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DocuSign Envelope ID:47D12065-7220-4277-A47F-FC1 DACOCA54F
<br /> -� 0 DATE(MM1DDIYYYY)
<br /> ACORN CERTIFICATE OF LIABILITY INSURANCE 0 312 81201 9
<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 /> PHONE FAX
<br /> 20 CHURCH STREET,8TH FLOOR JAIC,No.9 xQ, (Adc,No):
<br /> HARTFORD,CT 06103 EDM�IE
<br /> _ INSURER(S)AFFORDING COVERAGE _ NAICN
<br /> 102428280.Otis-GAWX-19-20 INSURER A:Hartford Fire Insurance Company CGmpany 19682
<br /> INSURED OTIS ELEVATOR COMPANY INSURER B:Hartford Underwriters Insurance Company 30104
<br /> ONE FARM SPRINGS ROAD INSURER C:National Union Fire iris Cc Pittsburgh PA _ 19445
<br /> FARMINGTON,CT 06032 INSURER D:American Home Assu rance Cornpany 19380
<br /> INSURER E:New Ham1 shire Ins Co 23841
<br /> INSURER F:AIU Insurance Co 19399
<br /> COVERAGES CERTIFICATE NUMBER: NYC-010502694.01 REVISION NUMBER: 0
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN}SSUE❑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 TYPE OF INSURANCE AODL SUER
<br /> POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER lMMIDDIYYYYI iMMIDDIYYYYILIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 02CSET10004 04/0112019 04MV2020 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE FK OCCUR "$2,OOD,000 General Aggregate" PREMISES Ea occAi rence $ 300,000
<br /> "Per Project 1 Location" MED EXP(Any oneperson) $ 10,n00
<br /> "$10,000,000 General Aggregate" PERSONAL&ADV INJURY $ 1,000,000
<br /> GE N'L AGGRE GATE LI MIT APPLIES PER: PerPadicy' GENERAL AGGREGATE $ 2,00000
<br /> ! 1 JPRO-
<br /> POLICY LOC PRODUCTS-COMPIOP AGG $ 2,000.000
<br /> OTHER' $
<br /> A AUTOMOBILELIABILITY 020SET10000(AQS) 04/0112019 0410112020 COMB[NED SINGLE LIMIT $ 1,000,000
<br /> Ea accident)
<br /> B X ANY AUTO 02SET10019(HI) DQ0112019 04101/2020 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTYOAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per aocidenl
<br /> s
<br /> )( UMBRELLA LIAB X OCCUR 02HUT10021 0410V2019 0410112020 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> RED I I RETENTION$ $
<br /> C WORKERS COMPENSATION CT-QSI5565605(SIR$2.5M) D 11 020 X AND EMPLOYERS'LIABILITY PER
<br /> STATVTE OTH-
<br /> {] YIN {E}FL+712T1T193;MULTI.012717191 ER 041D112019 04101f202U i00D0flD
<br /> ANYICERIM MB RIPARTNERIExECUTIVE E.L.EACH AGGIpENT $
<br /> E OFFICERTy In N RExCLUDED? N Ip` MULTI.0 1 2717 1 94;MULTI.012717190 04101/2019 0410112020 1,00D,ODD
<br /> {Mandatory in NH) E,L.DISEASE-EA EMPLOYEE $
<br /> F Ir es,describe under [F)NY-012717197(D)CA-012717192 04101/2019 04/0112020 E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLFS(AC ORD 1e1,Additional Remarks Schedule,may he attached if more space Is required)
<br /> This certificate only applies to 100 E KING ST,300 W TRYON ST-HUMAN SVC,106 E MARGARET LANE,125 COURT ST,COUNTY JAIL,510 MEADOWLANDS DRIVE,106 E MARGARET LANE,2551
<br /> HOMESTEAD ROAD,COURT AND KING STREETS,301 W TRYON STREET,200 S CAMERON STREET,1 D6 NASH&KOLLOCK ST
<br /> TR008016A.
<br /> TR008016Z
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> PO Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Hillsharough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA Inc.
<br /> Manashi Mukherjee 1�iati.cae�+• 3+0...�cc.,s�a e�
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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