Orange County NC Website
DocuSign Envelope ID:2CDD1A17-B035-4812-8F35-A9B16898AB3C <br /> 7 ® DATE(MMIDD/YYYY) <br /> CERTIFICATE LIABILITY INSURANCE 09/19/2018 <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. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> MARSH USA,INC. NAME: <br /> 445 SOUTH STREET PHONEo Ext A/C No): <br /> MORRISTOWN,NJ 07960-6454 EMAIL <br /> ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC q <br /> 100129-SBT--18/19 228 Rentas NOC60 INSURER A:HDI Global Insurance Coi-npany 41343 <br /> INSURED SIEMENS INDUSTRY,INC. INSURER B:Travelers Property Casualty Co.of America 25674 <br /> BUILDING TECHNOLOGIES INSURER C:The Travelers Indemnity Company 25658 <br /> 1000 DEERFIELD PARKWAY <br /> BUFFALO GROVE,IL 60089 INSURER D: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: NYC-009196547-11 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 POLICY LTR TYPE OF INSURANCE INSD MD SUER POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY GLD11101-10 10/01/2018 10/01/2019 EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $ <br /> 1,000,000 <br /> MED EXP(Any one person) $ 100,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 <br /> X POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ INCL <br /> JECT <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-18 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT $ 2,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ N/A <br /> X OWNED SCHEDULED BODILY INJURY(Per accident) $ N/A <br /> AUTOS ONLY AUTOS <br /> X HIRED FX <br /> NON-OWNED PROPERTY DAMAGE g NIA <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> B WORKERS COMPENSATION TC2J UB-8049X508-18(ADS) 10101/2019 X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> C Y/N TRK-UB-8049X51A-18 AZ,MA,OR,WI 10101/2018 10101/2019 E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDANYPROPRIETORJPARTNEE/D?ECUTIVE N N/A ( ) 1,000,000 <br /> B (Mandatory in NH) TWXJ-UB-7440L338-18(OH&WA) 10/01/2018 10/01/2019 E.L.DISEASE-EA EMPLOYEE $ <br /> 1,000,000 <br /> If yes,describe under """"$500K LIMIT/$500K SIR 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE:JOB NO.N/A <br /> SEE ATTACHED <br /> CERTIFICATE HOLDER CANCELLATION <br /> COUNTY OF ORANGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ASSET MANAGEMENT SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 600 NC HIGHWAY 86 N ACCORDANCE WITH THE POLICY PROVISIONS. <br /> HILLSBOROUGH,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh USA Inc. <br /> Manashi MukherjeeR <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />