXCLUDED ? a NIA FL-015519206, MA-015519212
<br /> (Mandatory In NH) MN-0155192013 MULTI -D15519204 E.L, DISEASE - EA EMPLOYEE S 14000,000
<br /> IIyes, describe under MULTI .015519 07 , MULTt-
<br /> DESCRIPTION OF OPEf14TIONS below 1016519211 E-L, DISEASE • POLICY LIMIT $ 1 ,Q00, OQ0
<br /> 5
<br /> S
<br /> 5
<br /> S
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 16i , Additional Remarks Schedule, may be attached It mare spats Is roqulrod)
<br /> This cerllfEcate only applies to 100 EKING ST, 300 W TRYON ST - HUMAN SVC , 106 E MARGARET LANE , 125 COURT ST, COUNTY JAIL , 510 MEADOWLANDS
<br /> DRIVE , 106 E MARGARET LAMS, 2551 HOMESTEAD ROAD, COURT AND KING STREETS , 301 W TRYON STREET, 200 S CAMERON STREET, 106 NASH &
<br /> KOLLOCK ST
<br /> TRD0801 SA.
<br /> TRD08016Z
<br /> CERTIFICATE MOLDER CANCELLATION
<br /> SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE:
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS ,
<br /> Orange County AUTHOAIZEO REPRESENTATIVE
<br /> PO Box 8181
<br /> Hillsborough , NC 27278
<br /> Page 1 of 1 p 1988 - 2015 ACORD CORPORATION . All rights reserved ,
<br /> ACORD 25 (20161U3 ) The ACORD name and logo are registered marks of ACORD
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