Orange County NC Website
DocuSign Envelope ID:507D9E2F-FB6E-4E76-877E-AC5BC90428B3 <br /> Ac7 <br /> ® HATE(MMIDDIYYYY)vRD CERTIFICATE OF LIABILITY INSURANCE o9119R018 <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 /> PRONE <br /> 445SOUTH STREET FAX o <br /> MORRISTOWN,NJ 07960-6454 EMAIL <br /> ADDRESS: <br /> _ INSURE%S AFFORDING COVERAGE NAIC 4 <br /> 100129-SBT--18119 228 Rentas NOC60 INSURER A:HDI Global Insurance Company 41343 <br /> INSURED INSURER R:Travelers Pr Casualty Co.of America 25674 <br /> SIEMENS INDUSTRY,INC. <br /> BUILDING TECHNOLOGIES INSURERS:The Travelers Indemnity Co an 25658 <br /> 1000 DEERFIELD PARKWAY INSURER D <br /> BUFFALO GROVE,IL 60089 <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 /> TYPE OF INSURANCE ADDL SUPOLICY EFF POLICY EXP <br /> LTR D POLICY NUMBER MMIDDIYYYY1 (MMIDDIYYYYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY GLD11101.10 1010112018 1010112019 EACH OCCURRENCE S 1,000,000 <br /> DA GE TO RENTER <br /> CLAIMS-MAOE I X J OCCUR PREMISES Ea9c% enoe $ 1,000,000 <br /> -- - MED E]P[AM— ersan $ 100,000 <br /> PERSONAL s ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 <br /> X POLICY❑IE° LOC PRODUCTS-COMPIOPAGG $ INCL <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-18 10/0112018 10/01/2019 CEe accOMBINED SINGLE LIMITidenl $ 2,000,000 <br /> _ <br /> X ANY AUTO BODILY INJURY(Per person) $ NIA <br /> X pW1IED SCHEDULED BODILY INJURY(Per accident) $ WA <br /> AUTOS ONLY AUTOS _ <br /> X HIRED x NON-OWNED PROPERTY DAMAGE $ --NIA <br /> AUTOS ONLY AUTOS ONLY sccidenl <br /> UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DEp I I RETENTION S $ <br /> B WORRERSCOMPENSATION TC2J-UB-8049X508.18(ADS) 1010112018 I0112O19 X STA U E ERH _ <br /> C AND EMPLOYERS'LIABILITY YIN TRK-UB-8049X51A-18{AZ,MA,OR,WI} 101OW018 10MI2019 -- <br /> ANYPROPRIETORIPARTNERIEXECUTIVE E-L-EACH ACCIDENT $ 1,000,000 <br /> B OFFICE ERE](CLUDED7 NIA TWXJ-UB-744OL338.18 OH&WA 118 10101/2019 <br /> (Mandalury wy in in NH) � � O101I20 E.L-DISEASE-EA EMPLOYEE $ 1,000,000 <br /> II yes,describe under "'°"'$500K LIMIT I$500K SIR—,, 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E-L-DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,AddillataI Remarks Schedule,in ay be attached I more space Is requl red I <br /> RE:JOB NO.NIA <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 NO HIGHWAY 86 N ACCORDANCE WITH THE POLICY PROVISIONS. <br /> HILLSBOROUGH,NO 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh USA Inc. <br /> Manashi Mukherjee --NNko,%A-o at <br /> C 1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(20 6103) The ACORD name and logo are registered marks of ACORD <br />