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DocuSicgn Envelope ID : CCEE7SID�6B8O4A5E- B1AE-A9B2F7789842
<br /> �,C40, R�) C � �c�Y E� fY�' r�� � F LI �� � � � �`. .�� 0 �� 't� E � C � ; 6 � �� �� Df�TE (FAPIUOD(lW�p
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER T IFIC b E HOLDER , THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX[TrnND 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 , ANDTHE CERTIFICATE HOLDER *
<br /> IMPORTANT : If the certificate holder Is an ADDITIONAL INSURED , the policy( les) roust have ADDITIONAL II'vSURED provisions ny he endorsed .
<br /> If SUBROGATION IS WAIVED , subject to the forms and conditions of the policy, cerlaln policies may require an endorsement . A, Matement on
<br /> tlrls certificate does not confer rights to the (mrllflcato holder In lieu rf such endorsemen4 s .
<br /> PRODUCER — CORTACT
<br /> MARSH USA INC. NAME:
<br /> AX
<br /> 20 CHURCH STREET PRONE arc No
<br /> HAR7FORD, CT 06103 EmU1AIL
<br /> ADDRESS :
<br /> INSURER( 3) AFFORDING COVERAGE NAIC JV
<br /> INSURERA , Hartford Flm insurance Companyo 19682
<br /> TISINSURED ELEVATOR COMPANY
<br /> OINSURER a on AoUet Unlon Fire Insurance Company of Pittsbur h , PA 19446
<br /> TIS
<br /> ONE FARM SPRINGS ROAD INSURER c :American Home Assurance Company 19380
<br /> FARMINGTON , CT 06032 INSURER O : New Hampshire Insurance Company 23841
<br /> ENSURER E
<br /> UdSURER F :
<br /> COVERAGES ---_-- — CERTIFICATE 14UMBER: 13TOCEZHT _ REVISION NUMBER .
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN tSSUED 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 /> IN3R
<br /> LTR TYPE OF INSURANCE POLICY NUMBER _ APAM EF t�MfDD P LIMITS
<br /> A X 2C ET 0 DODl /201 04101 2019 1 ,400, 000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _
<br /> CLAIMS-A1ADE OCCUR s260001000 anerai Aggregate par PRE MI UAMAGE1 En • ED s S 3G0,000
<br /> locaUordpro ct —
<br /> 10 , 000500 policy general aggregate MED EXP Ary one person) S 10,000
<br /> PEPZONAL d ADV INJURY 3 1 , D00,040
<br /> GENt AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE S 21000, 000
<br /> POLICY i ' • I JECT LOC PRODUCTS - COMPIOP AGG S 2 D00 000
<br /> OTHER: S
<br /> A AUTOMOBILE LIABILITY 2 ) 04/01 /2018 04/01 /2019 ( Ea OWED s IT 1 ,Ot)0,000
<br /> 2CSET10019 (HI )
<br /> X ANY MTO Hartford Underwriters Iris BODILY INJURY (Per psrson) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY (Parnodda-M) $
<br /> HIRED NONOWNEO 15140 S
<br /> AUTOS ONLY AUTOS ONLY Pvr a�klsnt
<br /> S
<br /> A x UMBRELLALIAB )( OCCUR 2HUTlUD21 04/61 /2018 04101 /2019 EACH OCCURRENCE $ 14,0OO,ODO
<br /> EXCESS LIA9 CLAIMS-MADE AGGREGATE S 10,ODO,OQO
<br /> OED RETENTION S S
<br /> B WORKERS COMPENSATION CT WC (
<br /> S► R 2.5MM)EX COV• 04/01 /2018 04/01 /2019 x PER OTH.
<br /> C AND EMPLOYERS' LIARILfrY 85=4
<br /> D ANY PROPRIETORIPAITINERIEXECUTIVE YIN CA-D15519205 E .L . EACH ACCIDENT S 110001000
<br /> OFFICERIMEMBER EXCLUDED ? N ! A FL415519206 MA-015519212
<br /> (Mandatory In NH) MN-015519206 MULTI -015519204 EL. DISEASE - EA EMPLOYEE S 11000 ,04D
<br /> If "so describe under MULTI -015519 07 ,MULT1 •
<br /> DESCRIPTION OF OPERATIONS below i5519211 EL DISEASE - POLICY LIMIT S 1 ,040 , 004
<br /> S
<br /> S
<br /> S
<br /> S
<br /> DESCRIPTION OF OPERATIONS ILOCATIONS J VEHICLES (ACORD 101 , Addllional Remarks Schaduls, may bs attached If mover apses Is rsqulrad)
<br /> This certificate only applies to 100 E KING ST, 300 W TRYON S I -HUMAN SVC, 105 E MARGARET LANE, 125 COURT ST, COUNTY JAIL , 510 MEADOWLANDS
<br /> DRIVE, 106 E MARGARET LANE, 2551 HOMESTEAD ROAD, COURT AND KING STREETS, 301 W TRYON STREET, 20D S CAMERON STREET, 106 NASH «
<br /> KOLLOCK ST
<br /> TRODa016A .
<br /> TRD08016Z
<br /> CERTIFICATE HOLDER 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 AUrNORLLEb REPRESENTATIVE
<br /> PO Box 8181 Ag'& r lj 6
<br /> HHisbarough , NC 27278
<br /> Page 1 of t Q1988- 2015 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 ( 2016103 ) The ACORD name and logo are registered marks of ACORD
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